Mohand Hassan Malla 1 Micturition Mohand Hassan Malla

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(Mohand Hassan Malla) 1

(Mohand Hassan Malla) 1

Micturition (Mohand Hassan Malla) 2

Micturition (Mohand Hassan Malla) 2

Micturition n Filling of the bladder n Empting of the bladder (Mohand Hassan Malla)

Micturition n Filling of the bladder n Empting of the bladder (Mohand Hassan Malla) 3

Micturition n Micturition is the process by which the urinary bladder empties when it

Micturition n Micturition is the process by which the urinary bladder empties when it becomes filled. n two main steps: n the bladder fills progressively until the tension in its walls rises above a threshold level n nervous reflex called the micturition reflex that empties the bladder (Mohand Hassan Malla) 4

Micturition n When the bladder is filling with urine, sympathetic control predominates n Sympath:

Micturition n When the bladder is filling with urine, sympathetic control predominates n Sympath: - Filling of the bladder n When the bladder is full with urine “fullness” and start to empting n parasympathetic control predominates n Parasympath : - Empting of the bladder “micturition reflex” (Mohand Hassan Malla) 5

Micturition reflex n First sensation = 150 ml n Fullness = 400 ml pelvic

Micturition reflex n First sensation = 150 ml n Fullness = 400 ml pelvic nerves S 2 S 3 S 4 pelvic nerves (Mohand Hassan Malla) 6

Micturition Reflex n n Receptors : - stretch receptors in the bladder wall (detrusor

Micturition Reflex n n Receptors : - stretch receptors in the bladder wall (detrusor muscle) Afferent fibers: - are conducted Sensory signals from the stretch receptors to the sacral segments “pelvic nerves “ => parasympath. Efferent fibers: - reflexively signals back again to the bladder “pelvic nerves “ => parasympath. Effector organ: - contraction of the detrusor muscle and relaxation of the internal sphincters. (Mohand Hassan Malla) 7

Summary n During filling of the bladder : n Sympath. control predominates Ø detrusor

Summary n During filling of the bladder : n Sympath. control predominates Ø detrusor muscle (Relaxation) Ø internal sphincter (Contraction). n During empting of the bladder : n Parasympath. control predominates Ø detrusor muscle (Contraction) Ø internal sphincter (Relaxation). (Mohand Hassan Malla) 8

n The external sphincter is voluntary controlled via pudendal nerve S 2 S 3

n The external sphincter is voluntary controlled via pudendal nerve S 2 S 3 S 4 pudendal nerve (Mohand Hassan Malla) 9

Abnormalities of Micturition (Mohand Hassan Malla) 10

Abnormalities of Micturition (Mohand Hassan Malla) 10

n Automatic Bladder Caused by Spinal Cord Damage Above the Sacral Region S 2

n Automatic Bladder Caused by Spinal Cord Damage Above the Sacral Region S 2 S 3 S 4 pudendal nerve (Mohand Hassan Malla) 11

n Atonic Bladder Caused by Destruction of Sensory Nerve Fibers or sacral segment pelvic

n Atonic Bladder Caused by Destruction of Sensory Nerve Fibers or sacral segment pelvic nerves S 2 S 3 S 4 pelvic nerves overflow incontinence (Mohand Hassan Malla) 12

(Mohand Hassan Malla) 13

(Mohand Hassan Malla) 13