5 Micturition Reflex 2022

MICTURITION REFLEX
Suman Pokhrel
Dept. of Physiology
BMCTH
Learning Objectives
Introduction
Functional anatomy of urinary bladder
Mechanics of micturition
Neural mechanism of micturition

Introduction
 Micturition is the process of emptying the urinary
bladder.
 Two processes are involved:
(1) The bladder fills progressively until the tension in its

wall rises above a threshold level, and then
(2) micturition reflex occurs that empties the bladder
 Micturition reflex is a spinal cord (sacral) reflex; it

can be inhibited or facilitated by higher centers
(brainstem), subject to voluntary facilitation &
inhibition (cerebral cortex)
Functional anatomy of urinary bladder
Body & Neck (posterior urethra)
Smooth muscle-
involuntary
Mucosa- smooth
Skeletal-voluntary
Mechanics of micturition
 Two phases: 1-filling & 2- emptying of bladder
Filling of bladder
 Urine flow from collecting ducts
Ureter have inherent pacemaker activity
 initiates regular peristaltic contraction (1-5

times/min) spread downward along length of
ureter & urine enters in spurts synchronous with
each peristaltic wave into bladder
• Peristaltic contraction in ureter- increased by

parasympathetic & decreased by sympathetic
stimulation
Mechanics of micturition contd….
 Initially During filling phase, bladder pressure-low &
internal sphincter- high
Bladder pressure is low because

- Of manifestation of Laplace law: P= 2T/r
- Detrusor muscle has property of plasticity (when stretch,
tension initially produced is not maintain)
Internal sphincter (functional sphincter, corresponds to

bladder neck) pressure- high due to high tension
(presence of elastic fibers).
External sphincter remains tonically contracted

Cystometrogram
Relation between intravesical pressure & volume can be
studied by Cystometry (recording pressure while bladder is
filled with 50 ml increments of H2O or air)
 a plot of intravesical pressure against

volume of fluid in bladder is called
Cystometrogram
Ia- initial slight rise in

pressure when first
increment in volume
Ib- long, nearly flat segment
as further increments are
produced (manifestation of
Laplace law: P= 2T/r)
II- sudden sharp rise in
pressure as micturition reflex
(+)
1st urge to void: ~150ml;
marked sense of fullness:
~400ml
Cystometrogram in a normal human
Emptying of the bladder Micturition
contraction-
result of stretch
reflex initiated by
stretch receptors
(especially in neck
region)
(N)Cystometrogram, showing acute

pressure waves (dashed spikes) caused by
micturition reflexes
Emptying of the bladder contd…
Voluntary urination
- Contracts abdominal muscles- pressure in bladder-
allows extra urine to enter posterior urethra &
relaxation of muscles of Pelvic floor - causes
downward tug on detrusor muscle; both initiates
contraction of detrusor muscle
Neural mechanism of micturition
Parasympathetic Somatic
Pudendal nerves (S2,S3,S4)
motor & sensory fibres
Sympathetic
External urethral sphincter
Sympathetic
Hypogastric nerves (L1,L2,L3)
Bladder wall relaxation
Internal sphincter contraction
Parasympathetic
Pelvic nerves (S2,S3,S4)
Bladder wall contraction
Somatic (voluntary control)
Internal sphincter relaxation
Micturition Reflex flow chart
Neural mechanism of micturition contd….
Micturition reflex- integrated in sacral portion of spinal

cord
Threshold for micturition reflex- is adjusted by activity

of facilitatory & inhibitory centers in brainstem
- Facilitatory area- in pontine region + posterior
hypothalamus
- Inhibitory area- in midbrain
Neural mechanism of micturition contd….
In human beings- Higher centers
- Keep micturition reflex partially inhibited except
when micturition is desired
- Keep tonic contraction of external sphincter &

prevents micturition even if micturition reflex
occurs
- voluntary component is added to micturition. If

proper place & time: facilitate sacral micturition
centers to initiate micturition reflex + relax
external sphincter- urination
For Knowledge only
Abnormalities of micturition
Effects of deafferentation
destruction of sensory nerve fibers. Eg- diseases of
dorsal roots (tabes dorsalis)
Atonic bladder
All reflex contraction- abolished
Bladder: thin-walled, distended, & hypotonic; some
contraction (+)- due to intrinsic responses of smooth
muscle to stretch
Person loses bladder control; bladder fills to capacity &
overflows a few drops at time through urethra passively
(overflow incontinence)
Abnormalities of micturition contd….
Effects of denervation
Afferent + efferent nerves= destroyed (eg, tumors of
cauda equina or filum terminale)
Decentralized bladder:
-initially, flaccid & distended.
-Gradually becomes hyperactive (due to development of
denervation hypersensitization), with many contraction
waves that expel dribbles of urine out of urethra, becomes
small & hypertrophied
Effects of spinal cord cord transection
During spinal shock- bladder: flaccid & unresponsive,

overflow incontinence
After spinal shock passed- micturition reflex returns

(bladder fills to threshold & then empties); however, no-
voluntary control & facilitation & inhibition from higher
centers (automatic bladder)
Paraplegic patients are trained to initiate urination by

pinching or stroking thighs (provoke mild mass reflex)
Abnormalities of micturition contd….
Neurogenic bladder
Due to incomplete destruction of some neuronal
pathways of micturition
irritable bladder, empties small quantities of urine

at a time repeatedly, unable to control onset of
micturition satisfactorily
Happiness is…
END OF RENAL PHYSIOLOGY..!
THANK YOU

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MICTURITION REFLEX

Functional anatomy of urinary bladder

Neural mechanism of micturition

(1) The bladder fills progressively until the tension in its

 Micturition reflex is a spinal cord (sacral) reflex; it

 initiates regular peristaltic contraction (1-5

• Peristaltic contraction in ureter- increased by

Bladder pressure is low because

tension initially produced is not maintain)

Internal sphincter (functional sphincter, corresponds to

External sphincter remains tonically contracted

 a plot of intravesical pressure against

Ia- initial slight rise in

(N)Cystometrogram, showing acute

Micturition reflex- integrated in sacral portion of spinal

Threshold for micturition reflex- is adjusted by activity

- Keep tonic contraction of external sphincter &

- voluntary component is added to micturition. If

During spinal shock- bladder: flaccid & unresponsive,

After spinal shock passed- micturition reflex returns

Paraplegic patients are trained to initiate urination by

irritable bladder, empties small quantities of urine

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