Innervation of the bladder: symptoms, impaired
An important element in the process of cellulose is the occurrence of urge to defecation. This mechanism provides the innervation of the bladder — the many nerve endings of the authority to timely submit the necessary to the body’s signals. Disruption of the nervous system may cause dysfunction and emptying. To understand the relationship of structures is to look at the mechanism of allocation of urine.
Algorithm urinary tract
The average bladder volume is 500 ml. a Little more for men (up to 750 ml). Women, as a rule, it does not exceed the 550 ml. Continuous functioning of the kidneys provides periodic filling of the on the urine. His ability to stretching of the walls allows urine to fill the on to 150 ml without any discomfort. When the walls begin to stretch and the pressure on the body increases (this usually occurs in the formation of urine volume more than 150 ml), the man feels the urge to defecation.
Reaction to the irritation happens on the reflex level. Between the urethra and the bladder is the internal sphincter, a little below, one — outer. In the normal state, these muscles are compressed and prevent involuntary urine excretion. If you experience the urge to get rid of urine, the valves relax, which ensures the contraction of muscles collects urine body. Thus occur emptying of the bladder.
The model of innervation of the bladder
The relationship of urinary organ Central nervous system is ensured by the presence in it of the sympathetic, parasympathetic, and spinal nerves. Walls it is equipped with a large number of receptor nerve endings, scattered neurons of the autonomic nervous system and ganglia. Their functionality is the basis for stable controlled urination. Each type of fibre performs a specific task. Innervation lead to various disorders.
In the sacral region of the spinal cord is the parasympathetic center of the bladder. From there originate preganglionic fibers. They participate in the innervation of the pelvic organs, in particular, form the pelvic plexus. Fibers stimulate the ganglia located in the walls of the organ of the urinary system, after that its smooth muscle contracts, respectively, relaxes sphincters, increases intestinal peristalsis. So is emptying.
Cells of the autonomic nervous system involved in micturition, located in the lateral intermediate gray column of the lumbar spinal cord. Their main purpose is to stimulate closure of the cervix, which occurs due to the accumulation of fluid in the bladder. It is for this sympathetic nerve endings in large numbers are concentrated in the triangle of the bladder and cervix. On locomotor activity, i.e. the process of release of urine from the body, these nerve fibers have virtually no effect.
The role of the sensitive nerves
The reaction to the stretching of the walls of the bladder, in other words, the emergence of desire for stool, possible due afferentny fibers. They are beginning to proprioreceptor and noncapture of the body wall. The signal goes through them to the spinal cord segments T10-L2 and S2−4 via pelvic, and pudendal nerves hypoestrogenia. So the brain receives the impulse of the need of emptying the bladder.
Violation of the nervous regulation of urination
The violation of innervation of the bladder is possible in 3 options:
- Hyperreflection bladder — urine ceases to accumulate and is immediately allocated, therefore urination in the toilet frequent, and the volume of secreted fluid is very small. Illness — a consequence of the defeat of the Central nervous system.
- Hyporeflectivity bladder. Urine in large quantity is accumulated, but its exit from the body difficult. Bubble much crowded (it can be collected to one and a half liters of fluid), inflammatory and infectious processes in the kidney on the background of the disease. Giporeflexia determine krestovogo lesions of the brain.
- Reflectory the bladder at which the patient does not affect urination. It is happening by itself at the moment of maximum filling of the bladder.
Such deviations determined by various factors, among which the most common are traumatic brain injury, cardiovascular disease, brain tumors, multiple sclerosis. Identify pathology based only on external symptoms rather problemno. Form of the disease depends on the fragment of the brain, has undergone a negative change. To indicate dysfunction of the storage of urine due to nervous disorders in medicine introduced the term «neurogenic bladder». Various types of lesions of nerve fibers in different ways disrupt excretion of urine from the body. Main discussed below.
Brain damage that violates the innervation of the
Multiple sclerosis affects the operation of the side and posterior columns of the cervical spinal cord. More than half of patients have involuntary urination. The symptoms develop gradually. Sequestration of a herniated disc at the initial stage causes a delay output of urine and difficulty emptying. This is followed by symptoms of irritation.
Supraspinally lesions of the motor systems of the brain incapacitate the reflex of urination. Symptoms seen in incontinence of urine, frequent urination and nighttime evacuations. However, by maintaining the coordination of the work underlying muscles of the bladder, it retains the required level of pressure, which eliminates the occurrence of urological diseases.
Peripheral paralysis also inhibits reflex contraction of the muscles causes inability to self-relaxation of the lower sphincter. Diabetic neuropathy causes disorder in the bladder detrusor. Stenosis of the lumbar spine affects the urinary system according to type and level of the destructive process. When cauda equina syndrome is possible incontinence due to overflow of a hollow muscular organ and delay of excretion of urine. Hidden spina bifida is a violation of the reflection of the bladder, in which a conscious defecation impossible. The process takes place independently at the moment of maximum filling body in the urine.
Options dysfunction, severe damage of the brain
The syndrome of complete interruption of the spinal cord manifests these effects to the urinary system:
- In the event of failure necrectomy segments of the spinal cord that can be caused by tumors, inflammation or trauma, the mechanism of destruction following. Development starts with hyperreflexia of the detrusor, followed by involuntary contractions of bladder muscles and sphincter. The result of intravesical pressure is very high, and the volume of urine coming out is very small.
- In lesions of the sacral segments of the spinal cord due to injury or disc herniation, conversely, a decrease in the frequency of emptying and delay the release of urine. A person loses the ability to control the process. Involuntary release of urine occurs due to overflow of the bladder.
Diagnosis and treatment of disease
The first signal to the survey are changes in the frequency of bowel movements. In addition, the patient loses control over the process. The disease diagnosis is carried out only in the complex: the patient receives an x-ray of the spine and skull, abdominal cavity, may appoint a magnetic resonance imaging, ultrasound of the bladder and kidneys, General and bacteriological analysis of blood and urine, uroflowmetry (recording speed of the urine stream during normal urination), cytoscopy (inspection of the inner surface of the affected organ).
There are 4 method that helps to restore the innervation of the bladder:
- Electrical stimulation of moonbounce, the muscles of the groin and anal sphincter. The goal is to activate the reflection of the sphincter and restore them in common with detrusor activity.
- The use of cofactors, agonists, cholinomimetics and antagonists of calcium ions for activation of the efferent components of the Autonomous nervous system. Shown to receive the drugs: «Isoptin», «Ephedrine hydrochloride», «Aceclidine», «Cytochrome».
- Restore and maintain autonomic regulation of tranquilizers and antidepressants.
- Antagonists of calcium ions, holinoliticheskie, anticholinergic drugs, and-adrenostimulyatory restore the ability of the patient to monitor urine output, normalize retention of urine in the bladder, regulate the established work of the sphincter and the detrusor. Prescribed «Atropine sulfate», «Nifedipine», «Pilocarpine».
Innervation of the bladder can be restored. Treatment depends on the extent and nature of the lesion and may be pharmacological, non-pharmacological and surgical. It is extremely important to keep regular hours, regular walking in the fresh air, perform a recommended by doctors set of exercises. To restore the innervation of using folk remedies at home is impossible. To illness respond to treatment, you should follow all the prescriptions of the attending physician.