contents 1.ANATOMYCAL INTRODUCTION 2.CAPACITY THE BLADDER 3.NERVE SUPPLY 4.PHYSIOLOGICAL REFLEX...
-
Upload
rudolf-malone -
Category
Documents
-
view
223 -
download
0
description
Transcript of contents 1.ANATOMYCAL INTRODUCTION 2.CAPACITY THE BLADDER 3.NERVE SUPPLY 4.PHYSIOLOGICAL REFLEX...
TYPES OF URINARY BLADDER
DYSFUNCTION PRESENTED BY:
SHILPA K. PRAJAPATI (1st year MPT)
contents1. ANATOMYCAL INTRODUCTION2. CAPACITY THE BLADDER3. NERVE SUPPLY4. PHYSIOLOGICAL REFLEX5. NEUROGENIC BLADDER6. INCONTINENCE7. REFERENCE
URINARY BLADDER
URINARY BLADDER ANATOMICAL INTRODUCTION
Urinary bladder is the temporary store house of urine which gets emptied through the urethra.
The male urethra subserving the functions of urination and ejaculation.
Female urethra is for urination only.
CAPACITY OF THE BLADDERCapacity in an adult male 120 to 320 ml.
Filling beyond 220 ml causes micturition, emptied when filled to about 250 to 300 ml.
Filling up to 500 ml may be tolerated, but beyond this it becomes painful.
Referred pain: lower part of the anterior abdominal wall, perineum and penis(T11-L2,S2-S4).
NERVE SUPPLY
NERVE SUPPLYIts contains both sympathetic and parasympathetic components.
Parasympathetic efferent fibers S2,S3, S4 are motor to the detrusor muscle and inhibitory to the sphincter vesicae.
If these are destroyed, normal micturition is not possible.
NERVE SUPPLY CONTI…. Sympathetic efferent fibers (T11 to L2): - inhibitory to the detrusor -motor to the sphincter vesicae The pudendal nerve (S2, S3, S4) -supplies the sphincter urethrae which is
voluntary Sensory nerves:• pain sensations, causes: - spasm of bladder wall - carried by parasympathetic nerves and
partly by sympathetic nerves
NERVE SUPPLY CONTI….
HIGHER CENTER Higher centers for micturition
1) Inhibitory centers : midbrain -cerebral cortex 2) Facilitatory centers : Pons - cerebral cortex
FUNCTIONS OF NERVES
Nerve On
detrusor muscle
On internal sphincter
On external sphincter
Function
Sympathetic nerve
Relaxation Constriction Not supplied Filling of urinary bladder
Parasympathetic nerve
Constriction Relaxation Not supplied Emptying of urinary bladder
Somatic nerve Not supplied Not supplied Constriction Voluntary control of micturition
MICTURITION REFLEX.
Filling of urinary bladder
Stimulation of stretch receptor
Afferent impulses pass via pelvic nerve
Efferent impulses via pelvic nerve
Contraction of detrusor muscle & relaxation of internal sphincter
Sacral segments of spinal cord
MICTURITION REFLEX CONTI…Flow of urine into urethra and stimulation of stretch receptors
Afferent impulses via pelvic nerve
Inhibition of pudendal nerve
Relaxation of external sphincter
Voiding of urine
NEUROGENIC BLADDER BY: P.J.MEHTA
There are five types of neurogenic bladder:
TYPE LESION
1. Uninhibited bladder ..cortico regulatory tract
2. Reflex bladder ..spinal cord above S2
3. Autonomous bladder ..at S2, S3 and S4 level
4. Motor atonic bladder ..motor efferents
5. Sensory atonic bladder ..sensory afferents
1. UNINHIBITED BLADDERCAUSES: -cerebrovascular accidents, -head injuries, -brain tumors, etc.Voluntary control of micturition is lost.Hesitancy and precipitancy of evacuation is present.Lesion : - the midbrain - superior frontal gyrus
2.REFLEX BLADDERETIOLOGY:Transverses myelitis Trauma NeoplasmsMeningitisDisseminated sclerosisLesion :
complete transection of spinal cord above sacral segments
REFLEX BLADDER CONTI…PATHOGENESIS:Acute transaction of the cord causes retention of urine during the stage of spinal shock.
Leads to retention of residual urine.
During recovery stage, reflex activity begins and automatic evacuation of bladder results.
3. AUTONOMOUS BLADDERETOLOGY:Congenital : spina bifida, meningomyelocele
Trauma: gunshot, auto accidents
Infective: arachnoiditis, radiculitis
Neoplasms of the cord
Surgery: combined perineal and abdominal resection.LESION: sacral segment of spinal nerve.
AUTONOMOUS BLADDER CONTI…CLINICAL FEATURES:Loss of bladder sensation
Inability to initiate micturition normally paralysis of pariurethral striated muscles
associated with anesthesia and absent bulbocavernous reflex.
4. SENSORY PARALYTIC BLADDERETIOLOGY:Tabes dorsalisPernicious anemiaDiabetesDisseminated sclerosisSyringomyeliaLesion : afferent fibers from the bladder
SENSORY PARALYTIC BLADDER CONTI..
PATHOGENESIS:Loss of bladder sensation, which leads to overdistension of bladder.
Initially there is normal capacity increases and residual urine appears.
CLINICAL FEATURES:Initially these patients are asymptomatic.Gradually there is terminal dribbling and later overflow incontinence.
5. MOTOR PARALYTIC BLADDERETIOLOGY:PoliomyelitisPolyradiculopathyCongenital anomaliesTumorTraumaLesion : Efferent fibers of the bladder
MOTOR PARALYTIC BLADDER CONTI..PATHOGENESIS:Since the sensory nerves are intact, bladder if left alone, distends and decompensates.
CLINICAL FEATURES:Painful distention of the bladder and inability to initiate micturition.Decrease in size and force of steam and interrupted stream.Recurrent episodes of urinary infections.
INCONTINENCE OF URINEThe term ‘continence’ is used to describe the normal ability of a person to store urine and faeces temporarily, with conscious control over the time and place of micturition and defaecation.
‘Incontinence’ has been defined as the involuntary or inappropriate passing of urine or faeces, or both, that has an impact on social functioning or hygiene(DoH 2000).
INCONTINENCE OF URINETypes:
1. Extra urethral incontinence2.Detrusor overactivity incontinence3.Urodynemic stress incontinence4.Nocturnal enuresis5.Giggle incontinence6.Incontinence associaed with sexual activities7.Functional incontinance
1.Extraurethral incontinenceLoss of urine through channels other than the urethraCAUSEScongenital abnormality.trauma at pelvic surgery such as hysterectomy endometriosis, infection or carcinoma.Child birth(Wall 1999)
2. Detrusor overactivity incontinence
-present as a symptom, a sign and as a condition
The symptoms: complains of urge incontinence, immediately preceded by urgency, that is a strong desire to void.
Detrusor overactivity incontinence
The sign: conformed as a sign observed at urodynamic assessment
The condition: May be further qualified as neurogenic, in neurological condition
3.URODYNAMIC STRESS INCONTINENCE
Symptom: during increased intra-abdominal pressure, such as during coughing, laughing, sneezing and liftingSign:An involuntary spurt dribble or droplet of urine is observed to leave urethra immediately on an increase in intra-abdominal pressure
URODYNAMIC STRESS INCONTINENCE
Condition : in absence of detrusor contraction
4.NOCTURNAL ENURISISDuring sleep, or “bed wetting”15-20% of 5 year old children and up to 2% of young adults(Glazener &Evans 2003)
5.GIGGLE INCONTINENCE
In girls around puberty
Caused by detrusor overactivity induced by laughter(chandra et al 2002)
6.INCONTINENCE ASSOCIATED WITH SEXUAL ACTIVITY
After following intercourse in young women postcoital dysuria
postmenopausal women dysuria, urgency and urinary tract infection
Hilton(1988) found 24% of 324 sexually active women referred to gynaecological clinic experience incontinence – two third on penetration and one third on orgasm.
7.FUNCTIONAL INCONTINENCE
involuntary loss of urine in ability to perform toileting functions secondary to physical or mental limitation
ReferencesP.J. mehta’s Practical Medicine
Physiotherapy in obstetrics and gynaecology, 2nd edition, jill mantle
Essentials of medical physiology, 5th edition, K Sembulingam
B.D.Chaurasia’s human anatomy, 4th editionInternet
THANKING YOU….