Center : Brain stem

Facilitatory area : Pontine

REFLEX FACILITATION & Post hypothalamus
FILLING THE BLADDER
Inhibitory : Midbrain

Sacral center: (+) facilitatory impulses

from pontine micturating c. & (-) by Vol control of micturition
medullary c. influcences threshold
for micturition reflex (corticol areas)  control EUS & abd m.

Urine collected in renal pelvis

 Pudendal n. Pelvic floor m.
Pressure in pelvis  somatic fiber
 Retain urine Untimely to Contrxn  retain
Peristaltic contrx initiated (in pelvis) urinate → urine by tighten
 signal from openings of the
Contrx spread  (ureter to bladder) pons excite urethra
 the nerve→
Peristaltic wave occur (1.5x / min) keep EUS to
contract
ABNORMALITY Voiding Time to Relaxing/lowering
Symp : invol
urinate (reach  allows passage
Parasymp : invol  control bladder wall & IUS threshold)→ of urine
Incontinence
 (-) nerve
Somatic: Vol. (skeletal m) Parasym.n damaged  absence of micturition r. →EUS relax
Contxn of  bladder shrunk & bladder wall hypertrophied
detrusor m in  contxn/relaxtn. EUS
 detrusor m hyperactive  expel  urine 
bladder walls &
involve in incontinence
micturition r.

Spinal Shock transection

Deafferentation
 Bladder is flaccid & unresponsive
 Urine dribbles out when overfilled: overflow incontinence Loss of sacral afferents  no micturition r.
 Upon recovery:- micturition r. returns, but loss of voluntary
control & no inhibition / facilitation from higher c. Denervation

Spastic neurogenic bladder  AN & EN destroyed  no micturition r.

CYSTOMETROGRAM
 eg: tumours of cauda equine
 Micturition r. becomes hyperactive, bladder capacity  & wall
of bladder hypertrophied