Anatomy of urinary bladder and

Mechanism of urine formation

Shape of the Bladder

The appearance of the bladder varies depending on the amount of urine stored.
When full, it exhibits an oval shape, and when empty it is flattened by the
overlying bowel.
The external features of the bladder are:

Apex – located superiorly, pointing towards the pubic symphysis. It is

connected to the umbilicus by the median umbilical ligament (a remnant of the
urachus).
Body – main part of the bladder, located between the apex and the fundus
Fundus (or base) – located posteriorly. It is triangular-shaped, with the tip of
the triangle pointing backwards.
Neck – formed by the convergence of the fundus and the two inferolateral
surfaces. It is continuous with the urethra
 Urine enters the bladder through the left and right ureters, and exits via the urethra.
Internally, these orifices are marked by the trigone – a triangular area located within
the fundus.
There are also two muscular sphincters located in the urethra:

Internal urethral sphincter:

Male – consists of circular smooth fibres, which are under autonomic control. It
is thought to prevent seminal regurgitation during ejaculation.
Females – thought to be a functional sphincter (i.e. no sphincteric muscle
present). It is formed by the anatomy of the bladder neck and proximal urethra.
External urethral sphincter – has the same structure in both sexes. It is skeletal
muscle, and under voluntary control. However, in males the external sphincter
mechanism is more complex, as it correlates with fibres of the rectourethralis muscle
and the levator ani muscle.
vasculature
Nervous Supply

Neurological control is complex, with the bladder receiving input from both the autonomic
(sympathetic and parasympathetic) and somatic arms of the nervous system:

Sympathetic – hypogastric nerve (T12 – L2). It causes relaxation of the detrusor

muscle, promoting urine retention.
Parasympathetic – pelvic nerve (S2-S4). Increased signals from this nerve causes
contraction of the detrusor muscle, stimulating micturition.
Somatic – pudendal nerve (S2-4). It innervates the external urethral sphincter,
providing voluntary control over micturition.
THE BLADDER STRETCH REFLEX

The reflex arc:

Bladder fills with urine, and the bladder walls stretch. Sensory nerves detect
stretch and transmit this information to the spinal cord.
Interneurons within the spinal cord relay the signal to the parasympathetic
efferents (the pelvic nerve).
The pelvic nerve acts to contract the detrusor muscle, and stimulate
micturition.
URINE FORMATION
Waste is excreted from the human body, mainly in the form of urine. Our kidneys
play a major role in the process of excretion. Constituents of normal human urine
include 95 percent water and 5 percent solid wastes. It is produced in the nephron,
which is the structural and functional unit of the kidney. Urine formation in our body is
mainly carried out in three phases namely

1. Glomerular filtration
2. Reabsorption
3. Secretion
 Glomerular Filtration

Glomerular filtration occurs in the glomerulus where blood is filtered. This process
occurs across the three layers- the epithelium of Bowman’s capsule, the endothelium
of glomerular blood vessels, and a membrane between these two layers.

Blood is filtered in such a way that all the constituents of the plasma reach the
Bowman’s capsule, except proteins. Therefore, this process is known as ultrafiltration.
Reabsorption

Around 99 per cent of the filtrate obtained is reabsorbed by the renal

tubules. This is known as reabsorption. This is achieved by active and
passive transport.
Secretion

The next step in urine formation is tubular secretion. Here, tubular cells secrete
substances like hydrogen ions, potassium ions, etc into the filtrate. Through this
process, the iconic, acid-base and the balance of other body fluids are maintained.
The secreted ions combine with the filtrate and form urine. The urine passes out of
the nephron tubule into a collecting duct.
Urine

The urine produced is 95% water and 5% nitrogenous wastes. Wastes such as
urea, ammonia, and creatinine are excreted in the urine. Apart from these, the
potassium, sodium and calcium ions are also excreted.
BLADDER INCONTINENCE
● Urinary incontinence means there is a loss of bladder control which leads to
unintentional passing of urine.
● There are several times of bladder incontinence which are
1. Stress incontinence - occurs during certain activities like
coughing,sneezing ,laughing.
2. Urge incontinence -leakage of urine which involves a strong and sudden
need to urinate
ANATOMY OF BOWEL
The colon averages 150cm in length, and can be divided into four parts (proximal to distal): ascending,
transverse, descending and sigmoid.

Ascending Colon
The colon begins as the ascending colon, a retroperitoneal structure which ascends superiorly from the
cecum.

When it meets the right lobe of the liver, it turns 90 degrees to move horizontally. This turn is known as the
right colic flexure (or hepatic flexure), and marks the start of the transverse colon.

Transverse Colon

The transverse colon extends from the right colic flexure to the spleen, where it turns another 90 degrees to
point inferiorly. This turn is known as the left colic flexure (or splenic flexure). Here, the colon is attached to
the diaphragm by the phrenicocolic ligament.

The transverse colon is the least fixed part of the colon, and is variable in position (it can dip into the pelvis in
tall, thin individuals). Unlike the ascending and descending colon, the transverse colon is intraperitoneal and
is enclosed by the transverse mesocolon
Descending Colon
After the left colic flexure, the colon moves inferiorly towards the pelvis – and is called the
descending colon. It is retroperitoneal in the majority of individuals, but is located anteriorly to the
left kidney, passing over its lateral border.
When the colon begins to turn medially, it becomes the sigmoid colon.

Sigmoid Colon
The 40cm long sigmoid colon is located in the left lower quadrant of the abdomen, extending
from the left iliac fossa to the level of the S3 vertebra. This journey gives the sigmoid colon its
characteristic “S” shape.
The sigmoid colon is attached to the posterior pelvic wall by a mesentery – the sigmoid
mesocolon. The long length of the mesentery permits this part of the colon to be particularly
mobile.
NEUROVASCULAR SUPPLY

Ascending colon and proximal 2/3 of the transverse colon

– derived from the midgut.
Distal 1/3 of the transverse colon, descending colon and
sigmoid colon – derived from the hindgut.
● The ascending colon receives arterial supply from two branches of the superior
mesenteric artery
● The transverse colon is derived from both the midgut and hindgut, and so it is supplied
by branches of the superior mesenteric artery and inferior mesenteric artery:
Right colic artery (from the superior mesenteric artery)
Middle colic artery (from the superior mesenteric artery)
Left colic artery (from the inferior mesenteric artery).
The descending colon is supplied by a single branch of the inferior mesenteric artery; the left
colic artery. The sigmoid colon receives arterial supply via the sigmoid arteries
BOWEL DYSFUNCTION
bowel dysfunction, or commonly referred to as incontinence, (the inability to
control your bowels).