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Urinary Bladder


Urinary bladder –  Anatomy
      Nerve supply
      Parasympathetic       -  S2, S3, S4 ( Pelvic N) Q
      Sympathetic             -  T11 – L2  ( Hypogastric N) Q
      Somatic                   -  S2, S3, S4  (Pudendal nerve) Q
      Detrusor ms             - Parasympathetic (Pelvic nerve)
      Trigone                    - Sympathetic (Hypogastric nerve).
      Ext. sphincter           - Somatic (Pudendal nerve).

Physiology of micturition:

  1. Afferent by all three nerves i.e. Pelvic, Hypogastric, Pudendal nerve.
  2. Efferent mainly by pelvic nerve
  3. Area of social behaviour and personality lies in frontal lobe.

Types of urinary bladder disturbance

  1. Autonomous/Hypotonic bladder – Q
    1. Lesion at S2, S3, S4                      
    2. Large capacity bladder.               
    3. Distention with overflow
  2. Complete spastic/automatic/Hypertonic bladderQ
    1. Lesion in the spinal segment above S2, S3, S4
    2. Small capacity bladder
    3. Frequent voiding at interval (Bladder start behaving like bladder of a new born baby)
  3. Cortical/Uninhibited Bladder
    Frontal - Inappropriate micturition, loss of social inhibition control.
Recent Advances:
  1. Overactive bladder (OAB) is defined by symptoms of urgency, with or without urinary incontinence, usually
  2. with frequency and nocturia.
  3. This is a common condition in people older than 45 years, and symptoms are similar to those of BHP in
  4. males and incontinence in females.
  5. Anticholinergic drugs, are used in the treatment of this condition.
  6. Recent drugs, oxybutynin and tolterodine & Trospium are efficacious in treating OAB.


Recent Advances: 

Newer Anticholinergic Drugs for Unstable bladder

  1. Solifenacin
  2. Darifenacin
  3. Trospium
  4. Tolterodine

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