Abnormalities of Micturition

Abnormalities of Micturition

Atonic Bladder Caused by Destruction of Sensory Nerve Fibers. Micturition reflex contraction cannot occur if the sensory nerve fibers from the bladder to the spinal cord are destroyed, thereby preventing transmission of stretch signals from the bladder. When this happens, a person loses bladder control, despite intact efferent fibers from the cord to the bladder and despite intact neurogenic connections within the brain. Instead of emptying periodically, the bladder fills to capacity and overflows a few drops at a time through the urethra.This is called overflow incontinence.

A common cause of atonic bladder is crush injury to the sacral region of the spinal cord. Certain diseases can also cause damage to the dorsal root nerve fibers that enter the spinal cord. For example, syphilis can cause constrictive fibrosis around the dorsal root nerve fibers, destroying them. This condition is called tabes dorsalis, and the resulting bladder condition is called tabeticbladder.

Automatic Bladder Caused by Spinal Cord Damage Above the Sacral Region. If the spinal cord is damaged above thesacral region but the sacral cord segments are still intact, typical micturition reflexes can still occur. However, they are no longer controlled by the brain. During the first few days to several weeks after the damage to the cord has occurred, the micturition reflexes are sup-pressed because of the state of “spinal shock” caused by the sudden loss of facilitative impulses from the brain stem and cerebrum. However, if the bladder is emptied periodically by catheterization to prevent bladder injury caused by overstretching of the bladder, the excitability of the micturition reflex gradually increases until typical micturition reflexes return; then, periodic (but unan-nounced) bladder emptying occurs.

        Some patients can still control urination in this con-dition by stimulating the skin (scratching or tickling) in the genital region, which sometimes elicits a micturition reflex.

Uninhibited Neurogenic Bladder Caused by Lack of Inhibitory Signals from the Brain. Another abnormality of micturi-tion is the so-called uninhibited neurogenic bladder, which results in frequent and relatively uncontrolled micturition. This condition derives from partial damage in the spinal cord or the brain stem that interrupts most of the inhibitory signals. Therefore, facilitative impulses passing continually down the cord keep the sacral centers so excitable that even a small quantity of urine elicits an uncontrollable micturition reflex, thereby pro-moting frequent urination.