What is innervation of the bladder and what are the signs of its violation? Dysfunctions of the autonomic nervous system Damage to the parasympathetic innervation.

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The bladder is described as a muscular organ with an elastic and extensible sheath of walls, having a free, empty space inside. It is located in the lower abdomen and serves as a reservoir for the accumulation of urine.

Urine is excreted by the body from the kidneys through the ureters. Emptying occurs when a certain pressure is applied to the bubble. In fact, these are nerve endings in such a way that they signal the need for emptying. Urine exits through the urethra.

The shape of a hollow muscular organ is directly related to the phenomena and needs occurring in the body. It can change when filled with urine, when emptying from waste products, due to the location of nearby organs.

The innervation of the bladder plays an important role in the functioning of the organ itself. If any violations occur, the patient may feel an increased or a small number of incentive reactions in the saccular organ. Any deviations in the intended work of the bladder can cause a number of ailments and ailments.

Diseases provoked by the innervation of the organ in a filled and empty state of urine

The excess innervation leads to a neurogenic bladder. This ailment indicates the beginning of the incorrect work of the urinary canals. Problems urinary tract can be obtained throughout life or be a congenital disorder associated with nerves.

The connection between the bladder and the nervous system is very important for full life person. When a disease occurs, the patient's urinary canals atrophy, or they work too actively. Such violations can manifest themselves with injuries or concurrent diseases (pathologies anterior section central nervous system, multiple sclerosis, stroke, parkinsonism, Alzheimer's disease, spinal cord injury). The patient completely loses control over the process of urine excretion from the body.

In turn, the neurogenicity of the muscular organ is subdivided into hyperactive and hypoactive types of disease development.

Overactive type of neurogenic organ of accumulation and excretion of urine

This type of development of malaise of the neurogenic bladder entails impaired functioning of the part of the nervous system, which is located above the bridge of the anterior part of the central nervous system. In this case, the tension of the muscles of the urinary system becomes more intense.

Doctors diagnose phenomena such as detrusor hyperreflexia. This type of excess innervation of the saccular organ leads to uncontrolled urination, involuntary urine flow can begin at any inopportune moment. The disease causes a person severe social and psychological discomfort.

When a patient has an overactive detrusor disease, urine does not accumulate in the hollow organ, so he is forced to visit the toilet many times.

Hypoactive type of neurogenic muscular bladder

This type of disease begins its development under the bridge of the brain, most of the lesion occurs in the sacral region. Such a defectiveness of the nervous system entails incomplete contractions of the muscles of the lower urine excreters or the complete absence of the necessary contractions. Doctors diagnose this course of the disease as detrusor areflexia.

Patients are simply not physiologically able to go to the toilet normally when the organ is full. They lose the sensitivity of the exhaustion of the muscular organ, suffering from pain in the urethra. Some do not feel the urge to urinate, they cannot control the circular muscle, which serves to narrow or close the urinary duct.

Complications of innervation of the saccular bladder

The innervation of the bladder in any of its manifestations negatively affects human health and can lead to trophic disorders. In case of deviations in the functioning of the saccular organ with nerves, the blood supply to the urinary organs fails.

In addition to the whole bouquet of unpleasant sensations, cystitis may also begin to disturb, which can be re-transformed into microcystitis. Microcystitis leads to a decrease in the size of the bladder due to chronic inflammation. Microcystitis quite strongly and negatively affects all functions of the bladder. This disease characterized as the most dangerous among chronic cystitis and neurogenic bladder.

Residual urine increases the risk of organ infections and inflammation throughout the canal. Usually, neurogenic bladder disease complicated by cystitis is resolved with surgical methods.

Diagnosis and timely therapy

The patient needs to undergo general blood and urine tests to identify a possible inflammatory process. You should also go through a series of procedures to comprehensive survey urinary tract, such as: ultrasound, urethrocytography, cytoscopy, urography, MRI if necessary, and others.

For the study of neurological abnormalities, they may prescribe to undergo an EEG, MRI scan, or appoint examinations using other techniques. Neurogenic bladder disease is often cured. The main thing is to contact a specialist in time. From medications, you may be prescribed medications that improve blood circulation, antibiotics, andrenoblockers, anticholinergics.

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The normal functioning of the bladder is regulated by a large number of plexuses at several levels. From congenital defects of the terminal spine and spinal cord to dysfunction of the nerve regulation of the sphincter - all these disorders can provoke the appearance of symptoms of a neurogenic bladder. These disorders can be the consequences of trauma and can be explained by other pathological processes of the brain, such as:

• Multiple sclerosis.
• Stroke.
• Encephalopathy.
• Alzheimer's disease.
• Parkinsonism.

Spinal cord lesions such as spondyloarthrosis, osteochondrosis, Schmorl's hernia, and trauma can also cause the development of a neurogenic bladder.

All types of violations have different causes. Most common: traumatic brain injury. cardiovascular diseases. tumors.

1. Cauda equina syndrome... Cause incontinence due to overflow of the urinary organ or suspension of excretion.
2. Diabetic neuropathy... It causes dysfunction of urine pushing out of the organ cavity. A narrowing (stenosis) occurs in the lumbar spine. The urinary system is disturbed.
3. Peripheral paralysis... Muscles cannot reflexively contract. The lower sphincter does not relax on its own.
4. Supraspinal disorders of the motor systems of the brain... The reflex function of urination is affected. Enuresis develops, increased urge even at night. The functionality of the underlying muscles is preserved, the pressure is normal, threats urological diseases not.
5. Multiple sclerosis - disrupts the functions of the side, back columns cervical spinal cord, which leads to areflexion. Symptoms develop gradually.

Classification

The connection between the urinary system and the central nervous system is carried out through parasympathetic, sympathetic, sensitive fibers. The slightest interruption in these areas leads to various disorders.

The parasympathetic center (excitatory fibers), located in the sacral spinal cord, is involved in innervation pelvic organs... Responsible for the relaxation of the sphincter muscles, the secretion of urine.

The sympathetic center (autonomic), located in the intermediate lateral column of the lumbar spinal cord, stimulates neck closure and urine retention in the bladder cavity.

The sensory nerves located in the posterior part of the urethral canal stretch the walls of the bladder and are responsible for the appearance of a reflex to emptying its cavity.

Distortion of the nervous regulation of urination leads to disruptions in the innervation of the organ.

Diseases provoked by the innervation of the organ in a filled and empty state of urine

The excess innervation leads to a neurogenic bladder. This ailment indicates the beginning of the incorrect work of the urinary canals. Problems of the urinary tract can be obtained during life or turn out to be a congenital disorder associated with nerves.

The connection of the bladder with the nervous system is very important for a full life of a person. When a disease occurs, the patient's urinary canals atrophy, or they work too actively. Such disorders can manifest themselves with trauma or concurrent diseases (pathologies of the anterior central nervous system, multiple sclerosis, stroke, parkinsonism, Alzheimer's disease, spinal cord lesions). The patient completely loses control over the process of urine excretion from the body.

In turn, the neurogenicity of the muscular organ is subdivided into hyperactive and hypoactive types of disease development.

Violation of the innervation of the bladder in children

According to statistics, neurogenic bladder 10% of children suffer. This disease does not pose a threat to the child's life, and nevertheless it unpleasantly complicates the socialization of the baby: complexes arise, the quality of life is disturbed.

It is known that infants and children under two or three years old are not able to control the act of urination. However, when the sphincter control develops sufficiently, which is carried out with the help of the brain and spinal cord, the child asks for a potty, and then learns to go to the toilet on his own. If a child of three years and older is not able to control the process of urination, this indicates violations:

• pathologies of the central nervous system;
• neoplasms in the spine (malignant or benign);
• spinal hernia;
• encephalitis;
• do not lie;
• pathologies in the development of the sacrum and coccyx;
• violation of the autonomic nervous system;
• hypothalamic-pituitary insufficiency.

Usually, children suffering from a neurogenic bladder are prescribed therapy only after a complete examination of the child's body for possible pathologies in development. The complex of analyzes in children is no different from adults. This also includes general analysis blood, blood biochemistry, ultrasound, etc.

During treatment, excessive physical and emotional stress is contraindicated in children, hypothermia should not be allowed. Parents should be sympathetic to the baby's health problems, and should not swear for wet clothes or bed.

Signs and symptoms

Let's consider in order each deviation separately. Thus, a hyperreflex bladder is characterized by a constant urge to empty. This is because the impulse enters the spinal cord too quickly when the bladder is only half full. However, very little fluid is released each time you urinate. The cause of the hyperreflex bladder may be a malfunction of the central nervous system (central nervous system).

A hyporeflex bladder is characterized by excessive fluid filling of the bladder as a result of inability to empty. In this case, the bladder does not contract. This is due to disturbances in the functioning of the sacral part of the spinal cord, because it is known that the spine affects the bladder (in which the human spinal cord is located).

If a patient has an areflex bladder, this means that his brain is not able to control the process of urination. As a result, a person experiences great stress, because when the bladder fills up, urine can begin to flow at the most inopportune moment.

The main causes of impaired urination or neurogenic bladder:

• encephalitis;
• tuberculomas;
• cholesteatoma;
• post-vaccination neuritis;
• diabetic neuritis;
• demyelinating diseases;
• nervous system injury;
• spinal cord pathology;
• pathology of the development of the central nervous system.

Signs and symptoms

In the presence of neurogenic dysfunction of the bladder, the ability to arbitrarily control the process of urination is lost.

The manifestations of a neurogenic bladder are of 2 types: hypertensive or hyperactive type, hypoactive (hypotonic) type.

Hypertensive type of neurogenic bladder

This type appears when the function of the part of the nervous system, which is located above the bridge of the brain, is impaired. At the same time, the activity and strength of the muscles of the urinary system becomes much greater. This is called detrusor hyperreflexia. With this type of disturbance of the innervation of the bladder, the process of urination can begin at any time, and often it occurs in an uncomfortable place for a person, which leads to serious social and psychological problems.

In the presence of an overactive detrusor, the possibility of urine accumulation in the bladder is excluded, so people feel the need to go to the toilet very often. Patients with a hypertensive type of neurogenic bladder feel the following symptoms:

• Stranguria is pain in the urethra.
• Nocturia is frequent urination at night.
• Urgent urinary incontinence - rapid flow with strong urge.
• Strong tension of the pelvic floor muscles, which sometimes provokes a return direction of urine flow through the ureter.
• Frequent urge to urinate with a small amount of urine.

Hypoactive type of neurogenic bladder

The hypotonic type develops when a part of the brain is damaged below the bridge of the brain, most often these are lesions in the sacral region. For such defects of the nervous system, insufficient contractions of the muscles of the lower urinary tract or a complete absence of contractions, which is called detrusor areflexia, are inherent.

With a hypotonic neurogenic bladder, physiologically normal urination is absent, even with a sufficient amount of urine in the bladder. People feel these symptoms:

• Feeling of insufficient bladder emptying that ends with a feeling of fullness.
• No urge to urinate.
• Very sluggish urine stream.
• Pain along the urethra.
• Incontinence of the bladder sphincter.

Disruption of innervation at any level can cause trophic disorders.

After collecting a detailed history, it is important to pass urine and blood tests to rule out the inflammatory nature of the disease. After all, often the symptoms inflammatory processes very similar to the manifestation of a neurogenic bladder.

It is also worth examining the patient for anatomical anomalies in the structure of the urinary tract. For this, X-rays, urethrocystography, ultrasound, cystoscopy, MRI, pyelography and urography are performed. The most complete and clear picture is given by ultrasound.

After all the reasons have been ruled out, neurological examinations are worthwhile. For this purpose, EEG, CT, MRI are performed and various techniques are used.

A neurogenic bladder is treatable. To do this, use anticholinergics, adrenergic blockers, means to improve blood supply, if necessary, antibiotics. Physiotherapy exercises, rest and balanced nutrition will help to overcome the process faster.

To make an accurate diagnosis, the patient needs to consult a urologist and neurologist. The doctor will interview the patient, suggest the following methods:

• For several days, keep a log of time, volume of fluid drunk and urination.
• Hand over bacterial culture, OAM for infections.
• Get an X-ray with contrast agent, MRI, ultrasound to exclude tumors, inflammatory processes.
• To exclude pathological changes in the brain, spinal cord - CT, MRI.
• Additionally - uroflowmetry and cystoscopy.

If this diagnosis does not allow determining the cause, the diagnosis is made - neurogenic bladder of indeterminate origin.

In case of any violations of the urinary function in the body, you should immediately consult a urologist. After taking the history, the doctor may send you for the following tests:

1. x-ray of the spine and skull.
2. x-ray abdominal.
3. MRI (magnetic resonance imaging).
4. Ultrasound of the kidneys and bladder.
5. UAC - general blood analysis.
6. blood seeding tank.
7. uroflowmetry.
8. cytoscopy.

X-rays of the spine and skull will reveal abnormalities in the patient's brain and spinal cord.

An abdominal X-ray is able to diagnose pathologies of the kidneys, bladder. A significant advantage of MRI compared to X-rays is the ability to see human organs in 3D, which will allow the doctor to diagnose the cause of the patient's disease with high accuracy.

Ultrasound of the kidneys and bladder will help to identify various pathologies and neoplasms in the kidneys and bladder, for example, stones, polyps.

A general blood test is an obligatory component of a complex of analyzes in the diagnosis of any disease. This study is able to identify the quantitative components of blood ( blood cells): leukocytes, erythrocytes, platelets. Any deviations from the norm in their composition will indicate the development of the disease.

A blood culture tank will help to identify the presence of bacteria in the patient's blood, to identify their sensitivity to various kinds of antibiotics.

Uroflowmetry is a procedure through which you can find out the basic properties of the patient's urine. This procedure will help to identify: the rate of urine flow, its duration, amount.

Cytoscopy is an examination of the inner walls of the bladder. For cytoscopy, a special device is used - a cystoscope.

Influence of innervation disorders on the urinary tract

With the wrong innervation, the blood supply to the organs of the urinary tract is disrupted. So, with a neurogenic bladder, cystitis often joins, which can cause a microcyst.

A microcyst is a decrease in the size of the bladder due to chronic inflammation. With a microcyst, the function of the bladder is significantly impaired. The microcyst is one of the most difficult complications of chronic cystitis and neurogenic bladder.

With residual urine in the bladder, the risk of inflammatory diseases urinary tract. If the neurogenic bladder is complicated by cystitis, then this poses a health hazard and sometimes requires surgical intervention.

Diagnosis and treatment of neurogenic bladder and its type

In this case, drug, non-drug treatment is used. To restore the reflex function of the sphincters and their activity with the detrusor, electrical stimulation of the muscles of the bladder, groin, and sphincter of the anus is prescribed.

To restore and activate the efferent links of the ANS, calcium ion antagonists, adrenomimetics, coenzymes, and cholinomimetics are prescribed. Frequently used: Aceclidine, Ephedrine hydrochloride, Cytochrome C, Isoptin.

To maintain and restore the regulation of the ANS, the doctor individually selects tranquilizers and antidepressants.

In exceptional cases, appointed surgery... Based on the reasons, the nervous apparatus of the organ or the plastic of the musculo-ligamentous apparatus can be adjusted.

Disruption of the innervation of the bladder is common. It is important to take steps at the first symptoms to correct the problem.

In order to restore the normal innervation of the bladder, the following methods are used:

1. electrical stimulation (urine collector, groin muscles and anal sphincter).
2. drug therapy (coenzymes, adrenomimetics, cholinomimetics, calcium ion antagonists).
3. taking antidepressants, tranquilizers.
4. taking anticholinergic, anticholinergic drugs, andrenostimulants.

Unfortunately, there is no therapy for disorders of the innervation of the bladder using folk remedies... For any problems with dysfunction of urination, you should immediately consult a urologist. Truth to improve efficiency drug therapy you should move more, regularly walk in the fresh air, perform exercises according to the method of exercise therapy (physical therapy).

Treatment of the disorder depends on the etiology of the disease, as well as on concomitant inflammatory diseases. There are four types of effective conservative treatment:

• Electrical stimulation. Sphincter reflexes can be activated by applying electrical stimulation to the groin and anal sphincter muscles. The procedure restores the connection between the sphincter and the detrusor.
• Medication therapy. Isoptin, Aceclidine or Cytochrome C is prescribed to activate the efferent impulses of the ANS. Preparations based on: coenzymes, calcium ion antagonists, adrenomimetics and cholinomimetics.
• Tranquilizers and antidepressants act in a complex manner on the entire nervous system.
• Cholinergic, anticholinergic drugs restore the ability to control the process, stabilize the pressure inside the organ.

In other cases, a decision is made to perform surgery.

Effects

Untimely treatment of disorders of the innervation of the bladder can lead to unpleasant consequences. The quality of life may be significantly impaired: sleep will be restless, the patient may suffer from depression, others psychological disorders... Chronic cystitis may also occur, chronic renal failure, pyelonephritis, vesicoureteral reflux.

The innervation of the bladder in any of its manifestations negatively affects human health and can lead to trophic disorders. In case of deviations in the functioning of the saccular organ with nerves, the blood supply to the urinary organs fails.

In addition to the whole bouquet of unpleasant sensations, cystitis may also begin to disturb, which can be re-transformed into microcystitis. Microcystitis leads to a decrease in the size of the bladder due to chronic inflammation. Microcystitis quite strongly and negatively affects all functions of the bladder. This disease is characterized as the most dangerous among chronic cystitis and neurogenic bladder.

Residual urine increases the risk of organ infections and inflammation throughout the canal. Usually, neurogenic bladder disease complicated by cystitis is resolved with surgical methods.

Of great practical importance is the identification of dysfunctions of the bladder, which occurs in connection with a disorder of its innervation, which is provided mainly by the autonomic nervous system (Fig. 13.4). Afferent somatosensory fibers originate from the proprioceptors of the bladder, which react to its stretching. Nerve impulses arising in these receptors through the spinal nerves S „-SIV penetrate Fig. 13.4. Innervation of the bladder (according to Mueller). 1 - paracentral lobule; 2 - hypothalamus; 3 - upper lumbar spinal cord; 4 - lower sacral spinal cord; 5 - bladder; 6 - genital nerve; 7 - hypogastric nerve; 8 - pelvic nerve; 9 - plexus of the bladder; 10 - detrusor of the bladder; 11 - internal sphincter of the bladder; 12 - external sphincter of the urinary bladder. into the posterior cords of the spinal cord, then they fall into the reticular formation of the brain stem and then into the paracentral lobules of the cerebral hemispheres, while along the route, some of these impulses pass to the opposite side. Thanks to the information passing along the indicated peripheral, spinal and cerebral structures to the paracentral lobules, the bladder is distended when it is filling, and the presence of an incomplete intersection of these afferent pathways leads to the fact that, with the cortical localization of the pathological focus, the violation of control over pelvic functions usually occur only with damage to both paracentral lobules (for example, with a falx meningioma). The efferent innervation of the bladder is carried out mainly due to the paracentral lobules, reticular formation brainstem and spinal autonomic centers: sympathetic (neurons of the lateral horns of Th11 — L2 segments) and parasympathetic, located at the level of spinal cord segments S2 — S4. Conscious regulation of urination is carried out mainly due to nerve impulses coming from the motor zone of the cerebral cortex and the reticular formation of the trunk to the motor neurons of the anterior horns of the S3-S4 segments. It is clear that to ensure the nervous regulation of the bladder, it is necessary to preserve the pathways connecting these structures of the brain and spinal cord with each other, as well as the formations of the peripheral nervous system that provide innervation to the bladder. Preganglionic fibers from the lumbar sympathetic center pelvic organs (L1-L2), pass as part of the pre-sacral and hypogastric nerves in transit through the caudal sections of the sympathetic paravertebral trunks and along the lumbar visceral nerves (pi. splanchnici lumbales) reach the nodes of the lower mesenteric plexus (plexus mesentericus inferior). The postganglionic fibers emanating from these nodes take part in the formation of the nerve plexuses of the bladder and provide innervation, first of all, of its internal sphincter. Due to sympathetic stimulation of the bladder, the internal sphincter, formed by smooth muscles, is contracted; at the same time, as the bladder fills, the muscle of its wall is stretched - the muscle that pushes urine (i.e. detrusor vesicae). All this ensures the retention of urine, which is facilitated by the simultaneous contraction of the external striated sphincter of the bladder, which has somatic innervation. It is carried out by the pudendal nerves (pp. Pudendi), consisting of the axons of motor neurons located in the anterior horns of the S3-S4 segments of the spinal cord. Efferent impulses to the muscles of the pelvic floor and counter proprioceptive afferent signals from these muscles also pass through the genital nerves. Parasympathetic innervation of the pelvic organs is carried out by preganglionic fibers coming from the parasympathetic center of the bladder, located in the sacral spinal cord (S1-S3). They are involved in the formation of the pelvic plexus and reach the intramural (located in the wall of the bladder) ganglia. Parasympathetic stimulation causes contraction of the smooth muscle that forms the body of the bladder (i.e., detrusor vesicae), and the concomitant relaxation of its smooth sphincters, as well as increased intestinal motility, which creates conditions for the emptying of the bladder. Involuntary, spontaneous or provoked contraction of the bladder detrusor (detrusor overactivity) leads to urinary incontinence. Detrusor hyperactivity can be neurogenic (for example, in multiple sclerosis) or idiopathic (in the absence of an identified cause). Retention of urine (retentio urinae) often occurs due to lesions of the spinal cord above the location of the spinal sympathetic autonomic centers (Th10-L2), which are responsible for the innervation of the bladder. Dyssynergy of the state of the detrusor and the sphincters of the bladder (contraction of the internal sphincter and relaxation of the detrusor) leads to urinary retention. This happens, for example, for traumatic injury spinal cord, intra-vertebral tumor, multiple sclerosis. In such cases, the bladder overflows and the bottom of it can rise to the level of the navel and above. Urinary retention is also possible due to the defeat of the parasympathetic reflex arc, which closes in the sacral segments of the spinal cord and provides innervation of the bladder detrusor. The cause of paresis or paralysis of detrusor can be both a lesion of the specified level of the spinal cord, and a dysfunction of the structures of the reflex arc of the peripheral nervous system. In cases of persistent urinary retention, patients usually need to empty the bladder through a catheter. Simultaneously with the retention of urine, there is usually a neuropathic retention of feces (retencia alvi). Partial damage to the spinal cord above the level of the location of the autonomic spinal centers responsible for the innervation of the bladder can lead to impaired voluntary control of urination and the emergence of the so-called urge to urinate, in which the patient, sensing the urge, is unable to hold urine. Likely big role violation of the innervation of the external sphincter of the bladder, which can normally be controlled to a certain extent by willpower. Such manifestations of disorders of the functions of the bladder are possible, in particular, with bilateral lesions of the medial structures of the lateral canals in patients with an intramedular tumor or multiple sclerosis... A pathological process that affects the spinal cord at the level of the location in it of the sympathetic autonomic centers of the bladder (cells of the lateral horns of the Th1-L2 segments of the spinal cord) leads to paralysis of the internal sphincter of the bladder, while the tone of its protrusor appears to be increased, in In connection with this, there is a constant excretion of urine in drops - true urinary incontinence (incontinentia urinae vera) as it is produced by the kidneys, while the bladder is practically empty. True urinary incontinence can be caused by a spinal stroke, spinal cord injury, or a spinal tumor at the level of these lumbar segments. True urinary incontinence can also be associated with damage to the structures of the peripheral nervous system involved in the innervation of the bladder, in particular when diabetes mellitus or primary amyloidosis. With urinary retention due to damage to the structures of the central or peripheral nervous system, it accumulates in the overstretched bladder and can create so much high pressurethat under its influence there is a stretching of the internal and external sphincters of the bladder, which are in a state of spastic contraction.In this regard, urine is constantly excreted through the urethra in drops or periodically in small portions while maintaining the overflow of the bladder - paradoxical urinary incontinence (incontinentia urinae paradoxa) , which can be established by identifying by visual examination, as well as by palpation and percussion of the lower abdomen, the standing of the bottom of the bladder above the pubis (sometimes to the navel). With the defeat of the parasympathetic spinal center (segments of the spinal cord S1-S3) and the corresponding roots of the cauda equina, weakness and a simultaneous violation of the sensitivity of the muscle ejecting urine (i.e. detrusor vesicae) may develop, and urinary retention occurs. However, in such cases, over time, it is possible to restore reflex emptying of the bladder, it begins to function in an "autonomous" mode (autonomous bladder). Clarification of the nature of the dysfunctions of the bladder can help to determine the topical and nosological diagnoses of the underlying disease. In order to clarify the features of the disorders of the functions of the bladder, along with a thorough neurological examination according to indications, an X-ray of the upper urinary tract, bladder and urethra is performed using X-ray contrast solutions. The results of urological examinations, in particular cystoscopy and cystometry (determination of pressure in the bladder while filling it with liquid or gas), can help to clarify the diagnosis. In some cases, electromyography of the periurethral striated musculature may be helpful.

Urination is a reflex act, manifested by the appearance of the urge to defecate. This mechanism is provided by the innervation of the bladder. It is based on the transmission of impulses along the nerve fibers connecting the sacral spine and the central nervous system, followed by a reduction in detrozur and relaxation of the sphincters of the urethra.

Urinary mechanisms

Excretion of urine occurs through humoral and neuronal regulation. Humoral is carried out through the secretion of the hormones vasopressin and aldosterone. The reasons for the release of antidiuretic hormone are a decrease in the volume of circulating blood and an increase in the concentration of sodium in it. Aldosterone is produced with a small accumulation of Na ions and a high content of K. Vasopressin is produced in the posterior lobe of the pituitary gland and has such effects as:

• increased reabsorption of water in the renal tubules;
• a decrease in the level of Na ions and the release of concentrated urine in small volumes;
• an increase in the amount of circulating fluid in the blood and tissues;
• increased smooth muscle tone.

Aldosterone is produced by the adrenal cortex and affects urine production in the following ways:

• increases the concentration of Na by reabsorbing it;
• increases the volume of physiological fluid (NaCl);
• reduces the level of K ions and promotes their excretion by urine;
• increases muscle tone.

Among dysuric disorders of urination, urine retention is distinguished.

Neural regulation is based on the transmission of an impulse from an irritated receptor to the central structures of the brain (paracentral part of the frontal lobe, Barrington's nucleus), spinal cord and vice versa, in order to contract and relax muscles to empty the bladder. The pathology of the process is manifested by a number of dysuric disorders, in the form of:

• pollakiuria - increased urinary frequency;
• stranguria - problems with excretion due to spasm of the urea neck;
• ishurii - urine retention;
• - an increase in the volume of urine output;
• anuria - removing no more than 50 ml of fluid per day.

How does the innervation process of the bladder take place?

Control of the transmission of nerve impulses is carried out by the central, peripheral and autonomic nervous system (NS). Each has a different anatomical control structure. The autonomic nervous system is a complex of direct voluntary reactions that regulates the process of emptying urea with the help of cute and parasympathetic fibers.

Sympathetic and parasympathetic NS

The ganglia of the sympathetic part of the autonomic nervous system (ANS) are located far from the organs. They form a chain of nerve fiber bodies, lateral to the ridge in the sacral and lower thoracic regions (Th12, L1 and L2). The efferent innervation of the sympathetic system is built of preganglionic fibers, paravertebral sympathetic ganglion, postganglionic fibers. The impulse is transmitted through the visceral nerves to the inferior mesenteric node. Here the hypogastric plexus catches the impulse, and conducts to the smooth muscles. There is a contraction of the internal sphincter and relaxation of the detrusor (the middle layer of the urea wall).

The parasympathetic system is responsible for motor mechanisms. Nerve fibers localized in the organ itself or near it. From the sacral centers vertebral divisions S2, S3 and S4 along the pelvic visceral nerves, the impulse reaches the smooth muscle tissue of the bladder. The external sphincter relaxes and the detrusor contracts, allowing urination.

Parasympathetic and sympathetic innervation is provided efferent fibers, and are responsible for unconscious urination. For the conscious excretion of urine, afferent neurons are responsible: with an increase in intravesical pressure, receptors are excited and transmit a signal to the spinal cord, then to the cerebral hemispheres to the medial surface with localization in the paracentral lobe.

Disruption of the innervation of the bladder

There are 3 types of innervation problems.

A syndrome that combines a set of symptoms that manifest themselves for congenital or acquired reasons. There are three pathological conditions, which are described in the table:

What are the reasons?

• Oncological diseases: prostatic hyperplasia, brain tumor.
• Injuries.
• Diseases of the central nervous system and of cardio-vascular system.
• Organic disorders in the brain.
• Spinal cord pathologies.