contents 1.ANATOMYCAL INTRODUCTION 2.CAPACITY THE BLADDER 3.NERVE SUPPLY 4.PHYSIOLOGICAL REFLEX...
-
Upload
rudolf-malone -
Category
Documents
-
view
223 -
download
0
description
Transcript of contents 1.ANATOMYCAL INTRODUCTION 2.CAPACITY THE BLADDER 3.NERVE SUPPLY 4.PHYSIOLOGICAL REFLEX...
![Page 1: contents 1.ANATOMYCAL INTRODUCTION 2.CAPACITY THE BLADDER 3.NERVE SUPPLY 4.PHYSIOLOGICAL REFLEX 5.NEUROGENIC BLADDER 6.INCONTINENCE 7.REFERENCE.](https://reader035.fdocuments.in/reader035/viewer/2022081513/5a4d1b1a7f8b9ab059993168/html5/thumbnails/1.jpg)
TYPES OF URINARY BLADDER
DYSFUNCTION PRESENTED BY:
SHILPA K. PRAJAPATI (1st year MPT)
![Page 2: contents 1.ANATOMYCAL INTRODUCTION 2.CAPACITY THE BLADDER 3.NERVE SUPPLY 4.PHYSIOLOGICAL REFLEX 5.NEUROGENIC BLADDER 6.INCONTINENCE 7.REFERENCE.](https://reader035.fdocuments.in/reader035/viewer/2022081513/5a4d1b1a7f8b9ab059993168/html5/thumbnails/2.jpg)
contents1. ANATOMYCAL INTRODUCTION2. CAPACITY THE BLADDER3. NERVE SUPPLY4. PHYSIOLOGICAL REFLEX5. NEUROGENIC BLADDER6. INCONTINENCE7. REFERENCE
![Page 3: contents 1.ANATOMYCAL INTRODUCTION 2.CAPACITY THE BLADDER 3.NERVE SUPPLY 4.PHYSIOLOGICAL REFLEX 5.NEUROGENIC BLADDER 6.INCONTINENCE 7.REFERENCE.](https://reader035.fdocuments.in/reader035/viewer/2022081513/5a4d1b1a7f8b9ab059993168/html5/thumbnails/3.jpg)
URINARY BLADDER
![Page 4: contents 1.ANATOMYCAL INTRODUCTION 2.CAPACITY THE BLADDER 3.NERVE SUPPLY 4.PHYSIOLOGICAL REFLEX 5.NEUROGENIC BLADDER 6.INCONTINENCE 7.REFERENCE.](https://reader035.fdocuments.in/reader035/viewer/2022081513/5a4d1b1a7f8b9ab059993168/html5/thumbnails/4.jpg)
URINARY BLADDER ANATOMICAL INTRODUCTION
Urinary bladder is the temporary store house of urine which gets emptied through the urethra.
The male urethra subserving the functions of urination and ejaculation.
Female urethra is for urination only.
![Page 5: contents 1.ANATOMYCAL INTRODUCTION 2.CAPACITY THE BLADDER 3.NERVE SUPPLY 4.PHYSIOLOGICAL REFLEX 5.NEUROGENIC BLADDER 6.INCONTINENCE 7.REFERENCE.](https://reader035.fdocuments.in/reader035/viewer/2022081513/5a4d1b1a7f8b9ab059993168/html5/thumbnails/5.jpg)
CAPACITY OF THE BLADDERCapacity in an adult male 120 to 320 ml.
Filling beyond 220 ml causes micturition, emptied when filled to about 250 to 300 ml.
Filling up to 500 ml may be tolerated, but beyond this it becomes painful.
Referred pain: lower part of the anterior abdominal wall, perineum and penis(T11-L2,S2-S4).
![Page 6: contents 1.ANATOMYCAL INTRODUCTION 2.CAPACITY THE BLADDER 3.NERVE SUPPLY 4.PHYSIOLOGICAL REFLEX 5.NEUROGENIC BLADDER 6.INCONTINENCE 7.REFERENCE.](https://reader035.fdocuments.in/reader035/viewer/2022081513/5a4d1b1a7f8b9ab059993168/html5/thumbnails/6.jpg)
NERVE SUPPLY
![Page 7: contents 1.ANATOMYCAL INTRODUCTION 2.CAPACITY THE BLADDER 3.NERVE SUPPLY 4.PHYSIOLOGICAL REFLEX 5.NEUROGENIC BLADDER 6.INCONTINENCE 7.REFERENCE.](https://reader035.fdocuments.in/reader035/viewer/2022081513/5a4d1b1a7f8b9ab059993168/html5/thumbnails/7.jpg)
NERVE SUPPLYIts contains both sympathetic and parasympathetic components.
Parasympathetic efferent fibers S2,S3, S4 are motor to the detrusor muscle and inhibitory to the sphincter vesicae.
If these are destroyed, normal micturition is not possible.
![Page 8: contents 1.ANATOMYCAL INTRODUCTION 2.CAPACITY THE BLADDER 3.NERVE SUPPLY 4.PHYSIOLOGICAL REFLEX 5.NEUROGENIC BLADDER 6.INCONTINENCE 7.REFERENCE.](https://reader035.fdocuments.in/reader035/viewer/2022081513/5a4d1b1a7f8b9ab059993168/html5/thumbnails/8.jpg)
NERVE SUPPLY CONTI…. Sympathetic efferent fibers (T11 to L2): - inhibitory to the detrusor -motor to the sphincter vesicae The pudendal nerve (S2, S3, S4) -supplies the sphincter urethrae which is
voluntary Sensory nerves:• pain sensations, causes: - spasm of bladder wall - carried by parasympathetic nerves and
partly by sympathetic nerves
NERVE SUPPLY CONTI….
![Page 9: contents 1.ANATOMYCAL INTRODUCTION 2.CAPACITY THE BLADDER 3.NERVE SUPPLY 4.PHYSIOLOGICAL REFLEX 5.NEUROGENIC BLADDER 6.INCONTINENCE 7.REFERENCE.](https://reader035.fdocuments.in/reader035/viewer/2022081513/5a4d1b1a7f8b9ab059993168/html5/thumbnails/9.jpg)
HIGHER CENTER Higher centers for micturition
1) Inhibitory centers : midbrain -cerebral cortex 2) Facilitatory centers : Pons - cerebral cortex
![Page 10: contents 1.ANATOMYCAL INTRODUCTION 2.CAPACITY THE BLADDER 3.NERVE SUPPLY 4.PHYSIOLOGICAL REFLEX 5.NEUROGENIC BLADDER 6.INCONTINENCE 7.REFERENCE.](https://reader035.fdocuments.in/reader035/viewer/2022081513/5a4d1b1a7f8b9ab059993168/html5/thumbnails/10.jpg)
FUNCTIONS OF NERVES
Nerve On
detrusor muscle
On internal sphincter
On external sphincter
Function
Sympathetic nerve
Relaxation Constriction Not supplied Filling of urinary bladder
Parasympathetic nerve
Constriction Relaxation Not supplied Emptying of urinary bladder
Somatic nerve Not supplied Not supplied Constriction Voluntary control of micturition
![Page 11: contents 1.ANATOMYCAL INTRODUCTION 2.CAPACITY THE BLADDER 3.NERVE SUPPLY 4.PHYSIOLOGICAL REFLEX 5.NEUROGENIC BLADDER 6.INCONTINENCE 7.REFERENCE.](https://reader035.fdocuments.in/reader035/viewer/2022081513/5a4d1b1a7f8b9ab059993168/html5/thumbnails/11.jpg)
MICTURITION REFLEX.
Filling of urinary bladder
Stimulation of stretch receptor
Afferent impulses pass via pelvic nerve
Efferent impulses via pelvic nerve
Contraction of detrusor muscle & relaxation of internal sphincter
Sacral segments of spinal cord
![Page 12: contents 1.ANATOMYCAL INTRODUCTION 2.CAPACITY THE BLADDER 3.NERVE SUPPLY 4.PHYSIOLOGICAL REFLEX 5.NEUROGENIC BLADDER 6.INCONTINENCE 7.REFERENCE.](https://reader035.fdocuments.in/reader035/viewer/2022081513/5a4d1b1a7f8b9ab059993168/html5/thumbnails/12.jpg)
MICTURITION REFLEX CONTI…Flow of urine into urethra and stimulation of stretch receptors
Afferent impulses via pelvic nerve
Inhibition of pudendal nerve
Relaxation of external sphincter
Voiding of urine
![Page 13: contents 1.ANATOMYCAL INTRODUCTION 2.CAPACITY THE BLADDER 3.NERVE SUPPLY 4.PHYSIOLOGICAL REFLEX 5.NEUROGENIC BLADDER 6.INCONTINENCE 7.REFERENCE.](https://reader035.fdocuments.in/reader035/viewer/2022081513/5a4d1b1a7f8b9ab059993168/html5/thumbnails/13.jpg)
NEUROGENIC BLADDER BY: P.J.MEHTA
There are five types of neurogenic bladder:
TYPE LESION
1. Uninhibited bladder ..cortico regulatory tract
2. Reflex bladder ..spinal cord above S2
3. Autonomous bladder ..at S2, S3 and S4 level
4. Motor atonic bladder ..motor efferents
5. Sensory atonic bladder ..sensory afferents
![Page 14: contents 1.ANATOMYCAL INTRODUCTION 2.CAPACITY THE BLADDER 3.NERVE SUPPLY 4.PHYSIOLOGICAL REFLEX 5.NEUROGENIC BLADDER 6.INCONTINENCE 7.REFERENCE.](https://reader035.fdocuments.in/reader035/viewer/2022081513/5a4d1b1a7f8b9ab059993168/html5/thumbnails/14.jpg)
1. UNINHIBITED BLADDERCAUSES: -cerebrovascular accidents, -head injuries, -brain tumors, etc.Voluntary control of micturition is lost.Hesitancy and precipitancy of evacuation is present.Lesion : - the midbrain - superior frontal gyrus
![Page 15: contents 1.ANATOMYCAL INTRODUCTION 2.CAPACITY THE BLADDER 3.NERVE SUPPLY 4.PHYSIOLOGICAL REFLEX 5.NEUROGENIC BLADDER 6.INCONTINENCE 7.REFERENCE.](https://reader035.fdocuments.in/reader035/viewer/2022081513/5a4d1b1a7f8b9ab059993168/html5/thumbnails/15.jpg)
2.REFLEX BLADDERETIOLOGY:Transverses myelitis Trauma NeoplasmsMeningitisDisseminated sclerosisLesion :
complete transection of spinal cord above sacral segments
![Page 16: contents 1.ANATOMYCAL INTRODUCTION 2.CAPACITY THE BLADDER 3.NERVE SUPPLY 4.PHYSIOLOGICAL REFLEX 5.NEUROGENIC BLADDER 6.INCONTINENCE 7.REFERENCE.](https://reader035.fdocuments.in/reader035/viewer/2022081513/5a4d1b1a7f8b9ab059993168/html5/thumbnails/16.jpg)
REFLEX BLADDER CONTI…PATHOGENESIS:Acute transaction of the cord causes retention of urine during the stage of spinal shock.
Leads to retention of residual urine.
During recovery stage, reflex activity begins and automatic evacuation of bladder results.
![Page 17: contents 1.ANATOMYCAL INTRODUCTION 2.CAPACITY THE BLADDER 3.NERVE SUPPLY 4.PHYSIOLOGICAL REFLEX 5.NEUROGENIC BLADDER 6.INCONTINENCE 7.REFERENCE.](https://reader035.fdocuments.in/reader035/viewer/2022081513/5a4d1b1a7f8b9ab059993168/html5/thumbnails/17.jpg)
3. AUTONOMOUS BLADDERETOLOGY:Congenital : spina bifida, meningomyelocele
Trauma: gunshot, auto accidents
Infective: arachnoiditis, radiculitis
Neoplasms of the cord
Surgery: combined perineal and abdominal resection.LESION: sacral segment of spinal nerve.
![Page 18: contents 1.ANATOMYCAL INTRODUCTION 2.CAPACITY THE BLADDER 3.NERVE SUPPLY 4.PHYSIOLOGICAL REFLEX 5.NEUROGENIC BLADDER 6.INCONTINENCE 7.REFERENCE.](https://reader035.fdocuments.in/reader035/viewer/2022081513/5a4d1b1a7f8b9ab059993168/html5/thumbnails/18.jpg)
AUTONOMOUS BLADDER CONTI…CLINICAL FEATURES:Loss of bladder sensation
Inability to initiate micturition normally paralysis of pariurethral striated muscles
associated with anesthesia and absent bulbocavernous reflex.
![Page 19: contents 1.ANATOMYCAL INTRODUCTION 2.CAPACITY THE BLADDER 3.NERVE SUPPLY 4.PHYSIOLOGICAL REFLEX 5.NEUROGENIC BLADDER 6.INCONTINENCE 7.REFERENCE.](https://reader035.fdocuments.in/reader035/viewer/2022081513/5a4d1b1a7f8b9ab059993168/html5/thumbnails/19.jpg)
4. SENSORY PARALYTIC BLADDERETIOLOGY:Tabes dorsalisPernicious anemiaDiabetesDisseminated sclerosisSyringomyeliaLesion : afferent fibers from the bladder
![Page 20: contents 1.ANATOMYCAL INTRODUCTION 2.CAPACITY THE BLADDER 3.NERVE SUPPLY 4.PHYSIOLOGICAL REFLEX 5.NEUROGENIC BLADDER 6.INCONTINENCE 7.REFERENCE.](https://reader035.fdocuments.in/reader035/viewer/2022081513/5a4d1b1a7f8b9ab059993168/html5/thumbnails/20.jpg)
SENSORY PARALYTIC BLADDER CONTI..
PATHOGENESIS:Loss of bladder sensation, which leads to overdistension of bladder.
Initially there is normal capacity increases and residual urine appears.
CLINICAL FEATURES:Initially these patients are asymptomatic.Gradually there is terminal dribbling and later overflow incontinence.
![Page 21: contents 1.ANATOMYCAL INTRODUCTION 2.CAPACITY THE BLADDER 3.NERVE SUPPLY 4.PHYSIOLOGICAL REFLEX 5.NEUROGENIC BLADDER 6.INCONTINENCE 7.REFERENCE.](https://reader035.fdocuments.in/reader035/viewer/2022081513/5a4d1b1a7f8b9ab059993168/html5/thumbnails/21.jpg)
5. MOTOR PARALYTIC BLADDERETIOLOGY:PoliomyelitisPolyradiculopathyCongenital anomaliesTumorTraumaLesion : Efferent fibers of the bladder
![Page 22: contents 1.ANATOMYCAL INTRODUCTION 2.CAPACITY THE BLADDER 3.NERVE SUPPLY 4.PHYSIOLOGICAL REFLEX 5.NEUROGENIC BLADDER 6.INCONTINENCE 7.REFERENCE.](https://reader035.fdocuments.in/reader035/viewer/2022081513/5a4d1b1a7f8b9ab059993168/html5/thumbnails/22.jpg)
MOTOR PARALYTIC BLADDER CONTI..PATHOGENESIS:Since the sensory nerves are intact, bladder if left alone, distends and decompensates.
CLINICAL FEATURES:Painful distention of the bladder and inability to initiate micturition.Decrease in size and force of steam and interrupted stream.Recurrent episodes of urinary infections.
![Page 23: contents 1.ANATOMYCAL INTRODUCTION 2.CAPACITY THE BLADDER 3.NERVE SUPPLY 4.PHYSIOLOGICAL REFLEX 5.NEUROGENIC BLADDER 6.INCONTINENCE 7.REFERENCE.](https://reader035.fdocuments.in/reader035/viewer/2022081513/5a4d1b1a7f8b9ab059993168/html5/thumbnails/23.jpg)
INCONTINENCE OF URINEThe term ‘continence’ is used to describe the normal ability of a person to store urine and faeces temporarily, with conscious control over the time and place of micturition and defaecation.
‘Incontinence’ has been defined as the involuntary or inappropriate passing of urine or faeces, or both, that has an impact on social functioning or hygiene(DoH 2000).
![Page 24: contents 1.ANATOMYCAL INTRODUCTION 2.CAPACITY THE BLADDER 3.NERVE SUPPLY 4.PHYSIOLOGICAL REFLEX 5.NEUROGENIC BLADDER 6.INCONTINENCE 7.REFERENCE.](https://reader035.fdocuments.in/reader035/viewer/2022081513/5a4d1b1a7f8b9ab059993168/html5/thumbnails/24.jpg)
INCONTINENCE OF URINETypes:
1. Extra urethral incontinence2.Detrusor overactivity incontinence3.Urodynemic stress incontinence4.Nocturnal enuresis5.Giggle incontinence6.Incontinence associaed with sexual activities7.Functional incontinance
![Page 25: contents 1.ANATOMYCAL INTRODUCTION 2.CAPACITY THE BLADDER 3.NERVE SUPPLY 4.PHYSIOLOGICAL REFLEX 5.NEUROGENIC BLADDER 6.INCONTINENCE 7.REFERENCE.](https://reader035.fdocuments.in/reader035/viewer/2022081513/5a4d1b1a7f8b9ab059993168/html5/thumbnails/25.jpg)
1.Extraurethral incontinenceLoss of urine through channels other than the urethraCAUSEScongenital abnormality.trauma at pelvic surgery such as hysterectomy endometriosis, infection or carcinoma.Child birth(Wall 1999)
![Page 26: contents 1.ANATOMYCAL INTRODUCTION 2.CAPACITY THE BLADDER 3.NERVE SUPPLY 4.PHYSIOLOGICAL REFLEX 5.NEUROGENIC BLADDER 6.INCONTINENCE 7.REFERENCE.](https://reader035.fdocuments.in/reader035/viewer/2022081513/5a4d1b1a7f8b9ab059993168/html5/thumbnails/26.jpg)
2. Detrusor overactivity incontinence
-present as a symptom, a sign and as a condition
The symptoms: complains of urge incontinence, immediately preceded by urgency, that is a strong desire to void.
![Page 27: contents 1.ANATOMYCAL INTRODUCTION 2.CAPACITY THE BLADDER 3.NERVE SUPPLY 4.PHYSIOLOGICAL REFLEX 5.NEUROGENIC BLADDER 6.INCONTINENCE 7.REFERENCE.](https://reader035.fdocuments.in/reader035/viewer/2022081513/5a4d1b1a7f8b9ab059993168/html5/thumbnails/27.jpg)
Detrusor overactivity incontinence
The sign: conformed as a sign observed at urodynamic assessment
The condition: May be further qualified as neurogenic, in neurological condition
![Page 28: contents 1.ANATOMYCAL INTRODUCTION 2.CAPACITY THE BLADDER 3.NERVE SUPPLY 4.PHYSIOLOGICAL REFLEX 5.NEUROGENIC BLADDER 6.INCONTINENCE 7.REFERENCE.](https://reader035.fdocuments.in/reader035/viewer/2022081513/5a4d1b1a7f8b9ab059993168/html5/thumbnails/28.jpg)
3.URODYNAMIC STRESS INCONTINENCE
Symptom: during increased intra-abdominal pressure, such as during coughing, laughing, sneezing and liftingSign:An involuntary spurt dribble or droplet of urine is observed to leave urethra immediately on an increase in intra-abdominal pressure
![Page 29: contents 1.ANATOMYCAL INTRODUCTION 2.CAPACITY THE BLADDER 3.NERVE SUPPLY 4.PHYSIOLOGICAL REFLEX 5.NEUROGENIC BLADDER 6.INCONTINENCE 7.REFERENCE.](https://reader035.fdocuments.in/reader035/viewer/2022081513/5a4d1b1a7f8b9ab059993168/html5/thumbnails/29.jpg)
URODYNAMIC STRESS INCONTINENCE
Condition : in absence of detrusor contraction
![Page 30: contents 1.ANATOMYCAL INTRODUCTION 2.CAPACITY THE BLADDER 3.NERVE SUPPLY 4.PHYSIOLOGICAL REFLEX 5.NEUROGENIC BLADDER 6.INCONTINENCE 7.REFERENCE.](https://reader035.fdocuments.in/reader035/viewer/2022081513/5a4d1b1a7f8b9ab059993168/html5/thumbnails/30.jpg)
4.NOCTURNAL ENURISISDuring sleep, or “bed wetting”15-20% of 5 year old children and up to 2% of young adults(Glazener &Evans 2003)
![Page 31: contents 1.ANATOMYCAL INTRODUCTION 2.CAPACITY THE BLADDER 3.NERVE SUPPLY 4.PHYSIOLOGICAL REFLEX 5.NEUROGENIC BLADDER 6.INCONTINENCE 7.REFERENCE.](https://reader035.fdocuments.in/reader035/viewer/2022081513/5a4d1b1a7f8b9ab059993168/html5/thumbnails/31.jpg)
5.GIGGLE INCONTINENCE
In girls around puberty
Caused by detrusor overactivity induced by laughter(chandra et al 2002)
![Page 32: contents 1.ANATOMYCAL INTRODUCTION 2.CAPACITY THE BLADDER 3.NERVE SUPPLY 4.PHYSIOLOGICAL REFLEX 5.NEUROGENIC BLADDER 6.INCONTINENCE 7.REFERENCE.](https://reader035.fdocuments.in/reader035/viewer/2022081513/5a4d1b1a7f8b9ab059993168/html5/thumbnails/32.jpg)
6.INCONTINENCE ASSOCIATED WITH SEXUAL ACTIVITY
After following intercourse in young women postcoital dysuria
postmenopausal women dysuria, urgency and urinary tract infection
Hilton(1988) found 24% of 324 sexually active women referred to gynaecological clinic experience incontinence – two third on penetration and one third on orgasm.
![Page 33: contents 1.ANATOMYCAL INTRODUCTION 2.CAPACITY THE BLADDER 3.NERVE SUPPLY 4.PHYSIOLOGICAL REFLEX 5.NEUROGENIC BLADDER 6.INCONTINENCE 7.REFERENCE.](https://reader035.fdocuments.in/reader035/viewer/2022081513/5a4d1b1a7f8b9ab059993168/html5/thumbnails/33.jpg)
7.FUNCTIONAL INCONTINENCE
involuntary loss of urine in ability to perform toileting functions secondary to physical or mental limitation
![Page 34: contents 1.ANATOMYCAL INTRODUCTION 2.CAPACITY THE BLADDER 3.NERVE SUPPLY 4.PHYSIOLOGICAL REFLEX 5.NEUROGENIC BLADDER 6.INCONTINENCE 7.REFERENCE.](https://reader035.fdocuments.in/reader035/viewer/2022081513/5a4d1b1a7f8b9ab059993168/html5/thumbnails/34.jpg)
ReferencesP.J. mehta’s Practical Medicine
Physiotherapy in obstetrics and gynaecology, 2nd edition, jill mantle
Essentials of medical physiology, 5th edition, K Sembulingam
B.D.Chaurasia’s human anatomy, 4th editionInternet
![Page 35: contents 1.ANATOMYCAL INTRODUCTION 2.CAPACITY THE BLADDER 3.NERVE SUPPLY 4.PHYSIOLOGICAL REFLEX 5.NEUROGENIC BLADDER 6.INCONTINENCE 7.REFERENCE.](https://reader035.fdocuments.in/reader035/viewer/2022081513/5a4d1b1a7f8b9ab059993168/html5/thumbnails/35.jpg)
THANKING YOU….