Normal bladder control and function

doi:10.1017/CBO9780511527036.008

7 - Normal bladder control and function

from Part I - Normal development

Published online by Cambridge University Press: 04 May 2010

Nikesh Thiruchelvam and

Edited by

Jane MacDougall and

Nikesh Thiruchelvam: Affiliation:
The Institute of Child Health, London, UK
Peter M. Cuckow: Affiliation:
Great Ormond Street Hospital for Children and the Institute of Urology, London, UK
Adam H. Balen: Affiliation:
Leeds Teaching Hospitals, University Trust
Sarah M. Creighton: Affiliation:
University College London Hospitals
Melanie C. Davies: Affiliation:
University College London
Jane MacDougall: Affiliation:
Addenbrooke's Hospital, Cambridge
Richard Stanhope: Affiliation:
Great Ormond Street Hospital

Book contents

Get access

Summary

Introduction

The bladder is an amazing organ with an ability to increase its volume dramatically with little increase in its internal pressure whilst maintaining a securely closed outlet. This enables the bladder to collect urine excreted by the kidneys and store it securely within the body. When the time is appropriate, contraction of the bladder muscular wall causes a rapid rise in its internal pressure and, together with simultaneous relaxation of its outlet, allows urine to be expelled via the urethra. The bladder empties to completion before its outlet closes and its walls relax again to start the next filling cycle.

We start this chapter with a discussion of the anatomy, innervation and control mechanisms of the normal bladder, followed with the evolution of its function from the fetus to the continent adult, the means by which we assess its function and, finally, what is currently known about the effect of sex steroids, the menstrual cycle and pregnancy on the female bladder.

Anatomy

The bladder is an abdominal organ in the fetus and infant that descends as the pelvis deepens towards puberty to become a truly pelvic organ in the mature female (Fig. 7.1). At its apex is the fibrous remnant of the urachus, which ascends in the midline to the umbilicus. Its posterosuperior surface is covered by peritoneum, which is continuous with that of the anterior abdominal wall. As it fills with urine, the bladder rises out of the pelvis between the anterior abdominal wall and its covering peritoneum.

Information

Type: Chapter
Information: Paediatric and Adolescent Gynaecology
A Multidisciplinary Approach
, pp. 65 - 76

DOI: https://doi.org/10.1017/CBO9780511527036.008 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2004

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Book purchase

Temporarily unavailable

References

Andersson, K E, Persson, K (1995). Nitric oxide synthase, the lower urinary tract: possible implications for physiology and pathophysiology. Scand J Urol Nephrol 175(Suppl.), 43–53Google Scholar PubMed

Bachelard, M, Sillen, U, Hansson, S, Hermansson, G, Jodal, U, Jacobsson, B (1999). Urodynamic pattern in asymptomatic infants: siblings of children with vesicoureteral reflux. J Urol 162, 1733–1737CrossRef Google Scholar PubMed

Batra, S, Andersson, K E (1989). Oestrogen-induced changes in muscarinic receptor density and contractile responses in the female rabbit urinary bladder. Acta Physiol Scand 137, 135–141CrossRef Google Scholar PubMed

Batra, S, Iosif, C S (1987). Progesterone receptors in the female lower urinary tract. J Urol 138, 1301–1304CrossRef Google Scholar PubMed

Batra, S, Bjellin, L, Iosif, S, Martensson, L, Sjogren, C (1985). Effect of oestrogen and progesterone on the blood flow in the lower urinary tract of the rabbit. Acta Physiol Scand 123, 191-194CrossRef Google Scholar PubMed

Blakeman, P J, Hilton, P, Bulmer, J N (2000). Oestrogen and progesterone receptor expression in the female lower urinary tract with reference to oestrogen status. Br J Urol Int 86, 32–38CrossRef Google Scholar PubMed

Blok, B F, Sturms, L M, Holstege, G (1998). Brain activation during micturition in women. Brain 121, 2033–2042CrossRef Google Scholar PubMed

Buzelin, J M (1995). [Physiology of continence, micturition.]Rev Prat 45, 286–291Google Scholar

Callahan, S M, Creed, K E (1985). The effects of oestrogens on spontaneous activity, responses to phenylephrine of the mammalian urethra. J Physiol 358, 35–46CrossRef Google Scholar PubMed

Chou, Q, Lancey, J O (2001). A structured system to evaluate urethral support anatomy in magnetic resonance images. Am J Obstet Gynecol 185, 44–50CrossRef Google Scholar PubMed

Clow, W M (1975). Effect of posture on bladder, urethral function in normal pregnancy: a preliminary report. Urol Int 30, 9–15CrossRef Google Scholar PubMed

Critchley, H O, Dixon, J S, Gosling, J A (1980). Comparative study of the periurethral, perianal parts of the human levator ani muscle. Urol Int 35, 226–232CrossRef Google Scholar PubMed

Groat, W C (1990). Central neural control of the lower urinary tract. Ciba Found Symp 151, 27–44Google Scholar PubMed

Groat, W C (1993). Anatomy and physiology of the lower urinary tract. Urol Clin North Am 20, 383–401Google Scholar PubMed

Lancey, J O (1990). Anatomy and physiology of urinary continence. ClinObstet Gynecol 33, 298–307

Dixon, J S, Jen, P Y, Gosling, J A (1998). Immunohistochemical characteristics of human paraganglion cells and sensory corpuscles associated with the urinary bladder. A developmental study in the male fetus neonate and infant. J Anat 192, 407–415CrossRef Google Scholar PubMed

Ekstrom, J, Iosif, C S, Malmberg, L (1993). Effects of long-term treatment with estrogen and progesterone on in vitro muscle responses of the female rabbit urinary bladder and urethra to autonomic drugs and nerve stimulation. J Urol 150, 1284–1288CrossRef Google Scholar PubMed

Elneil, S, Skepper, J N, Kidd, E J, Williamson, J G, Ferguson, D R (2001). Distribution of p2x(1), p2x(3) receptors in the rat and human urinary bladder. Pharmacology 63, 120–128CrossRef Google Scholar PubMed

Fry, C H, Wu, C (1998). The cellular basis of bladder instability. Br J Urol 81, 1–8CrossRef Google Scholar PubMed

Gitsch, E, Brandstetter, F (1954). Phasen-sphinctero-cystometrie. Z Gynakol 76, 1746–1754Google Scholar

Goellner, M H, Ziegler, E E, Fomon, S J (1981). Urination during the first three years of life. Nephron 28, 174–178CrossRef Google Scholar PubMed

Gosling, J A (1985). The structure of the female lower urinary tract and pelvic floor. Urol Clin North Am 12, 207–214Google Scholar PubMed

Gosling, J A, Dixon, J S, Jen, P Y (1999). The distribution of noradrenergic nerves in the human lower urinary tract: a review. Eur Urol 36(Suppl. 1), 23–30CrossRef Google Scholar PubMed

Gutierrez, S C (1997). Urine flow in childhood: a study of flow chart parameters based on 1361 uroflowmetry tests. J Urol 157, 1426–1428Google Scholar

Hextall, A, Bidmead, J, Cardozo, L D, Hooper, R (1999). Hormonal influences on the female lower urinary tract: a prospective evaluation of the effects of the menstrual cycle on symptomatology and the results of urodynamic investigation. Neurourol Urodyn 18, 363–364Google Scholar

Hilton, P, Stanton, S L (1983). The use of intravaginal oestrogen cream in genuine stress incontinence. Br J Obstet Gynaecol 90, 940–944CrossRef Google Scholar PubMed

Hjalmas, K (1988). Urodynamics in normal infants and children. Scand J Urol Nephrol 114(Suppl.), 20–27Google Scholar PubMed

Holmdahl, G, Hanson, E, Hanson, M, Hellstrom, A L, Hjalmas, K, Sillen, U (1996). Four-hour voiding observation in healthy infants. J Urol 156, 1809–1812CrossRef Google Scholar PubMed

Holmquist, F, Lundin, S, Larsson, B, Hedlund, H, Andersson, K E (1991). Studies on binding sites contents and effects of AVP in isolated bladder and urethra from rabbits and humans. Am J Physiol 261, R865–R874Google Scholar PubMed

Huisman, A B (1983). Aspects on the anatomy of the female urethra with special relation to urinary continence. Contrib Gynecol Obstet 10, 1–31Google Scholar PubMed

Iosif, C SBatra, S, Ek, A, Astedt, B (1981). Estrogen receptors in the human female lower urinary tract. Am J Obstet Gynecol 141, 817–820CrossRef Google Scholar

Iosif, S, Ingemarsson, I, Ulmsten, U (1980). Urodynamic studies in normal pregnancy, in puerperium. Am J Obstet Gynecol 137, 696–700CrossRef Google Scholar PubMed

Klevmark, B, Kulseng-Hanssen, S (1991). Continence mechanism in the female. Scand J Urol Nephrol 138(Suppl.), 35–40Google Scholar PubMed

Kogan, B A, Iwamoto, H S (1989). Lower urinary tract function in the sheep fetus: studies of autonomic control and pharmacologic responses of the fetal bladder. J Urol 141, 1019–1024CrossRef Google Scholar PubMed

Kokoua, A, Homsy, Y, Lavigne, J F et al. (1993). Maturation of the external urinary sphincter: a comparative histotopographic study in humans. J Urol 150, 617–622CrossRef Google Scholar PubMed

Kulseng-Hanssen, S (1987). Urethral pressure variations in women with neurourological symptoms. II Relationship to urethral smooth muscle. Neurourol Urodyn 6, 79–85CrossRef Google Scholar

Levin, R M, Shofer, F S, Wein, A J (1980). Estrogen-induced alterations in the autonomic responses of the rabbit urinary bladder. J Pharmacol Exp Ther 215, 614–618Google Scholar PubMed

Levin, R M, Jacobowitz, D, Wein, A J (1981). Autonomic innervation of rabbit urinary bladder following estrogen administration. Urology 17, 449–453CrossRef Google Scholar PubMed

Levin, R M, Zderic, S A, Ewalt, D H, Duckett, J W, Wein, A J (1991). Effects of pregnancy on muscarinic receptor density and function in the rabbit urinary bladder. Pharmacology 43, 69–77CrossRef Google Scholar PubMed

Maggi, A, Perez, J (1985). Role of female gonadal hormones in the CNS: clinical and experimental aspects. Life Sci 37, 893–906CrossRef Google Scholar PubMed

Meyer, S, Bachelard, O, Grandi, P (1998). Do bladder neck mobility and urethral sphincter function differ during pregnancy compared with during the non-pregnant state? Int Urogynecol J Pelvic Floor Dysfunct 9, 397–404CrossRef

Milley, P S, Nichols, D H (1971). The relationship between the pubo-urethral ligaments and the urogenital diaphragm in the human female. Anat Rec 170, 281–283CrossRef Google Scholar PubMed

Mitra, S C (1999). Effect of cocaine on fetal kidney and bladder function. J Matern Fetal Med 8, 262–269Google Scholar PubMed

Nel, J T, Diedericks, A, Joubert, G, Arndt, K (2001). A prospective clinical and urodynamic study of bladder function during and after pregnancy. Int Urogynecol J Pelvic Floor Dysfunct 12, 21–26CrossRef Google Scholar PubMed

Nicolaides, K H, Rosen, D, Rabinowitz, R, Campbell, S (1988). Urine production and bladder function in fetuses with open spina bifida. Fetal Ther 3, 135–140CrossRef Google Scholar PubMed

Ohel, G, Haddad, S, Samueloff, A (1995). Fetal urine production, micturition and fetal behavioral state. Am J Perinatol 12, 91–92CrossRef Google Scholar PubMed

Olsen, L H, Dalmose, A L, Swindle, M M, Jorgensen, T M, Djurhuus, J C (2001). Male fetal pig lower urinary tract function in mid second and early third trimester of gestation. J Urol 165, 2331–2334CrossRef Google Scholar PubMed

Rud, T, (1980). The effects of estrogens and gestagens on the urethral pressure profile in urinary continent and stress incontinent women. Acta Obstet Gynecol Scand 59, 265–270CrossRef Google Scholar PubMed

Schreiter, F, Fuchs, P, Stockamp, K (1976). Estrogenic sensitivity of alpha-receptors in the urethra musculature. Urol Int 31, 13–19CrossRef Google Scholar PubMed

Smet, P J, Edyvane, K A, Jonavicius, J, Marshall, V R (1996). Neuropeptides and neurotransmitter-synthesizing enzymes in intrinsic neurons of the human urinary bladder. J Neurocytol 25, 112–124CrossRef Google Scholar PubMed

Stanton, S L, Kerr-Wilson, R, Harris, V G (1980). The incidence of urological symptoms in normal pregnancy. Br J Obstet Gynaecol 87, 897–900CrossRef Google Scholar PubMed

Taki, N, Taniguchi, T, Okada, K, Moriyama, N, Muramatsu, I (1999). Evidence for predominant mediation of alpha1-adrenoceptor in the tonus of entire urethra of women. J Urol 162, 1829–1832CrossRef Google Scholar

Thiruchelvam N, Cuckow P M (1999). Fetal urodynamics: report of preliminary findings. In Proceedings of the International Feto-Maternal Medicine Society Annual Meeting, Newcastle 1999

Tong, Y C, Hung, Y C, Lin, J S, Hsu, C T, Cheng, J T (1995). Effects of pregnancy and progesterone on autonomic function in the rat urinary bladder. Pharmacology 50, 192–200CrossRef Google Scholar PubMed

Urner, F, Weil, A, Herrmann, W L (1983). Estradiol receptors in the urethra and the bladder of the female rabbit. Gynecol Obstet Invest 16, 307–313CrossRef Google Scholar PubMed

Valentino, R J, Miselis, R R, Pavcovich, L A (1999). Pontine regulation of pelvic viscera: pharmacological target for pelvic visceral dysfunctions. Trends Pharmacol Sci 20, 253–260CrossRef Google Scholar PubMed

Geelen, J M, Lemmens, W A, Eskes, T K, Martin, C B Jr (1982). The urethral pressure profile in pregnancy, after delivery in healthy nulliparous women. Am J Obstet Gynecol 144, 636–649CrossRef Google Scholar PubMed

Versi, E, Cardozo, L D (1986). Urethral instability: diagnosis based on variations in the maximum urethral pressure in normal climacteric women. Neurourol Urodyn 5, 535–541CrossRef Google Scholar

Versi, E, Cardozo, L D, Studd, J W, Brincat, M, O'Dowd, T M, Cooper, D J (1986). Internal urinary sphincter in maintenance of female continence. Br Med J (Clin Res Ed) 292, 166–167CrossRef Google Scholar PubMed

Visco, A G, Cholhan, H J, O'Toole, L, Guzick, D S (2000). Effects of menstrual cycle and urinary tract instrumentation on uroflowmetry. Neurourol Urodyn 19, 147–1523.0.CO;2-C>CrossRef Google Scholar PubMed

Wall, L L, Hewitt, J K, Helms, M J (1995). Are vaginal and rectal pressures equivalent approximations of one another for the purpose of performing subtracted cystometry?Obstet Gynecol 85, 488–493Google Scholar PubMed

Wang, P, Luthin, G R, Ruggieri, M R (1995). Muscarinic acetylcholine receptor subtypes mediating urinary bladder contractility and coupling to GTP binding proteins. J Pharmacol Exp Ther 273, 959–966Google Scholar PubMed

Weiner, C P, Lizasoain, I, Baylis, S A, Knowles, R G, Charles, I G, Moncada, S (1994). Induction of calcium-dependent nitric oxide synthases by sex hormones. Proc Natl Acad Sci USA 91, 5212–5216CrossRef Google Scholar PubMed

Wlodek, M E, Thorburn, G D, Harding, R, (1989). Bladder contractions and micturition in fetal sheep: their relation to behavioral states. Am J Physiol 257, R1526–R1532Google Scholar PubMed

Yeung, C K, Godley, M L, Ho, C K et al. (1995). Some new insights into bladder function in infancy. Br J Urol 76, 235–240CrossRef Google Scholar PubMed

Yeung, C K, Godley, M L, Dhillon, H K, Duffy, P G, Ransley, P G (1998). Urodynamic patterns in infants with normal lower urinary tracts or primary vesico-ureteric reflux. Br J Urol 81, 461–467CrossRef Google Scholar PubMed

Zahran, M M, Osman, M I, Kamel, M, Fayad, M, Mooro, H, Youssef, A F (1976). Effects of contraceptive pills and intrauterine devices on urinary bladder. Urology 8, 567–574CrossRef Google Scholar PubMed

Zimmer, E Z, Chao, C R, Guy, G P, Marks, F, Fifer, W P, (1993). Vibroacoustic stimulation evokes human fetal micturition. Obstet Gynecol 81, 178–180Google Scholar PubMed

Accessibility standard: Unknown

Why this information is here

This section outlines the accessibility features of this content - including support for screen readers, full keyboard navigation and high-contrast display options. This may not be relevant for you.

Accessibility Information

Accessibility compliance for the PDF of this chapter is currently unknown and may be updated in the future.