How the functions of the bladder work. Where is the bladder located and how does it work? Human urinary system

The bladder is an organ that performs important functions in the human body. According to statistics, diseases of this organ of the genitourinary system are more common in women than in men, which is explained by where it is anatomically located.

What symptoms indicate a serious pathology? Bladder, and what treatment will effectively cope with the disease?

Features of location and structure

The bladder is one of the pelvic organs; it is designed to store and subsequently remove waste products.

The organ consists of four fundamentally important parts. The anatomy of the bladder structure is as follows:

• apex;
• organ body;
• the bottom where the bladder triangle is located;
• the mouth containing the contractile muscle, the main function of which is to retain fluid in the urinary organ.

The volume of the bladder in adults reaches 500-700 ml. The shape and location relative to other organs varies depending on the filling. It is noteworthy that in women the volume of this organ of the genitourinary system is smaller than in men.

When the bladder is empty, it is located in the pelvis; when filled, changes occur in the body, the upper part of the bladder rises to the pubis, and in rare cases, to the person’s navel.

Pay attention to what the bladder looks like in representatives of different sexes.

The structure of the organ does not depend on the gender of the person. In men, the prostate and seminal ducts are adjacent to the bladder area, and in women, the organ is located next to the uterus and vagina.

Bladder functions

The human bladder performs two main functions: storing and excreting urine. How it works?

The urinary duct regularly delivers human waste products to the organ, which are excreted by the kidneys. The bladder, in turn, acts as a vessel for storing urine, with an average volume of up to 400 ml. When the “container” is filled, the process of urination occurs.

The function is triggered after stretching the walls of the bladder and is expressed in compression of the muscle fibers of this organ and relaxation of the sphincters. In this way, metabolic products are removed from the human body naturally.

Bladder diseases

Symptoms of bladder disease cause concern among patients. Among the most common pathologies of the urinary organ that occur in men and women, it is necessary to highlight the following:

• Cystitis is a common disease of the bladder, which is a lesion of the mucous membrane. The disease is a consequence of hypothermia, ignoring the rules of personal hygiene, and the entry of germs and bacteria into the body.

Note. Prolonged inflammation of the bladder, characterized by temporary periods of remission, is a sign of chronic cystitis. Ignoring the chronic inflammatory process can lead to damage to organ tissue.

• Bladder endometriosis is a disease of the female genitourinary system associated with the growth of the endometrium beyond its natural location. The disease affects the walls and cavity of the bladder, causing inflammation.

Note. The endometrium is the inner layer of the uterus, the main task of which is to fix the egg for further fertilization.

• Urolithiasis – characterized by the formation of stones in the affected organ. The cause of the disease is a metabolic disorder, disease thyroid gland and abnormal functioning of the genitourinary system, for example, in bedridden patients.

Note. The bladder in men more often suffers from diseases of other organs. For example, urolithiasis is usually caused by damage to the renal pelvis.

• Bladder tumors are a serious pathology that requires immediate attention. surgical intervention. Among benign tumors, it is necessary to note adenomas, papillomas, and polyps.

Note. The cause of papillomas is the human papillomavirus. Some types of neoplasms are prone to degeneration into malignant ones and require urgent diagnosis.

Symptoms

Bladder diseases in women are a common phenomenon associated with the structural features of the genitourinary system.

Signs of different diseases can be similar to each other; they are often caused by inflammation and infections in the bladder, caused by an unhealthy lifestyle or failure to comply with personal hygiene rules.

Symptoms of bladder disease in women:

• frequent urge to the toilet, accompanied by pain and a feeling of fullness of the bladder, indicate hypothermia and inflammatory processes in the diseased bladder;
• a change in the color of urine up to red, frequent urination, pain in the lumbar region - some of the symptoms of bladder pathology that characterize urolithiasis.

Note. In organism healthy person salts come out along with other waste products. With pathology, salts accumulate and stones form in the bladder;

• abnormal urination with a small amount of blood is a sign of a benign or malignant tumor at the patient.

Note. Some diseases of the genitourinary system, for example, endometriosis and cystitis, are also accompanied by the periodic appearance of blood in the urine;

• disturbance of urodynamics, the presence of pain and burning at rest and their intensification during urination are symptoms of cystitis;
• pain during sexual intercourse, difficulty urinating, inflammation in the area of ​​the affected organ are clear signs cystocele.

Thus, bladder disease in women is accompanied by unpleasant symptoms. At the first signs of the disease, you need to contact a specialist who will prescribe effective treatment to combat the disease.

Diagnostics

The patient needs a diagnosis of the bladder, which will determine the causes of the disease and prescribe proper treatment.
Among existing methods diagnostics it is necessary to highlight the following:

• general clinical – involves collecting anamnesis (patient complaints) and an initial examination of the patient by the attending physician;
• laboratory research - we're talking about about urine and blood analysis.

Note. The presence of leukocytes and bacteria in the urine may indicate the disease. A blood test allows diagnosis inflammatory process V genitourinary system;

• Ultrasound – performed when the bladder is filled with urine;
• X-ray method - allows you to examine the structure and study the functioning of all parts of the genitourinary system;
• magnetic resonance imaging – recommended for suspected bladder tumors;
• urodynamic study - indicated for urinary incontinence, cystitis;
• cystoscopy – examination is carried out if cystitis, tumors, or urolithiasis are suspected;
• biopsy - prescribed for diagnosis of benign and malignant tumors, tuberculosis.

Treatment

Bladder diseases in women and men must be treated under the strict supervision of a specialist. The patient needs to see a urologist, but a therapist can also prescribe an initial examination and establish a diagnosis.

Used to combat illness complex therapy. Usually the patient is prescribed a balanced diet and drinking plenty of fluids water.

Along with the diet, treatment is carried out with medications. Among the effective medicines, the following should be highlighted:

• antibiotics and antibacterial drugs – recommended for the treatment of diseases caused by bacterial infections;
• antispasmodics - do not affect the cause of the disease, but in short time eliminate pain syndrome;
• herbal medicines – they contain natural plant components. The remedies help against cystitis (mild forms) and inflammation caused by hypothermia;
• anti-inflammatory non-steroidal drugs– eliminate severe pain, inflammation, normalize body temperature.

Note. All medications are prescribed by the attending physician, who will select effective medicine, dosage and duration of treatment.

Surgical intervention is necessary in extreme cases. Surgery is recommended for malignant tumors, tuberculosis, and prolapsed bladder (cystocele). In other cases drug treatment enough to fight the disease.

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Functions

The main role of purifying the blood and filtering urine is performed by the kidneys. The resulting urine then flows through the ureters into the bladder.

Its maximum volume can be up to 700 ml, however, the formation of the desire to empty occurs when it is filled with 150 - 200 ml.

Location in the body

The anatomy of the location of the bladder is as follows: it is located in the lower abdominal cavity behind the pubic symphysis.

When urine accumulates, its upper part rises, sometimes it can even reach the navel.

In representatives of the stronger sex, it is located close to the rectum, seminal vesicles and vas deferens.

In women - in the immediate vicinity of the cervix and vagina.

Structure

The shape of the bladder is not constant. It may be pear-shaped or oval depending on the volume of accumulated urine. In the anatomy of this organ there are several divisions:

• the apex, which is the upper, pointed part that is directed towards the abdominal wall;
• the body is the largest part of the bladder, which is anatomically located in the middle;
• bottom, which faces down and slightly back;
• The neck is the narrow part that is located at the bottom.

The most complex is the anatomy of the bottom of the bladder. There is the so-called vesical triangle.

This part of the organ received its name due to its resemblance to this geometric figure. At two corners there are the orifices of the ureters, and in the third there is the internal sphincter of the urethra.

Through the ureters 3 – 4 times per minute into the bladder in small portions urine comes in.

In the anatomy of the walls of the bladder, there are anterior, posterior and lateral parts. The anterior edge practically touches the pubic joint.

The organ is separated from it by a thin layer of loose tissue, which forms the prevesical space.

The bladder is attached below by fixing ligaments, its upper part is freer. In men, the bladder is also connected to the prostate gland.

Organ shell

The anatomy of the bladder wall consists of several layers. She is educated:

• mucous membrane;
• submucosal layer in which blood vessels are located, nerve endings, The lymph nodes;
• muscle membrane;
• outer adventitia.

The anatomy of the bladder lining also partially includes the abdominal wall.

The mucous layer is represented by transitional epithelium, which is similar in anatomy to the inner lining of the ureters.

Together with the submucosa, it forms well-defined folds, which gradually straighten as the bladder fills with urine.

The exception is the area of ​​the bladder triangle. The mucous membrane there is poorly developed, so there are no folds in this place.

The inner shell is pinkish. It contains mucous glands and lymphatic follicles.

The muscles of the bladder wall play a major role in the process of urine excretion.

In their anatomy, there are three interconnected layers of longitudinal muscle fibers, circular muscles and a set of longitudinal and transverse muscle fibers. This entire system is called the detrusor.

The circular muscles are most developed around the mouths of the ureters and the internal sphincter of the urethra.

The process of urination

The urge to urinate is formed due to nerve fibers sympathetic and parasympathetic nervous system.

The bladder is directly innervated by the vesical plexus, which is anatomically located in the area of ​​the ureteric orifices.

In addition, the wall of the organ contains nerve endings that are sensitive to its filling with urine and, accordingly, an increase in intravesical pressure.

When the volume of urine reaches a certain “mark,” a signal is generated that is transmitted to the brain. A person feels the urge to urinate, which can be restrained for a certain time.

But as urine accumulates further, the urge becomes stronger, and when critical increase intravesical pressure causes uncontrolled urination.

From an anatomical point of view, the process of urination occurs as follows: under the influence of a nerve impulse, the detrusor muscle contracts and the sphincters of the urethra relax.

As the bubble empties, the reverse process occurs.

The most common pathologies

Bladder diseases can be caused by congenital changes in the normal anatomy of the bladder. These are such serious anomalies as exstrophy, epispadias and hypospadias.

Under the influence of various factors, a so-called bladder diverticulum can form, which is expressed in a violation of the anatomy of the shape of the organ.

With this disease, a cavity appears on its wall, which can be quite large.

Disruption of the innervation of the organ can lead to urinary incontinence and problems with urination.

Due to the anatomy of the bladder, it is susceptible to bacterial inflammation and cystitis. Women suffer from this to a greater extent.

Examination methods

Assess the anatomy of the bladder, the presence pathological formations possible using ultrasound and x-ray examination.

To obtain more informative X-ray images, contrast agents containing iodine or barium are injected into the patient's body.

For visual inspection Cystoscopy is performed on the inner surface of the bladder. This is the method endoscopic examination, which is carried out using special apparatus– cystoscope.

This is how you can diagnose chronic cystitis, diverticula, oncological neoplasms.

Symptoms of diseases

Signs that suggest illness lower section urinary system, are:

• urination disorders, which may manifest themselves in frequent urination, or, conversely, infrequent emptying;
• changes in the amount of urine excreted with a constant volume of drinking;
• pain and burning during urination;
• the appearance of blood in the urine, its cloudiness;
• lower abdominal pain.

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The prostate gland is adjacent to the outer part of the male bladder, and the seminal ducts are located on its sides. The female is located in close proximity to the uterus and vagina. In addition, there are differences in the length of the urethra: in men it reaches 15 centimeters, while in women it is only 3 centimeters.

The process of filling the bladder leads to a modification of its shape and to fluctuations in size. The shape of the bladder containing urine is round (oval). The normal bladder capacity is 250-500 milliliters. This is the norm for an adult. In newborns, it is, of course, fundamentally different, namely, it can hold about 50-80 cubic cm of urine. A five-year-old child can fill their bladder up to 180 milliliters, and children over twelve can fill their bladder up to 250 milliliters.

So, how is the bladder structured and where is it located in adults, or what is the anatomy of the bladder? The anterior-superior part of the bladder and its apex are facing the anterior abdominal wall. The median umbilical ligament, which is called the remnant of the embryonic urinary duct, stretches from the apex to the navel. Then the top passes into the expanding region of the bubble body, and from it into the bottom. This segment is characterized by the presence of a funnel-shaped narrowing, called the neck of the bladder, which is the transition to the urethra.

The walls of the bladder are covered by the mucous membrane, submucosa, muscular layer and adventitia, and the areas covered with peritoneum also have a serous membrane. When the bladder is emptied, it decreases in volume, and its muscle wall contracts, approaching 12-15 millimeters in thickness.

In newborns, it has a slightly different shape. When a child is born, its shape is spindle-shaped, in the first few years it is pear-shaped, by the age of eight it takes on an ovoid shape, and in adolescence it begins to resemble the shape of an adult bubble.

Human anatomy and its role are very important information, because it is the last organ of the vital urinary system.

Mucous membrane

The mucous membrane lining the inside of the bladder after it is emptied forms folds, which straighten again when the organ is filled with urine. The mucosa is covered with transitional epithelial cells. When the bladder is unfilled, these cells have a rounded shape; with the next filling, their walls become thinner and flattened, as a result of which they are pressed tightly against one another.

The anterior part of the bottom of the bladder is characterized by the presence of an internal urethral opening, and the two corners of its triangle are characterized by the presence of ureteral openings, left and right, respectively.

Submucosa

With the help of this anatomical structure, the lining of the bladder can form folds, but there are none in the triangle area. This is followed by the muscular layer, which is formed by smooth muscle tissue. The segment where it passes into the urethra has a sphincter formed by smooth muscles. When this sphincter opens, urine comes out.

In the very middle of the urethra there is another sphincter, an involuntary one, which was formed by striated muscles. When urinating, the muscles of both sphincters relax, while the walls of the bladder, on the contrary, tense.

Nerves and blood vessels

The branches of the umbilical arteries, right and left, approach the bladder itself and its apex.

The blood supply to the bottom and side walls of the organ is carried out by the inferior vesical arteries.

The outflow of venous blood into the venous plexus and into the internal iliac veins is carried out through the vesical veins.

It is not difficult to understand how the bladder works and where it is located. It is located in the small pelvis, behind the symphysis pubis, from which it is limited by a layer of loose tissue lying behind the pubis. At the moment the bladder is filled with urine, its apex comes into contact with the abdominal wall (anterior), and the bladder itself protrudes above the symphysis pubis.

The surfaces of the bladder, which are located on the sides, touch the paired muscle, the pubococcygeus (pc muscle) and the iliococcygeus, thanks to which the anus rises. On the sides, above and behind the bladder is covered with peritoneum, which in the case of men forms the vesico-rectal cavity, passing to the rectum, and in the case of women, the vesico-uterine cavity, passing to the uterus.

Thanks to fibrous cords, the bladder is attached to the walls of the pelvis, as well as to neighboring organs. In addition to them, its fixation is ensured by the ureters and the urethra (its initial section). In men, the bladder is secured with the help of the prostate, and in women, with the help of the urogenital diaphragm.

Urodynamics (urinary excretion process)

Immediately after the baby is born, the bladder slowly descends. Already in the fourth month of his life, the organ is located above the pubic symphysis, more precisely, at a distance of one centimeter from its upper edge. Two to three times a minute, the openings of the ureters open, releasing thin streams of urine.

The urinary process involves two phases:

1. The transport phase, during which urine moves through the urinary tract with the help of destructors, the so-called expulsion muscles.
2. Retention phase of detention, which is understood as a state when, under the action of the closing muscles (sphincters), stretching is observed urinary tract and accumulation of urine in it.

Note: excretory system, starting from the renal calyces and ending with the urethra, is a single hollow muscular internal organ, all parts of which are inseparable from each other in a functional sense, thereby ensuring the alternation of secretory and excretory phases.

Among women

Due to the gender difference in the reproductive system, the location of the bladder in women is determined by the intersection with the uterus and vagina, which are located behind it and touch their walls. It should be noted that the length of the urethra is important; it is only 3 centimeters, which serves for bacteria and
infections in a very short way.

This position of the organ especially manifests itself during pregnancy. Along with the increase in the size of the fetus, and, consequently, the uterus, the pressure on the organ increases weekly. Pregnant women often go to the ladies' room to empty their bladder. There is nothing wrong with this, only if the process of urination is not accompanied by discomfort or a feeling of not emptying afterwards.

The period after 23 weeks is always more dangerous. The uterus can put pressure on the urinary tract. Due to stagnation, urine begins to irritate the mucous membrane and even develop an infection.

10% of all pregnancies are accompanied by cystitis. In this position expectant mother She must listen even more strongly to her body, because danger threatens both her (in the form of a difficult birth) and the baby, who may be born underweight or before the allotted time.

In men

The location of the bladder in men naturally intersects with the prostate (at the bottom of the bladder) and the seminal ducts (at its sides). 15
the centimeter urethra does not allow harmful microorganisms to easily penetrate it. The structure of the bladder in men is identical to that of women,

but even this does not save them from terrible cancer diseases and hernias, from which they are forced to suffer more often than the weaker sex.

There is a version that smokers increase the chances of their body being affected by cancer with each cigarette they smoke.

But even if you know the anatomy of the male bladder and you feel pain in this area, this is not always a sign of damage. Inflamed kidneys or urethra, as well as problems with the prostate, are also accompanied by such symptoms.

In the case of pain when full or after urination, it can be assumed that this is a bladder disease. But, nevertheless, we do not advise you to “play doctor” and self-medicate based on an imaginary diagnosis.

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The main functions of the bladder are the deposition and subsequent removal of accumulated urine. To perform such tasks, you need powerful muscles and good extensibility of the organ, which is why it has a unique structure. There are as many as three layers of muscle fibers running through the wall, having a perpendicular and oblique direction in relation to each other. This structural feature allows the bladder to contract in all directions.

The most developed muscle, called the sphincter, is located at the exit of the bladder, surrounding the entrance to the urethra (urethra). This muscle has the shape of a circle, contracting, it compresses the canal, urine stops flowing, and when it relaxes, urination begins. Similar, but less developed sphincters are located at the entrance of the ureters to the bladder. The circular muscles are controlled by the nervous system. Signals coming from the brain cause the fibers to tense or relax.

Somewhat posterior to the outlet of the bladder in men there is a protrusion formed by the adjacent prostate gland. Normally, its size is small, but as the prostate enlarges, the size of this protrusion increases and a disturbance in the outflow of urine may occur.

The structure of the bladder membranes

The structure of the outer shell of the bladder is simple - it is partially covered with a serous film, which lines all the organs of the abdominal cavity, ensures their sliding, releasing a small amount of fluid. The inner lining is called mucosa. When the bladder is empty, it has small size and its mucous membrane gathers into folds; when straightened, the folds disappear. Plot triangular shape, located between the openings of the ureters, is not covered with folds. It's called Lietto's triangle. .

The inner covering in a healthy person has a pale red color, the same in all parts of the bladder. Changes in the mucous membrane can be noticeable during examination - cystoscopy, and indicate an inflammatory process in the bladder. The wall of the bladder also contains mucous glands and elements of the body's immune system - lymphatic follicles measuring 0.3 cm or less. The glands secrete a thick substance that protects the vulnerable wall of the mucous membrane from irritation by urine.

Where is the bladder located

This organ occupies the lowest part of the pelvis, the so-called small pelvis. The uterus and vagina in women are also located there, behind the bladder. In men, the seminal vesicles and the endings of the vas deferens are located in the same place. The rectum occupies a place behind all organs. Neighboring structures mutually influence each other, so when the uterus enlarges in women, compression occurs urinary tract, worried about frequent urination. Prostate adenoma causes similar problems in men.

When empty, the bladder is very small in size and looks like a deflated balloon. When full, on the contrary, it protrudes beyond the pelvis, rising almost to the level of the navel. Moreover, its shape resembles an egg. While Bottom part the organ is firmly secured by ligaments to adjacent tissues, the upper part is more mobile. It is noteworthy that in newborn children the topography of the bladder is special - it is located much higher, above the pubis, descending into the pelvis only by the 5th month of life.

Anatomy of the bladder

Anatomically, the bladder is usually divided into the following parts:

1. The fundus is the wide, flat part located at the bottom, facing back, towards the rectum. The openings of the ureters exit here. The bottom is strengthened by ligaments and is inactive. Has a relatively flat surface. This is where Lietto's triangle is located.
2. The bladder neck is the part lying between the urethra and the bottom of the bladder. Shaped like a tapering funnel, it is topographically the lowest structure.
3. The apex is the highest part, its shape is pointed. The apex is more mobile than the other parts due to the lack of rigid fixation by ligaments. It is adjacent to the anterior abdominal wall in the lower abdomen and if there is a large volume of fluid in the organ, it can be palpated.
4. The body is the main, wide part, the largest in size, if we are talking about a filled bladder. Highly extensible due to elastic fibers and folded structure of the mucous membrane.

There is another principle of anatomical division. When the anterior wall is isolated, it is adjacent to the pubic joint (the place where the pubic bones connect, the same bone formation that ends the lower abdomen). This wall of the bladder is separated from the pubis by loose tissue, which plays a primarily protective role. This space is called prevesical. The posterior wall faces the uterus or prostate. The lateral walls are adjacent to the ureters, which form bends in the pelvis.

The lower part of the bladder is fixed by powerful, strong connective tissue formations - pelvic ligaments. In men there is also an additional fusion with the prostate gland. Above, close to the bladder, are the intestinal loops in men, and in women - the uterus. With maximum filling with urine, the anterior wall slides along the inner surface of the abdominal wall, while serosa moves back. It is for this reason that in medicine a puncture of the bladder through the skin in the suprapubic area is often used, without the risk of damaging the peritoneum (serous membrane).

How the urinary system works

The walls are abundantly supplied blood vessels, through which oxygen is delivered to the organ and waste substances are removed through venous blood. It should be noted that there is an abundant network of lymphatic capillaries - the immune system must function intensively in this organ, providing protection against infections. Nerve endings also approach the muscular wall of the organ from all sides, some of which are responsible for relaxing the muscles, others for tensing them. Thanks to the coordinated work of the nervous system, there is a clear regulation of the outflow of urine.

Studies have demonstrated the presence of two phases of the human urinary system. During the transport phase, urine is expelled from urinary tract under the influence of contraction of special muscles. These muscles are called detrusors. The second phase of work is retention, translated from Latin as delaying. At this time, tension and compression of the sphincters occurs, the urinary tract cavity closes, and urine accumulates. Both phases constantly alternate with each other and are strictly connected with various departments of the system. When the kidneys are in the first phase, the bladder is in the second and vice versa.

The structure of the bladder in representatives of different sexes is almost the same, but the influence differs neighboring organs. What the urethra is in female body shorter and wider than men's, increases the risk of infectious diseases. Therefore, women are more likely to experience bacterial cystitis - inflammation of the walls of the bladder. In men, urinary disorders are usually mechanical in nature, due to prostate adenoma; inflammatory processes occur much less frequently. However, it is men who are at risk for urolithiasis; they more often undergo operations on the urinary organs.

The bladder acts as a reservoir for collecting urine. Infections, injuries, stress and other factors can lead to damage and loss of urinary control.

The bladder is a hollow, thick-walled muscular organ located in the lower part of the pelvic girdle, in the pelvis, between the pubic bones and the rectum. Visually it resembles an inverted pyramid. The base of the pyramid is the surface on which it is located small intestine in men or the uterus in women.

How does the bladder work?

The walls of the bladder are made up of a series of muscle layers that can stretch when filled and then contract to remove urine. Urine formation in the human body occurs continuously. Every 15-20 seconds, urine formed in the kidneys flows through channels called ureters into the bladder.

Muscular valves located at the entrance of the ureters into the bladder prevent the reverse movement of urine to the kidneys when the bladder overflows. The bladder acts like a balloon whose pressure continually increases as it fills. When the bladder fills, the muscle fibers in the bladder walls relax, allowing the bladder to stretch and accept more urine.

Urine is excreted through the urethra, which opens at the lowest point of the bladder from its neck. In the normal state, its opening is held by a closed sphincter - a circular muscle, the contraction of which closes the outlet. When urinating, the sphincter relaxes, and at the same time the muscles of the bladder walls contract, pushing out urine.

In women, the urethra, which is approximately 5 cm long, is not a very effective barrier to bacteria from external environment, especially if the sphincter is weakened as a result of a disease of the urethra or for some other reason. Men are better protected in this regard: their urethra is narrower and longer, 20 cm. It passes through the prostate gland and penis.

Although it is widely believed that women's bladder bigger size, than in men, since they empty it less often, this is not the case. The ability of women to hold back urination longer is due to the fact that they have greater control over this reflex process. However, due to stretching, the capacity of the bladder may increase if, as some women do, you empty it only once a day.

Bladder disorders

Cystitis is inflammation of the bladder. It is more common in women because their shorter and wider urethra is less effective at preventing infection. The disease can be caused by intestinal bacteria entering the bladder from the anus, vaginal flora or inflammation of neighboring organs, such as the kidneys, as well as infection introduced during sexual intercourse or childbirth. Symptoms of cystitis include frequent urgency to urinate and pain when urinating. The urine is either cloudy or contains pus (pyuria) or blood (hematuria). Pain may also be felt in the pubic area above bladder, especially before and after urination.

Cystitis is usually not a serious disorder, but in addition to physical discomfort, it can cause psychological discomfort. To treat cystitis, a urologist prescribes antibiotics; the course of treatment can take up to two weeks, but symptoms often disappear within a few days.

Read more about urinary tract diseases in our next publications.

It is not customary to talk about this problem. But it affects millions of people. Frequent urination in men and women - causes, treatment and prevention - is it possible to get rid of the problem without treatment?

Bladder problems are common as we age. However, there are many ways to make your bladder work better at any age, which will have a beneficial effect on a person's quality of life.

For example, you can change your diet. Recently, Japanese scientists from Nagasaki University conducted a study and found that if there is a lot of salt in a person’s diet, this causes the kidneys to secrete a large amount of urine. This in turn leads to excessive urination.

In the UK, for example, nine million women and four million men have problems with frequent urination. In the US, according to official data, 16% of the population suffers from overactive bladder syndrome (but in reality this figure can be much higher).

Do you often run to the toilet - how often?

The bladder is an organ with elastic walls for storing urine, which is periodically excreted through the urethra. On average, its capacity is 500-700 ml, depending on the organism.

We feel the first urge to empty the bladder when it is filled to about 150 ml. A strong urge is felt when filling 250-300 ml.

According to Professor Roger Kirby, consultant urologist at the Prostate Center in London, most people can hold 300-500ml of fluid in their bladder (if they drink about two liters of water during the day).

How long can a person hold 300-500 ml of liquid in the bladder? English urological surgeon Richard Viney from the Queen Elizabeth Hospital in Birmingham says that theoretically a person can keep this amount of fluid in the bladder for five hours. What is this conclusion based on? The fact is that the kidneys excrete 50 ml of urine per hour.

“Most people go to the toilet more often because they drink tea, coffee, alcohol more than their body needs due to the fact that, for example, “everyone drinks.” That's the problem," Richard Viney said.

Thus, the average person empties the bladder approximately six or seven times in a 24-hour period. Even if a person goes to the toilet nine or ten times because of this in one day, then this is also normal. But if you empty your bladder more than ten times a day or more than twice a night, then you need to see a doctor. It is possible that men in this case have a problem with the prostate gland.

“Some people, because of their profession, such as teachers, have to hold fluid in their bladder for a long time. Their bladder trains and gets used to a larger volume of fluid,” Viney said.

Stress and the Bladder

Often people during exams or before public speaking feel the need to empty the bladder. This happens due to nervous tension and stress.

At nervous overstrain the body produces adrenaline, the heart rate increases, arterial pressure. The person realizes that he will soon enter “stress mode,” and this information is transmitted to the brain, to the stretch receptors of the bladder, which wants to take advantage of the opportunity to get rid of fluid in advance.

Cold weather and the bladder

Cold weather can also affect how often you urinate. The fact is that when it is cold, the human body tries to warm up by reducing blood flow to the extremities. Blood begins to circulate over a smaller area, and as a result, blood pressure increases. The kidneys intervene and filter excess fluid from the blood, which is eliminated from the body through urine. In hot weather, the opposite can happen.

Frequent urination as a sign of serious health problems

Diabetes

Thirst and too frequent desire emptying your bladder are symptoms of diabetes. In diabetes, the body is unable to regulate blood sugar levels. Excess sugar causes more fluid to pass through the kidneys, causing the person to go to the toilet more often. This in turn causes dehydration - hence thirst.

Enlarged prostate

Some older men feel the need to empty their bladder too often (especially at night) due to benign prostatic hyperplasia (BPH), which is also known as BPH. At BPH prostate(the prostate gland, which lies under the bladder and surrounds the urethra), becomes enlarged. As a result, you may have problems emptying your bladder.

Bladder problems in older people

If a person over 65 gets up at night to go to the toilet to empty his bladder, this is normal. After 80 years of age, it is normal for a person to go to the bathroom twice a night. As you age, your bladder becomes weaker, so you have to empty it more often.

However, some experts argue that older people are more sensitive. Therefore, they wake up at night from even a small noise or light, and then go to the bathroom. In these cases, doctors recommend hanging thicker, dark curtains in the bedroom and using special earplugs.

Reinsurance is harmful

Some people, before going anywhere, first go to the bathroom to empty their bladder, although the body does not yet need it. Such reinsurance only harms this organ, which gets used to a small amount of liquid. Because of this, the urge to urinate occurs, for example, when the bladder is filled to 150 ml, instead of 300 ml.

Richard Viney recommends drinking fluids evenly throughout the day, and trying not to drink late at night. Also, if you have bladder problems, limit your intake of caffeinated drinks, including coffee, black tea, and green tea. Also, drink less sugary sodas and alcohol (especially sour white wine). These drinks can irritate your bladder, making you want to empty it more often.

Spices and citrus fruits, such as lemon, lime, grapefruit, and oranges, irritate the bladder. By the way, tomato juice has the same property.

Avoid dehydration, as this causes your bladder to receive more signals that it needs to empty.

Salty foods have great diuretic properties. Therefore, limit your consumption if you do not want to visit the bathroom too often.

Pregnancy and childbirth

Pregnancy and childbirth are damaging pelvic floor, which often leads to urinary incontinence. In order to solve this problem, you need to train your muscles. Squeeze your muscles for 10 seconds 10-15 times a day.

So, in men it is 15 centimeters or more long, and in women it is only 3 centimeters.

In children

In a newborn baby, the volume of the bladder is from 50 to 80 cubic cm. By the age of five, its volume increases to 180 ml. From the age of 12 its volume approaches lower limit“adult”, that is, to 250 ml.

During pregnancy

As pregnancy progresses, a woman usually begins to feel a more frequent urge to urinate, because the uterus is located directly behind the bladder, it enlarges and presses on the bladder. This is a completely normal condition. But if after urination there is a feeling of an unemptied bladder, if the process is accompanied unpleasant sensations, this may indicate inflammation. Most often, problems begin at 23 weeks of pregnancy. The cause of inflammation is the same enlarged uterus. It compresses the ureters, leading to stagnation, an infection develops in the urine.

The assistance of a doctor and qualified treatment are required. If you start the process, the result may be the appearance of a low-weight baby and a difficult birth.

Treatment is carried out using approved antibiotics, as well as bladder lavages.

No bubble

Diverticulum

A diverticulum is detected during cystoscopy. X-ray examination with contrast can also reveal a diverticulum.

The only treatment for diverticulum is surgery. It is eliminated, the exit to it is closed. The operation is performed both by abdominal and endoscopic methods.

Diseases

Inflammation – cystitis

The patient often has a small urge to go to the toilet, but very little urine is released. If the process is very advanced, the urge may occur at intervals of a quarter of an hour. The patient also feels pain, which is most severe when inflammation spreads to the mucous membrane of the bladder neck. The pain can shoot to the side anus, in the groin.

At first, a small amount of blood may be detected in the urine. The temperature may rise.

Antibiotics, vitamins and painkillers are used ( if you need to relieve pain). Sometimes for cystitis, sitz baths are prescribed with water temperatures up to 40 degrees with the addition of chamomile preparations. The duration of the procedure is ten minutes. You can place a warm heating pad on your lower abdomen. All thermal procedures are carried out only if there is no temperature.

It is important to temporarily give up canned food, pickles, spices, and marinades. You need to drink more if there is no swelling.

American scientists have discovered that drinking green tea helps eliminate signs of cystitis. The tea contains substances that protect the tissues of the mucous membrane of the bladder.

The acute stage of the disease is stopped within a week to a week and a half.

But the treatment must be completed, since otherwise the disease can become chronic.

Stones and sand (urolithiasis)

• Metabolic disorder
• Genetic predisposition,
• Chronic diseases of the digestive and urinary organs,
• Diseases of the parathyroid gland,
• Diseases of the skeletal system, fractures,
• Long-term dehydration
• Lack of vitamins, in particular vitamin D,
• Frequent eating of pickles, spicy, sour,
• Hot climate,
• Lack of ultraviolet radiation.

• Pain in the lower back,
• Frequent urination, pain when urinating,
• Presence of blood in urine ( may be in very small quantities, not detectable by eye),
• Urine with turbidity,
• Hypertension,
• At the start infectious process body temperature increases to febrile levels.

Urolithiasis is determined using ultrasound, blood tests, urine tests, blood biochemistry, and excretory urography.

The disease is treated with medication; if ineffective, surgical treatment is used. Stones are also crushed using ultrasound.

Much attention should be paid proper nutrition, which should be selected taking into account the composition of the stones.

Tumors

All tumors are divided into benign and malignant. In addition, the neoplasm may be located in the epithelial layer, or it may be created from connective fibers ( leiomyomas, fibromyxomas, fibromas, hemangiomas). Benign tumors include pheochromocytomas, endometriotic neoplasms and adenomas, as well as papillomas.

Treatment of tumors of any type is usually carried out surgical method. If possible, endoscopic techniques are used for benign tumors as they are less invasive.

• Smokers are four times more likely to
• For people who often come across aniline dyes,
• This disease is more common in men
• At chronic inflammation bubble
• If there is a violation of the formation of the pelvic organs,
• After irradiation of the urinary organs,
• In persons who do not urinate on demand. In this case, urine acts longer on the mucous membrane of the bladder and causes pathological processes,
• When using a number of medications, as well as sweeteners ( cyclamate, saccharin).

• Blood in urine. There is quite a lot of blood, it can be detected visually.

Leukoplakia

• Chronic cystitis,
• Presence of stones
• Mechanical or chemical effects on the mucous membrane.

The causes of leukoplakia have not yet been fully elucidated.

• Pain in the lower abdomen
• Frequent urge to urinate, sometimes fruitless,
• Unpleasant sensations during urination.

The disease is determined using cystoscopy.

Atony

Urine is not released in portions, the bladder is filled to the maximum, urine is removed from it drop by drop.

The most common reason is severe injury lower back ( sacrum), affecting the spinal cord. In addition, atony can develop as a complication of certain diseases ( syphilis), disrupting the function of the spinal cord roots.

Another type of atony is a neurogenic disinhibited bladder. In such a situation, the central nervous system does not provide enough strong signal bladder. Therefore, urination occurs frequently and the patient cannot influence it. A similar disorder is typical for damage to the brain stem, as well as incomplete rupture of the spinal cord.

Polyps

Polyps of various sizes, up to several centimeters, can develop in the bladder.

Most often, the polyp does not cause any specific symptoms. In some cases, there may be blood in the urine.

In most cases, polyps are discovered incidentally ultrasound examination genitourinary organs. Cystoscopy is prescribed if there is bleeding, and also if the doctor doubts the benignity of the polyp.

Typically, if the polyp is not too large and does not interfere with the flow of urine, it is not treated. If the presence of a polyp affects the patient’s well-being, surgery is performed to remove the growth. The operation is performed with a special type of cystoscope. The patient is given general anesthesia. The operation is not complicated.

Polyps are considered a transitional form between benign and malignant neoplasms. Therefore, their presence requires periodic examination for malignant cells.

Prolapse – cystocele

• Insufficiency of pelvic fiber,
• Perineal rupture during childbirth,
• Relaxation of the diaphragm, which supports the genitourinary organs,
• Non-physiological localization of the uterus,
• Prolapse and prolapse of the uterus.

• The walls of the vagina protrude when tense, and gradually a fragment of tissue with a volume of up to 200 ml may fall out,
• The bladder is partially emptied during urination,
• There may be urinary incontinence when coughing or laughing,
• Frequent urge to urinate.

Operating room only. During the operation, the pelvic muscles are strengthened and the organs are fixed in their normal places.

exstrophy

The violation is corrected promptly; usually a whole series of operations is required, the number of which depends on the degree of the defect. The first intervention is usually scheduled for the first ten days after the baby is born. Treatment rarely leads to complete control of the patient over the urinary process.

If the bladder does not grow in proportion to the child’s growth, despite surgery, augmentation is performed ( increase).

Cyst

A urachal cyst can only be treated surgically, and its treatment is an emergency. Since with suppuration there is a possibility of an abscess opening into the bladder or abdominal cavity.

Hyperactivity

Typically, an overactive bladder manifests itself with such a strong urge to urinate that the patient cannot resist. Sometimes patients experience incontinence.

• Urinary incontinence,
• Frequent urination
• Inability to hold urine when urging to go to the toilet.

This disease is not very well studied, but factors that increase the likelihood of developing OAB are already known:

A cystoscopy or x-ray may also be ordered.

• Charger,
• Physiotherapy,
• Biofeedback method,
• Surgical method
• Drug therapy.

Treating overactive bladder is a long process. Usually start with conservative techniques and if they do not give effect, they move on to surgery.

Tuberculosis

The causative agent of tuberculosis causes inflammation of the ureteric inlets, which then spreads to the entire organ.

The disease does not have specific signs. The patient feels a general malaise, may lose weight, as he has no appetite, gets tired quickly and sweats at night. But when further development Diseases also reveal disturbances in the functioning of the urinary organs.

• Frequent urination up to 20 times a day. During urination, patients complain of acute pain in the perineal area,
• In some cases, urinary incontinence occurs,
• There is blood in the urine
• Dull pain in lower back ( characteristic when associated with an inflammatory process in the kidneys) up to renal colic,
• Every fifth patient with bladder tuberculosis has pus in the urine and it is cloudy. This condition is called pyuria.

Treatment is carried out with the help of medications, and it lasts for six months. In this case, a group of drugs of at least three is prescribed. Antibiotics that are active against the causative agent of tuberculosis are used in therapy. The therapy is quite difficult to tolerate by patients, since the drugs have many undesirable effects. If the patient's kidneys are not functioning well, the amount of drugs is reduced, which helps reduce poisoning of the body.

Sclerosis

• urinary disturbances up to complete urinary retention.

• examination and interview of the patient,
• ascending contrast urethrography,
• urethroscopy,
• urofluometry,
• transrectal ultrasound.

Sclerosis is treated exclusively by surgery.

The symptoms are very similar to those of chronic cystitis.

• pain in the groin that appears from time to time,
• frequent urge to urinate.

Often in the fairer sex, a deterioration in the condition is observed before menstruation.

At the first stage, they resort to drug therapy, including antibiotics and irrigation of the bladder with medications. But similar treatment It helps very rarely.

Therefore, at the second stage, they resort to surgical treatment - removal of part of the bladder affected by the ulcer. If the diameter of the ulcer is large, a part of the intestine is delivered to the site of the removed area. In some cases even surgical treatment does not bring relief and the disease returns.

Hernia

• urinary disturbances,
• urinary excretion in two stages,
• urine with turbidity,
• before urine output hernia formation becomes larger and decreases after urination.

• cystoscopy,
• ultrasound examination of the bladder,
• cystography.

Treatment is only surgical. The operation is performed under general anesthesia, it is cavity. After the operation, the patient remains in the hospital for another five to seven days.

The operation is not considered very difficult, but after it there may be the following complications: divergence of the edges of the surgical wound, return of the hernia, peritonitis, urinary leaks, formation of a vesical fistula.

Endometriosis

• penetration of endometrial cells from the ovaries onto the bladder mucosa,
• release of menstrual blood,
• spread of endometriosis from the anterior wall of the uterus.

Sometimes the endometrium is transferred to the bladder during a caesarean section. In addition, there is also congenital endometriosis.

• heaviness in the lower abdomen, which is more pronounced before menstruation,
• frequent urination, sometimes painful,
• presence of blood in the urine.

After warming up, the patient's condition worsens.

Treatment of the disease is only surgical.

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Neurogenic bladder

A normally functioning bladder must store and remove urine in a coordinated and controlled manner. This coordinated activity is regulated by the central and peripheral nervous systems. What happens when the bladder malfunctions as a result of dysfunction, injury, illness or injury. The information below should help you recognize this problem before serious damage occurs.

What happens normally?

The bladder is a spherical organ, lined on the inside with mucous membrane and containing a layer of muscle in the wall. The bladder neck (located in front of the entrance to the urethra), the urethra (the tube that serves as a channel for the passage of urine from the bladder to the outside), and the external urethral sphincter (a group of muscles that prevent the release of urine and are located below the bladder neck) complete the urinary tract.

Muscles and nerves urinary system must function in coordination with the bladder to implement the function of storing and excreting urine. Nerves communicate between the bladder and the brain and then send signals from the brain to the bladder muscles, controlling their contraction or relaxation, which allows the bladder to be emptied during urination.

What is a neurogenic bladder?

Neurogenic bladder is a disorder of normal bladder function caused by damage to part of the nervous system. The damage can cause the bladder to be inactive, unable to contract, or overactive, contracting too quickly and often.

What are the risk factors for neurogenic bladder?

Risk factors for neurogenic bladder include various birth defects that adversely affect the spinal cord and bladder function, including spina bifida and other spinal cord abnormalities. Tumors of the spinal cord or pelvic organs can also disrupt this process, causing danger to humans. Spinal cord injury is also an important risk factor for the development of a neurogenic bladder.

What are the symptoms of neurogenic bladder?

Inability to control urination, also called urinary incontinence, can be a common symptom associated with a neurogenic bladder. This may be caused by an impairment of bladder capacity or a malfunction of the innervation mechanisms of the bladder neck or external bladder sphincter, which are important for the continence function of the bladder.

Symptoms such as sluggish urination, straining while urinating, and inability to urinate may also be associated with a neurogenic bladder. Urinary retention may be associated with dysfunction of the bladder muscles, incoordination between the bladder muscle and the external urethral sphincter.

Symptoms such as frequent urination and urinary urgency may be symptoms of an overactive bladder.

Other symptoms may include painful urination, which may be the result of a urinary tract infection caused by urine sitting in the bladder for a long time. Urinary tract infections and fever are signs of a serious kidney infection (pyelonephritis). And this is a rather alarming situation, because... may cause permanent kidney damage.

Stones can also form in the urinary tract of people with a neurogenic bladder, which can cause urine flow problems and/or infection. Pathological reflux of urine from the bladder into the kidney is called vesicoureteral reflux; it can develop as a consequence of increased intravesical pressure within the bladder. Urinary tract infections are of particular interest because they cause the risk of serious kidney infections by sending infected urine from the bladder directly to the kidney.

How is neurogenic bladder diagnosed?

If a neurogenic bladder is suspected, both the nervous system (including the brain) and the bladder itself should be examined. In addition, the following diagnostic procedures may be performed to complete the medical history and physical examination:

• radiography of the skull and spine
• electroencephalography to identify brain dysfunction
• ultrasound examination of the bladder or ureter
• functional tests, which involve filling the bladder to see how much fluid is being retained and how the bladder is emptying

How is neurogenic bladder treated?

Treatment of overactive bladder may reduce symptoms of irritation and/or incontinence. Antibiotics are necessary to treat and prevent urinary tract infections, especially in patients with vesicoureteral reflux. Other medications may help improve bladder control by increasing bladder neck resistance.

Jack Lapides initially proposed intermittent catheterization as a way to empty the bladder in cases of detrusor dysfunction, when it is unable to contract, with discoordination between the detrusor and the external sphincter of the bladder.

Endoscopic surgery can provide free urination without the need for intermittent catheterization to empty the bladder.

In addition, endoscopic injections of paralytic substances into the external urethral sphincter can be used, which provides temporary relief of symptoms.

Permanent stenting of the bladder neck can also be used to improve urination.

However, sometimes anatomical damage bladder is so serious that surgical enlargement of the bladder (using various tissues), elimination of vesicoureteral reflux, and installation of a cystostomy drainage to empty the bladder is necessary.

What to expect after treatment for neurogenic bladder?

Extensive follow-up testing of bladder and renal function will be necessary. Repeated x-rays, ultrasounds, blood tests, and bladder function tests may be necessary.

Although some neurogenic bladder symptoms can be improved or eliminated, most problems require ongoing attention and monitoring. Preventive treatment of bladder problems reduces the risk of bladder and kidney damage and the need for follow-up surgical intervention. This also applies to the treatment of neurogenic bladder in patients with Spina bifida.

FAQ:

What is the likelihood that a child with spina bifida will develop a neurogenic bladder?

The risk of developing neurogenic bladder exists in this group of people, so regular and careful monitoring is recommended.

What are the restrictions for bladder patients?

The reason for the restrictions, as a rule, is the reasons for the development of the neurogenic bladder and not the bladder itself.

Is it possible to prevent unwanted effects Bladder?

Some neurogenic bladder symptoms can be prevented with enhanced treatment or surgical interventions.

Neurogenic bladder. Why bladder dysfunction occurs, symptoms, causes, diagnosis and treatment of neurogenic bladder

This disease belongs to the specializations: Urology

1. Why bladder dysfunction occurs

The bladder is one of the few organs whose work is associated with consciousness. The accumulation of urine and the urge to urinate occur with the participation of humoral regulation However, a person is able to control the moment of emptying the bladder. The nervous system sends signals about the need to remove urine from the body, and it also triggers mechanisms that contract the bladder and open the urine exit channels. This is a rather complex process, violations of which lead to a functional pathology called “neurogenic bladder.” The walls of the bladder may become hypotensive or, conversely, become hypertonic. In both cases, control over the process of urination suffers, which causes a lot of inconvenience to the person.

As the bladder fills, signals are sent to the brain to empty it. When a person goes to the toilet, the conscious readiness to urinate is complemented by brain impulses that ensure the contraction of the bladder walls and the removal of urine from the body.

A complex chain of conscious and unconscious mechanisms must work very harmoniously. Otherwise, if at some stage the nerve impulses do not pass through or are distorted, the person experiences difficulty urinating or loses control over this act.

Dysfunction of the neuromuscular structures of the bladder not only brings discomfort to the patient’s life, but can also cause the development of concomitant diseases of the urinary system: pyelonephritis, cystitis, nephrosclerosis and chronic renal failure. Long-term problems with urination create a tense psycho-emotional background, which, combined with disorders of fluid metabolism in the body, provokes arterial hypertension in many patients.

2. Symptoms of a neurogenic bladder

There are two types of neurogenic bladder:

With a hyporeflex neurogenic bladder, the walls of the organ lose their elasticity and are unable to contract to the required extent. The bubble becomes stretched and increases in size. Added to this is the relaxation of the sphincter, which causes urinary incontinence. In addition, hyporeflexia allows urine to enter the ureters and renal pelvis, where it provokes inflammatory processes. Hyporeflex bladder is most often caused by disturbances in sacral region nervous system.

A hyperreflexive bladder is usually associated with nerve impulses emanating from the brain. In this case, with the slightest accumulation of urine, the urge to urinate occurs. As the bladder suffers from retention and filling with urine, it decreases in size. This condition is often combined with severe form cystitis.

In any case, the set of subjective sensations with a neurogenic bladder comes down to the following manifestations:

• urinary incontinence;
• dissatisfaction with the act of urination;
• frequent urge to urinate in combination with a small volume of urine produced;
• pain during emptying the bladder or immediately after;
• the need to visit the toilet several times during the night.

3. Causes of neurogenic bladder

This disease affects people of both sexes, as well as children and the elderly. And the reasons for the development of this pathology are different in each case.

In children, the diagnosis of “neurogenic bladder” is not made until the age of two, since during the first two years the child only develops the ability to control the process of urination. At a later age, it is necessary to identify the congenital or acquired nature of this disease.

In adults, a neurogenic bladder may be the result of concomitant diseases, injuries or mental disorders.

Chronic degenerative processes and tumor diseases in the brain and spinal cord are often manifested precisely by difficulties with urination. The neurogenic bladder develops against the background of:

• Alzheimer's disease;
• Parkinson's disease;
• with multiple sclerosis;
• after a stroke;
• for hernias and spinal injuries.

4. Diagnosis and treatment of neurogenic bladder

An examination when a patient complains of urinary problems begins with a history and examination. The patient is recommended to keep a diary for a certain period of time, recording the volume of liquid drunk and urine excreted. The doctor also prescribes:

• urine analysis according to Zimnitsky;
• urine analysis according to Nechiporenko;
• cystoscopy of the bladder;
• Ultrasound diagnostics;
• X-ray with contrast.

In the absence of signs of inflammation in the genitourinary system, diagnosis is complemented by studies of the brain and spinal cord:

• radiography of all parts of the spine;
• computed tomography of the head;
• electroencephalography.

A treatment plan is developed based on the diagnostic data obtained. The identified disorders determine which doctor will deal with the problem of neurogenic bladder. If a specific reason is identified that provokes disturbances in the chain of regulation of the urination process, therapeutic tactics is aimed at eliminating this problem. The consequences of injuries and neoplasms may require surgical treatment.

Neurogenic bladder - symptoms, causes, treatment

Neurogenic bladder is a condition in which the normal functionality of the bladder is impaired due to damage to multiple parts of the nervous system. This disease occurs due to the fact that a person has experienced a spinal cord or brain injury, and disturbances occur in the functionality of the nerve that is responsible for controlling the muscles of the walls of the bladder or its circular muscle (sphincter); in some cases, functionality may be impaired in several areas .

The neurogenic bladder is hypotonic, cannot contract normally, and does not empty completely, or, on the contrary, is too spastic, when it is very active during contraction, while the person cannot control his reflexes and control emptying.

Symptoms of a neurogenic bladder

Signs of the disease will depend on whether the bladder is flaccid or spastic.

Due to the fact that the bladder is hypotonic and cannot be completely emptied, it stretches greatly and then becomes very large. When enlarged, a person does not develop pain because the bladder expands too slowly. In some patients, the increase does not go away, a little urine is constantly released, and the person experiences incontinence due to the fact that the bladder is full.

Often, a sluggish bladder becomes infected because bacteria begins to develop due to the accumulation of urine that remains in the bladder. Because of this, stones form, especially if the infection is chronic, for this you need to constantly use a catheter.

If a patient has a spastic urinary tract, it may empty itself reflexively, the urge to urinate varies, and may be completely absent. The pressure and backflow of urine damages the kidneys. People with spinal cord damage cannot control the contractions of the bladder because the muscles are relaxed, which causes pressure in the bladder to increase and the renal pelvis does not empty completely.

Causes of neurogenic bladder

A hypotonic bladder occurs because the functionality of the nerve that controls the bladder muscles is impaired. This disease often affects children who have congenital pathology in the development of the spinal cord - with spina bifida or when the spinal cord protrudes between the vertebrae.

A spastic bladder occurs when its functionality is impaired due to the brain or spinal cord. This happens due to injury or sclerosis, which can affect the spinal cord, leading to paraplegia (paralysis of the legs) or paralysis of the arms. At first, the bladder becomes flaccid, then begins to empty uncontrollably, thus developing into a spastic one.

Diagnosis of neurogenic bladder

You can find out about an enlarged bladder after a full examination of the lower abdomen. To do this, an x-ray is performed - a radiopaque substance is injected intravenously or using a catheter into the urethra or bladder.

X-ray examination helps to find out about the size of the bladder and ureter, and to detect stones and kidney damage in time.

The patient must be prescribed an ultrasound and cytoscopy, with which one can find out about the inner surface of the bladder; for this, a fiber-optic tube is inserted, this diagnosis is not painful.

The remaining urine in the bladder can be determined after the catheter is inserted; the pressure is measured using a cystometrograph.

Treatment of neurogenic bladder

If the damage is neurological in nature, a catheter is inserted into the sluggish urethra so that urine can be continuously discharged.

It is very important to detect a neurogenic bladder in time in order to begin the procedure, this way you can protect yourself from damage, infection and overstretching of the muscles in the bladder.

For women, the catheter is not as dangerous as for men, because it can cause an inflammatory process in the urethra and the tissue that surrounds it.

In cases of spastic bladder, a catheter can be inserted only if muscle spasms prevent it from emptying completely. If a man has quadriplegia and cannot use a catheter himself, in this case needed radical methods– the sphincter must be cut so that the person can empty his bladder. After the surgical intervention, the patient will need to wear a special vessel on his body with which urine can be collected. Electrical stimulation is used to restore contractions in the bladder, but this type of treatment has not yet been fully developed.

With the help of drug therapy, you can improve the functioning of the bladder. In cases where the bladder is spastic, medications that are responsible for muscle relaxation will help. But they have many side effects - dry mouth, constipation. Medicines are not effective in treating neurogenic bladder.

In severe cases, surgery is needed to connect the stoma (made in the abdominal wall) and the bladder. Thus, urine is excreted. This procedure is called iliac loop formation. In some situations, cystoplasty may be prescribed, when a small piece of intestine is used to enlarge the bladder.

It is very important to monitor the condition of the kidneys; if an infection occurs, treat it immediately. Drink as much fluid as possible - up to 4 liters per day. If a person is not paralyzed, he should move as much as possible. The neurogenic bladder is restored depending on the disorder; some patients feel better after a full course of treatment.

So, a neurogenic bladder is a pathological condition of the urethra, in which some parts of the nerves responsible for removing urine from the human body are disrupted.

Urine, constantly filtered from the blood plasma by the kidneys, flows through the ureters into the bladder. Here it accumulates to a certain volume and is then excreted through the urethra from the body. The process of urination, or miction, is a complex of complex and sequential actions that the organ performs together with the urethra up to 10 times a day, under the control of the spinal nerves and cerebral cortex. Let's take a closer look at how this happens, where the bladder is located, whether there are differences in its structure and functions in men, women and children of different ages, what is the view of its activity in Eastern medicine.

How does the bladder work?

This unpaired spherical organ is created to serve as an excellent container for urine entering the ureters. It can stretch and increase its volume if necessary, but up to certain values. Depending on the height and weight of a person, the size of the organ varies. On average, bladder capacity is 500-700 ml, but there are significant individual variations.

Thus, the volume of the bladder in men is slightly larger than in women and children, and varies from 350 to 750 ml. The female organ holds 250-550 ml of urine; normal volume in children, taking into account their constant growth, also gradually increases. So, in one year old it is 50 ml, at 3 years old - 100 ml, and at 11-14 years old it can reach up to 400 ml. In some conditions, when it is impossible to empty the bladder in time, its walls stretch significantly, and the capacity in adulthood reaches 1000 ml (1 liter) of urine.

The organ size is individual characteristics in gender or age aspect, but it can also be influenced by various pathological or physiological conditions. For example, some diseases or degenerative processes.

All these factors can be represented as follows:

• surgical correction that reduces the size of the organ;
• long-term chronic diseases, leading to “wrinkling”;
• neoplasms that reduce the volume of internal space;
• influence from other internal organs (for example, compression of the bladder in women by the growing uterus during pregnancy);
• neurological diseases;
• degenerative-dystrophic processes in old age, leading to loss of normal tone of the detrusor or sphincters.

The brain is actively involved in urination

The inner surface of the organ has special baroreceptors that respond to increased pressure in it. As soon as approximately 200 ml of urine accumulates, the pressure in the cavity increases, and signals about this are sent to the cerebral cortex, to those parts of it that are responsible for the act of urination. From this moment on, a feeling of urge is formed, and the person knows that he will soon need to go to the toilet.

As urine accumulates, the urge to urinate increases, but the sphincter of the bladder is in a compressed state, preventing involuntary leakage of fluid. With the help of the sphincters of the organ and the urethra, a person can hold urine for 2 to 5 hours. The process of miction itself is regulated both by the cerebral cortex and by nerve branches extending from the spinal cord, and occurs as a result of contraction of the muscle layer and relaxation of the sphincters.

In children, the process of developing a normal urination process is quite long and takes 3-4 years (although, if parents try, they can teach a child to ask to go potty even at 1.5-2 years). From an unconditioned spinal reflex it becomes a voluntary reflex. This involves the cerebral cortex, subcortical centers, spinal zones (parts of the spinal cord), and the peripheral nervous system.

There are many different congenital and acquired diseases in which the urination process is disrupted. The reasons may lie in organic, or somatic, pathologies of the organ that affect the normal structure of tissues (infectious diseases, neoplasms, effects of neighboring organs) or in disruption of nervous regulation.

Structure

The anatomy of the bladder includes its localization in the human body, interaction with surrounding structures, macroscopic (conditional division into parts) and microscopic structure(from what fabrics). This organ looks like a small round sac and is located in the pelvic cavity. If it is emptied, it occupies a small volume and is completely hidden by the symphysis pubis. To that bone formation it adjoins with its front surface. As it fills, its size also increases, the walls of the organ straighten, and it gradually begins to rise above the symphysis pubis. In this state, it can be palpated (palpated) during a medical examination, ultrasound scanning, perform a puncture through the anterior abdominal wall.

The walls of the organ can be affected by various diseases, and the urethra can be compressed by the enlarged prostate gland

The posterior surface of the bladder in women comes into contact with the organs of the reproductive system: the vagina, uterus and ovaries. Further back is the final segment of the intestine, the rectum. The bladder in men is separated from the intestine by the seminal vesicles and a segment of the vas deferens. The upper part of the organ borders the loops small intestine. In newborn babies it is located higher than in adults, above the symphysis pubis. Only after a few months the apex disappears behind a bone formation.

The human bladder can be divided into several components:

• walls – front, side, back;
• body;
• bladder neck.

The anterior wall of the organ borders the anterior abdominal wall and the pubic joint, separated from them by a layer of loose fatty tissue that fills the prevesical space. The posterior and lateral walls are also separated from neighboring structures by fiber and the visceral layer of the peritoneum (a special tissue layer covering all organs). The upper part of the organ is more mobile and capable of significantly stretching, since it is not fixed by the ligamentous apparatus. With a large stretch, the thickness of the walls can be only 2-3 mm; with an empty organ, it reaches 15 mm.

On back wall , in its middle part, the bubble has two holes. These are the orifices of the ureters, symmetrically located, and they flow into the organ cavity at a certain angle. This fact is extremely important, since this forms a kind of “closing” mechanism that prevents urine from entering the ureters during detrusor contraction and urination. When this mechanism is disrupted, vesicoureteral reflux is formed, which can be called both an independent disease and a complication of other pathologies of the urinary system.

The oblique entry of the ureters is very important for the formation of a special valve mechanism

The upper part of the hollow organ is conventionally divided into an apex and a bottom. The bottom part is located behind and faces down, and the apex is directed towards the anterior abdominal wall and passes into the umbilical ligament. The bottom of the bladder, when filled with urine, rises above the symphysis pubis, so the apex begins to fit tightly to the anterior abdominal wall. The body of the organ is located between the bottom and the apex.

The lower part gradually narrows and forms the neck of the bladder, which, through the sphincter apparatus, passes into the urethra. In a man, the upper part of the urethra and the neck of the bladder are covered by prostate tissue, which, when developed in it, pathological processes, has a huge impact on the process of urination. In women, the bladder in its lower part borders directly on the muscles of the pelvic diaphragm.

The organ wall is three-layered and consists of the following structures:

• mucous membrane and submucosal layer;
• detrusor, or muscle layer;
• outer membrane covered by the visceral layer of peritoneum.

At histological examination(examination of tissue under a microscope) it is discovered that the mucous membrane consists of an outer epithelial layer and an underlying submucosal plate formed by loose connective tissue. It is thanks to the submucosal layer that when the cavity is unfilled, the mucous membrane forms a large number of folds, which straighten out when the organ is stretched. But the submucosal layer is not present everywhere. It is absent in the area of ​​the so-called vesical triangle, the apexes of which are the openings of the ureters and the orifice of the urethra. In this zone, the mucous membrane is adjacent directly to the muscle layer.

The urothelium, or epithelial layer of the mucous membrane, has several rows of cells. Each of them performs a specific task. Thus, the outermost layer consists of rounded cells, which, when the organ wall is stretched, become flat, thereby ensuring the integrity of the structure.

The transitional epithelium of the mucous membrane consists of several rows of cells various shapes and appointments

The muscle layer is made of three types of fibers, the functionality of which ensures the functioning of the entire organ: longitudinal, transverse, circular. Circular muscle fibers are especially developed around the ureters flowing into the organ and the mouth of the urethra. In these places they form muscular sphincters, or sphincters. During cystoscopy, in the resulting photo of the bladder from the inside, the ureteral sphincters look like small depressions, and the more developed sphincter in the lower part of the organ looks like a crescent-shaped area with a pink tint.

Functions

The most important task of the organ is to accumulate a certain amount of urine, store it for a certain time and regularly remove it from the body. These tasks are performed as expected if the mucous membrane is not affected by an inflammatory or tumor process, the size of the organ is within normal limits, and all sphincters and detrusors, regulated by the nervous system, function like a “clock.”

As soon as even one of these mechanisms is disrupted, the functionality of the organ is impaired, which is expressed by various dysuric symptoms. So, with a neurogenic disorder, it “breaks” normal regulation muscle layer and sphincters from the nervous system. This occurs with congenital or acquired neurological diseases, and hypo- or hyperreflexia is diagnosed, which is expressed either by incontinence or urinary retention (when the patient cannot urinate regularly). In another pathology, vesicoureteral reflux, which is formed in the absence or underdevelopment of the valve and sphincter mechanisms of the ureters, reverse flow of urine is observed. This may lead to undesirable consequences in the form of pyelonephritis and other kidney diseases.

Oriental medicine specialists have a completely different view of health and illness

What is the urinary meridian and channel

From the point of view of Eastern medicine, each internal human organ has special channels, or meridians, through which it receives energy. These meridians, including the bladder channel, intertwine and connect with each other, emerge from one another, forming a single whole. It is the interaction of the channels of the internal organs and the energy flow flowing through them that explains both the health of people and their various diseases.

The bladder meridian not only regulates the formation of urine in the kidneys, its accumulation and removal during urination, it is through it that all waste and toxins are removed from the body. It is quite long and branched, due to which it can influence the activity of other organs. The bladder canal starts from the eyes, passes through the parietal part of the head, then between the shoulder blades it runs along the spine and at the sacrum it enters the body, reaching the kidneys and ending in the hollow organ. Its branches cover the head, body, and descend to the feet.

This meridian is paired and symmetrical and belongs to the Yang type; energy moves along it in a centrifugal direction. If it is excessive, then the following symptoms are formed: pain in the abdomen and back, increased urination, spastic contraction calf muscles, pain in the eyes, watery eyes, maybe nose bleed. With a lack of energy, urination becomes rare, swelling, pain in the spine, weakness in the legs, and hemorrhoids appear.

The minimum energy activity of the channel is observed at night, between 3 and 5 o'clock; at this time it is not allowed to influence the meridian. The most convenient time to influence the channel is the interval between 15 and 17 hours. It is then that Eastern medicine specialists seek to treat the patient by influencing the organs through the bladder meridian.