Autonomic control of the pelvic viscera control of micturition
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AUTONOMIC CONTROL OF THE PELVIC VISCERA & CONTROL OF MICTURITION PowerPoint PPT Presentation


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AUTONOMIC CONTROL OF THE PELVIC VISCERA & CONTROL OF MICTURITION. BY DR. O. A. ROBERTS DEPT OF OBGYN, UCH, IBADAN. AUTONOMIC CONTROL OF THE PELVIC VISCERA. AUTONOMIC SYSTEM OF NERVES: Lies- Sidewall of Pelvis lat. to Rectum

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AUTONOMIC CONTROL OF THE PELVIC VISCERA & CONTROL OF MICTURITION

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Autonomic control of the pelvic viscera control of micturition

AUTONOMIC CONTROL OF THE PELVIC VISCERA & CONTROL OF MICTURITION

BY

DR. O. A. ROBERTS

DEPT OF OBGYN,

UCH,

IBADAN.


Autonomic control of the pelvic viscera

AUTONOMIC CONTROL OF THE PELVIC VISCERA

AUTONOMIC SYSTEM OF NERVES:

Lies- Sidewall of Pelvis lat. to Rectum

Sympathetic: Fibres From Hypogastric Plexus plus upper sacral ganglia of the Sypathetic Trunk. The plexus is ganglionated (T11&12).

Pre-ganglionic Fibres (half) synapse here while post-g. do not Synapse.

Parasympathetic fibres only synapse in the Visceral walls. Arising from S 2-4 bodies (Nervi Erigentes)

SYMPATHETIC FIBRES = VASOCONSTRICTOR

PARASYPATHETIC = MOTOR TO BLADDER, GUT & SECRETOMOTOR TO GUT GLANDS.


Autonomic control of the pelvic viscera1

AUTONOMIC CONTROL OF THE PELVIC VISCERA

  • THE SYMPATHETIC FIBRES ARE MOTOR TO SMTH. MUSCLE OF BLADDER & ANAL SPHINCTERS.

  • COURSE OF PAIN AND SENSORY FIBRES COMPLEX:

  • MOST TRAVEL WITH SYMP. SYSTEM,

    ESPECIALLY, FROM GUT & GONADS.

    THOSE FROM BLADDER & RECTUM ?TRAVEL IN NERVI ERIGENTIS. SAME FOR CERVIX

    UTERINE FIBRES FOLLOW HYPOGASRIC NN. TO DORSAL NERVE ROOTS OF T11 & 12.


Autonomic control of the pelvic viscera2

AUTONOMIC CONTROL OF THE PELVIC VISCERA

  • THE VAGINAL SUPPLY:

    • Sympathetic ganglia in Lower Lumbar via Hypogastric plexus.

    • Parasymp. Outflow S2-4 (nervi erigentis).

    • N.B. Nerve endings undecorated but PACINIAN copuscles found in adventitia.

      • VULVAL SUPPLY:

        • Postganglionic Symp. Fibres from Hypogastric plex. Via Pudendal Nn.

        • Parasympathetic S2-4 as Nervi Erigentis to join the pelvic plexus.


Control of micturition

CONTROL OF MICTURITION

BLADDER = HOLLOW MUSC. ORGAN BEHIND SYMPHISIS. MADE UP OF SMOOTH MUSCLE SYNCITIUM.

DETRUSOR MUSCLE= ↑Achase parasympathetic Nn S2-4

BLADDER DOME, URETHRA, BLADDER NECK = ß & α Adrenergic receptor symp. Outflow T10 - L2.

RHABDOSPHINCTER URETHRAE: Striated mm. in the middle of urethra – circularly arranged (External Sphincter or INTRINSIC SPHINCTER MECHANISM). FOR URETHRAL CLOSURE AT REST


Control of micturition1

CONTROL OF MICTURITION

  • S2-4 Nn. Roots traveling with Pelvic Splanchnic Nn. Supply smooth muscle of the urethra (longitudinally arranged & continuous with detrusor).

  • EXTRINSIC SPHINCTER MECHANISM:

    • Striated periurethral Mm (Levator ani) at junction of middle & lower 1/3of the Urethra.

      • For additional closure force at times of physical effort

        BOTH mechanisms Maintain greater I.U.P. than I.V.P. Ξ +VE Closure pressure.


Control of micturition2

CONTROL OF MICTURITION

  • Visceral Afferents => thoracolumbar nn & sacral efferents conveying the sensation of Bladder distention.

  • CNS control of Micturition:

    Complex, requiring a sacral spinal reflex arc modulated by frontal lobe, thalamus, B.G. & hypothalamus:

    Bladder stretch receptors => Visc. Afferents =>

    (with Pelvic Splanch. Nn.)

    => S2-4 Cord =>Controlled by Excitatory & Inhibitory receptor Centres which prevent Detrusor contractions & maintain Urethra sphincter control.


Control of micturition3

CONTROL OF MICTURITION

PHYSIOLOGY:

  • Storage Phase

  • I.V.P. = 10cm H2O

  • Gradual filling to 150-250ml => When 400-600ml of urine => Desire to void, I.V.P. = 25cm H2O.

  • Beyond this => Irresistible urge to void => release of cortical inhibition & voiding.


Control of micturition4

CONTROL OF MICTURITION

Voiding Phase

  • Relaxation of Pelvic Floor mm., Intrinsic straited mm. of the Urethra, fall in I.U.P.. Then efferent Parsymp. Detrus or stim. & contration (max 60cm H2O ). Once voiding in progress, I.V. P constant. Detusor mm efficiency ↑ with shortening of the Fibres, hence less force is reqd to maintain Mict.

  • N. B.Interruption is by contr. of Extrinsic Striated mm. of Pelvic floor.


Thank you

Thank you


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