Urinary Bladder

Question 1

What is the location of the urinary bladder?

Answer 1

below the peritoneum

Question 2

How does the location of the urinary bladder differ between males and females?

Answer 2

lower in the female than in the male

• prostate lifts it up in males
• uterus pushes it down in females

Question 3

What affects the size, shape, and position of the urinary bladder?

Answer 3

• age

- amount of urine which it contains

Question 4

What is the position of the urinary bladder when it is empty?

Answer 4

it lies entirely within the pelvis and rests against the pubis and the adjacent pelvic floor

Question 5

How does the position of the urinary bladder change as it fills up with urine?

Answer 5

as it fills, it rises into the abdomen and may reach the level of the umbilicus

Question 6

What is the urinary bladder like at birth?

Answer 6

• it is spindle shaped and lies mostly in the abdomen

- long and skinny tube

Question 7

When does the urinary bladder assume its adult shape and position?

Answer 7

during childhood

Question 8

What is the shape of the empty urinary bladder?

Answer 8

it has been compared to that of a ship

Question 9

What are the surfaces of the urinary bladder?

Answer 9

• superior (“deck”)
• left inferolateral (“side”)
• right inferolateral (“side”)
• fundus/base (“stern”)

Question 10

What forms the apex (“bow”) of the urinary bladder?

Answer 10

the superior and the two inferolateral surfaces meet in front to form the apex

Question 11

What structure comes off the apex of the urinary bladder?

Answer 11

median umbilical ligament

Question 12

What forms the neck of the urinary bladder?

Answer 12

the inferolateral surfaces and fundus meet below to form the neck

Question 13

What structure comes off the neck of the urinary bladder?

Answer 13

urethra

Question 14

What is the relation of the urinary bladder to the peritoneum?

Answer 14

peritoneum overlies the superior surface of the bladder

Question 15

What overlies the empty urinary bladder in the female?

Answer 15

the body of the uterus

Question 16

What results in frequent micturition during pregnancy?

Answer 16

the position of the uterus over the bladder

Question 17

What is the retropubic space?

Answer 17

• a U-shaped space between the pubis and bladder
• it contains the retropubic fat pad
• present in both males and females
• acts as a shock absorber
• cushioning of pad may not be sufficient; some distance runners notice blood in the urine after a long run - due to jarring of the bladder

Question 18

Which ligaments function to hold the bladder in place

Answer 18

• puboprostatic (pubovesical) ligament

- lateral ligament of the bladder

Question 19

What does the puboprostatic (pubovesical) ligament attach?

Answer 19

attaches the prostate gland (or neck of the bladder in the female) to the pubis

Question 20

What does the lateral ligament of the bladder attach?

Answer 20

passes from the base of the bladder to the rectovesical fold (males) or rectouterine fold (females)

Question 21

What is the trigone?

Answer 21

a small triangular structure located on the posterior and inferior wall of the bladder

Question 22

What are the openings in the trigone?

Answer 22

• internal urethral orifice: below and in front

- two ureteric orifices: above and behind

Question 23

How do the ureters travel? What is produced?

Answer 23

• travel obliquely through the bladder wall in an inferomedial direction
• produces a flap valve: ureter is compressed when the bladder is full or during micturition, preventing the reflux of urine into the ureters

Question 24

What is the interureteric crest?

Answer 24

• extends between each of the ureteric orifices

- upper edge of trigone

Question 25

What is the uvula of bladder?

Answer 25

• median ridge which extends above and behind the internal urethral orifice
• extends up to interureteric crest

Question 26

What is the detrusor muscle?

Answer 26

• bundles of smooth muscle which lie within the wall of the bladder
• squeezes the bladder to empty it

Question 27

What is the internal urethral sphincter?

Answer 27

• a circular layer of smooth muscle which surrounds the neck of the bladder in males (around the internal urethral orifice)
• prevents reflux of semen into the bladder during ejaculation

Question 28

What is the arterial supply to the urinary bladder?

Answer 28

• superior vesical arteries (from patent part of umbilical artery)
• inferior vesical arteries (from internal iliac artery)
• vaginal artery

Question 29

What is the venous drainage of the urinary bladder?

Answer 29

• Males: drained by the prostatic plexus of veins
• Females: drained by the vescial plexus of veins
• both drain into the internal iliac vein

Question 30

What is the innervation to the bladder?

Answer 30

• prostatic and vesical plexuses, which are extensions of the inferior hypogastric plexus
• sympathetic fibers from lower 3 thoracic and upper 2 lumbar levels
• parasympathetic fibers from pelvic splanchnic nerves (S2-S4)

Question 31

Describe the mechanism of micturition.

Answer 31

• Bladder fullness initiates the micturition reflex (learn to suppress during toilet training).
• Activation of parasympathetic fibers from the pelvic splanchnic nerves (S2-S4) causes contraction of the detrusor muscle (in both sexes) and relaxation of the internal urethral sphincter (in males).
• The external urethral sphincter is relaxed under voluntary control.

Question 32

What is the chiropractic note concerning the urinary bladder?

Answer 32

Sacral misalignment has been found to be related to nocturnal enuresis (bedwetting).