Urination

urination, also called Micturition, the process of excreting urine from the urinary bladder. Nerve centres for the control of urination are located in the spinal cord, the brainstem, and the cerebral cortex (the outer substance of the large upper portion of the brain). Both involuntary and voluntary muscles are involved.

The urinary bladder is a storage reservoir for urine—a liquid containing waste products given off by the body and extracted from the bloodstream by the kidneys. The major contractile muscle of the bladder is the detrusor. Urination involves either sustained contractions or short intermittent contractions of the detrusor along with contraction of the muscles in the urethra, the duct from the urinary bladder that conducts urine from the body.

In man and most other animals, voiding of the bladder is influenced by the volume of urine it contains. When 100–150 millilitres (3.5–5 ounces) of urine accumulate, the first sensations of a need to void are felt. The feeling increases in intensity as more urine accumulates, and it becomes uncomfortable at a bladder volume of 350–400 millilitres. Impulses from the pelvic nerves mediate the sensations of bladder filling, painful distension, and the conscious need to urinate.

A slowly filling bladder adapts progressively to the pressure from increased volume. Hence, a bladder that is rapidly filled stimulates urination faster than one that fills slowly. When enough pressure is sensed by the walls of the bladder, the detrusor muscle contracts, the bladder neck and opening to the urethra relax, and the contents of the bladder are emptied. Normally the bladder empties completely.

Voluntary restraint of urination involves inhibition of bladder contraction, closure of the opening to the urethra, and contraction of the abdominal muscles. The ability to start and stop the flow of urine depends largely on the normal functioning of the muscles of the pelvic floor, the abdominal wall, and the diaphragm (the muscular partition between the abdomen and the chest). Infants’ lack of inhibitory control over urination is related to the immaturity of the nervous system. Likewise, degeneration or destruction of certain areas of the central nervous system leads to incontinence due to the so-called neurogenic bladder. Such incontinence may be a dribbling overflow from a permanently distended bladder, or an efflux from a contracted bladder whose outlet is always open.

If the full bladder is not emptied, it becomes overdistended. In time, bladder distension can cause bleeding, ulcerations, and rupture of the bladder wall. Obstruction to the outflow of urine can follow enlargement of the prostate (the gland in males that encircles the urethra close to the bladder), swelling of the urethral tissue around its channel, fibrous stricture of the urethra, or contraction of the muscles at the openings of the bladder and the urethra. Usually urine is retained until the pressure in the bladder overcomes the obstruction. With moderately chronic retention and stress, the detrusor muscle increases in tone and the contractile force of the bladder is increased. When overdistension occurs over long periods, the detrusor muscle produces small rhythmic contractions that cause dribbling of urine. With continued distension, the muscle can become paralyzed, and urine voiding takes place only by overflow; this condition is usually termed passive incontinence. There may also be flow of urine back to the kidneys under these conditions, causing failure of kidney function.