nonneurogenic neurogenic bladder
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non·neu·ro·gen·ic neu·ro·gen·ic blad·der
motor paralytic bladder
nonneurogenic neurogenic bladderSee: Hinman syndrome
The bladder is situated in the anterior inferior portion of the pelvic cavity. In the female it lies in front of the anterior wall of the vagina and the uterus; in the male it lies in front of the rectum. The lower portion of the bladder, continuous with the urethra, is called the neck; its upper tip, connected with the umbilicus by the median umbilical ligament, is called the apex. The region between the openings of the two ureters and the urethra is the trigone. The wall of the bladder has three major layers. The mucous membrane lining is transitional epithelium. The middle layer is three sheets (longitudinal, circular, longitudinal) of smooth muscle, called the detrusor muscle. The outer layer on the superior surface is the visceral peritoneum; on the lateral and inferior surfaces it is areolar connective tissue. The bladder is supported by numerous ligaments; it is supplied with blood by the superior, middle, and inferior vesical arteries, and drained by numerous veins and lymphatics; and it is innervated by branches of the third and fourth sacral nerves by way of the hypogastric plexus.
The bladder has a normal storage capacity of 500 ml (about 16 oz) or more. In disease states it may be greatly distended. A frequent cause of distention of the bladder in older men is interference with urination due to hypertrophy of the prostate gland, which surrounds the urethra and neck of the bladder.
An average of 40 to 50 oz (about 1.2 to 1.5 L) of urine is excreted in a 24-hr period, but this varies with the amount of fluid ingested and the amount lost through exhalation, sweat, and the bowels. Inability to empty the bladder is known as retention and may require catheterization. Sphincter muscles are part of the mechanism that controls retention within the bladder.
For patients who need help in managing bladder elimination problems there are a variety of options: indwelling urethral catheters, Kegel exercises, intermittent catheterization, suprapubic indwelling catheters, external collecting devices (urinals and specially designed bedpans), medications for promoting bladder emptying (such as bethanechol, phenoxybenzamine, diazepam, dantrolene, or baclofen), and medicines to promote bladder storage (such as imipramine, oxybutynin, propanthelene, pseudoephedrine, or phenylpropanolamine). For men, a condom designed to collect and contain urine is available. See: bladder training
The force of urination is much greater in a child than in an adult because in the child the bladder is more an abdominal organ than a pelvic one. The child's abdominal muscles help to expel the urine.
Palpation: The bladder cannot be palpated when empty. When full it appears as a tumor in the suprapubic region that is smooth and oval on palpation.
Percussion: When it is distended with urine, the rounded superior margin is easily made out by observing the tympanic sound of the intestines on one hand and dull sound of the bladder on the other.