Micturition Involves Autonomic and Somatic Nerves

Micturition (urination), the periodic emptying of the bladder, is a complex act involving both autonomic and somatic nerve pathways and several reflexes that can be either inhibited or facilitated by higher centers in the brain. The basic reflexes occur at the level of the sacral spinal cord and are modified by centers in the midbrain and cerebral cortex. Distension of the bladder is sensed by stretch receptors in the bladder wall; these induce reflex contraction of the detrusor and relaxation of the internal and external sphincters. This reflex is released by removing inhibitory influences from the cerebral cortex. Fluid flow through the urethra reflexively causes further contraction of the detrusor and relaxation of the external sphincter. Increased parasympathetic nerve activity stimulates contraction of the detrusor and relaxation of the internal sphincter. Sympathetic innervation is not essential for micturition. During micturition, the perineal and levator ani muscles relax, shortening the urethra and decreasing urethral resistance. Descent of the diaphragm and contraction of abdominal muscles raises intra-abdominal pressure, and aids in the expulsion of urine from the bladder.

Micturition is fortunately under voluntary control in healthy adults. In the young child, however, it is purely re

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