Functions Of The Bladder
The bladder has two important roles. The most important one is protection of the Kidneys. Its does this by primarily by storing urine at low pressure and constantly cycling urine in and out of the bladder efficiently, at reasonably low pressures and avoiding any stasis.
The second role is convenience . It stores just enough urine so as to preserve the overall efficiency of the body. When full it does not occupy space that intrudes on other organs and it has a enlarge enough reservoir to hold a convenient amount of fluid between needs to empty.
Physiology Of The Bladder – How Does It Work?
The bladder has two separate components – the bladder wall and the sphincter. They are designed to work in sync so as to facilitate storage and emptying of urine. The controlling key is the sphincter. It acts as a sort of neurologic teeter toter switch. Changes in the sphincter tone reflexly influence tension in the bladder wall. At rest the sphincter has enough memorized tone so as to keep the bladder relaxed. As the bladder approaches fullness, a conscious increase in its tone (i.e., holding) will reflexly keep the bladder suppressed long enough to conveniently reach a bathroom. When its time to empty the bladder , the sphincter must be consciously relaxed. This removes its inhibitory influence over the bladder, allowing it to contract and empty out its contents. There is a rheostat effect here. Bladder contraction efficiency will reflect the completeness of sphincter relaxation. Is the pelvic floor (i.e., sphincter) relaxation is inefficient or incomplete, the bladder contraction will be compromised. if this reciprocal synchrony between the bladder and the sphincter is chronically impaired, then clinical problems start to occur. The symptoms arising from this compromise in bladder behavior, e.g., inappropriate urges, are the bodies way of alerting us to that fact that regulation of the bladder is breaking down. A visit to physician office, is therefore recommended.
The Impact of Pressure
The bladder protects the kidneys by storing urine at a relatively low pressure. This allows urine to be delivered to the bladder, via the ureters, at low pressure. This in turn keeps pressure in renal pelvis low and preserves the integrity of the kidneys, The ureters pass through the bladder wall in an oblique fashion. As pressures rise in the bladder toward fullness the, ureters beome compressed. Pressures rise in the ureters and the kidneys as urine production continues. The causes of ureteral bladder wall obstruction are several but mainly boil down to, 1) a chronically over distended bladder 2 )the spastic or overactive bladder wall wherein storage pressures are chronically elevated , or 3) a bladder that has become too thick and stiff. Bladders that are storing urine at inappropriate pressures will always be associated with some level of inappropriate dysfunctional behavior. Often it is a silent disorder. Alterations in voiding habit, can lead to very gradual changes in the bladder wall integrity. Because the changes take place slowly and subtly over time, they often go unrecognized. Not uncommonly, advanced changes can occur in the bladder that are difficult to fully reverse. The void diary can be instrumental in avoiding this process by raising an awareness to bladder behaviors that are a departure from the norm .How Is A Bladder Behavior Evaluated
A very complete view on the anatomy of the bladder can be obtained with Xray methods. The CT scan or MRI will give a nice picture of the entire Urinary Track system – Kidneys, Ureters, Bladder as well as all of the Pelvic Organs. A more limited X-ray study, called a cystogram , is performed specifically to look at the bladder anatomy and its position in the pelvis. Questions such as – thickness of the bladder wall , presence (or absence) of any masses or stones within the bladder lumen, any residual urine left in the bladder after emptying, reflux of urine into the ureters, or prolapse of the bladder base, can be ascertained.
Functional assessment of the bladder is obtained by doing what is referred to as a Urodynamic Evaluation. This is a method wherein the pressures in the bladder and sphincter are monitored during filling and emptying of the bladder. Usually the flow of urine from the bladder is also monitored, as this is the end result of all the forces at play that could effect performance of the bladder. Such a study can document and quantify any the level of dysfunction present. An appropriate plan of treatment(s) can be more accurately applied by utilizing these studies, rather than simply relying on the clinical trial approach. A therapeutic plan can more readily be evolved using combined therapies followed these studies. They also provide a record of behavior for future reference, if needed.
Interconnectivity
The pelvis has three important physiologies – a) the bladder or lower urinary tract, b) the reproductive system ( both male and female) and c) the bowel or rectum. All three receive the same innervation, share many of the neural reflexes that control their behavior, and are influenced and regulated by the pelvic floor sphincter mechanism. As a result, a behaviorally rooted failure in any one of these three systems can have a negative impact on the others. This failure follows a hierarchical rule linked to their physiologic roles. The bladder is the most active of the three organs, then follows the bowel and finally the reproductive system. Separation of behaviors is somewhat rooted in what the various physiologies do. The bladder deals with continuous flow of fluid , the bowel with slow delivery of solid material and the reproductive organs cycle weekly or monthly. Failure within these systems often is in line with their neural presence in the central nervous system – the more active the system , the greater the neural CNS representation. Thus the bladder will tend to show alterations in behavior first, then the bowel and lastly, the reproductive system. Hence a void diary can be a sensitive red flag to deteriorating physiologies in all three systems. If a void diary shows a departure from the norm, inquiries into the functional integrity of the bladder, the bowel and reproductive organs should be made.
Sleep & The Bladder
Every physician on earth will emphasize to his/her patients the importance of sleep. It is a basic need of the body. It is of utmost importance that the body enter into a 3-4hrs of continuous dream level sleep in order to physiologically recharge for the next day’s activities. There all kinds or repercussions if this isn’t allowed to happen. (Everyone can attest to the fact that their minds simply aren’t as sharp, nor is their productivity as efficient throughout the next day, with insufficient sleep habits). Recovery from illness or surgery is also affected by sleep patterns. If someone is getting up more than once in a 7-8 hr sleep cycle, the bodies recovery mechanisms are being adversely affected. The consequences of this are difficultly to measure but potentially enter adversely into the whole aging equation.