Internal urethral sphincter

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Internal urethral sphincter
Illu bladder.jpg
The urinary bladder, with the position of the internal urethral sphincter shown as the internal urethral orifice.
Details
Origin The inferior ramus of the pubic bone
Insertion Perineal raphe
Nerve Sympathetic fibers from T10-L2 through the inferior hypogastric plexus then vesical nervous plexus
Actions Constricts proximal urethra, maintains urinary continence
Identifiers
Latin musculus sphincter urethrae internus
TA98 A09.2.03.009
A09.4.02.013
TA2 3444, 3428
FMA 45769
Anatomical terms of muscle

The internal urethral sphincter is a urethral sphincter muscle which constricts the internal urethral orifice. It is located at the junction of the urethra with the urinary bladder and is continuous with the detrusor muscle, [1] [2] but anatomically and functionally fully independent from it. [3] It is composed of smooth muscle, so it is under the control of the autonomic nervous system, specifically the sympathetic nervous system.

Contents

Function

Image showing the sphincter in a female, and demonstrating its action to prevent urination. Urinary Sphincter.png
Image showing the sphincter in a female, and demonstrating its action to prevent urination.

This is the primary muscle for maintaining continence of urine, a function shared with the external urethral sphincter which is under voluntary control. It prevents urine leakage as the muscle is tonically contracted via sympathetic fibers traveling through the inferior hypogastric plexus and vesical nervous plexus. [4] Specifically, it is controlled by the hypogastric nerve, predominantly via the alpha-1 adrenergic receptor. [5]

During urination, the preganglionic neurons of this sympathetic pathway are inhibited via signals arising in the pontine micturition center and traveling through the descending reticulospinal tracts, allowing the muscle to relax. During ejaculation, the muscle contracts to prevent reflux of semen into the urinary bladder, a phenomenon called retrograde ejaculation. [6] [7]

Spasms of the internal urethral sphincter are associated with penile erection. [8] Because the internal urethral sphincter is under involuntary control, it is believed to play a role in paruresis, in which a person who perceives oneself to be under observation is unable to urinate.

See also

Related Research Articles

<span class="mw-page-title-main">Urethra</span> Tube that connects the urinary bladder to the external urethral orifice

The urethra is a tube that connects the urinary bladder to the urinary meatus for the removal of urine from the body of both females and males. In human females and other primates, the urethra connects to the urinary meatus above the vagina, whereas in marsupials, the female's urethra empties into the urogenital sinus.

<span class="mw-page-title-main">Bladder</span> Organ in humans and vertebrates that collects and stores urine from the kidneys before disposal

The bladder is a hollow organ in humans and other vertebrates that stores urine from the kidneys before disposal by urination. In humans, the bladder is a distensible organ that sits on the pelvic floor. Urine enters the bladder via the ureters and exits via the urethra. The typical adult human bladder will hold between 300 and 500 ml before the urge to empty occurs, but can hold considerably more.

<span class="mw-page-title-main">Prostate</span> Gland of the male reproductive system in most mammals

The prostate is both an accessory gland of the male reproductive system and a muscle-driven mechanical switch between urination and ejaculation. It is found in all male mammals. It differs between species anatomically, chemically, and physiologically. Anatomically, the prostate is found below the bladder, with the urethra passing through it. It is described in gross anatomy as consisting of lobes and in microanatomy by zone. It is surrounded by an elastic, fibromuscular capsule and contains glandular tissue, as well as connective tissue.

<span class="mw-page-title-main">Urinary system</span> Human anatomical system consisting of the kidneys, ureters, urinary bladder, and the urethra

The urinary system, also known as the urinary tract or renal system, consists of the kidneys, ureters, bladder, and the urethra. The purpose of the urinary system is to eliminate waste from the body, regulate blood volume and blood pressure, control levels of electrolytes and metabolites, and regulate blood pH. The urinary tract is the body's drainage system for the eventual removal of urine. The kidneys have an extensive blood supply via the renal arteries which leave the kidneys via the renal vein. Each kidney consists of functional units called nephrons. Following filtration of blood and further processing, wastes exit the kidney via the ureters, tubes made of smooth muscle fibres that propel urine towards the urinary bladder, where it is stored and subsequently expelled from the body by urination. The female and male urinary system are very similar, differing only in the length of the urethra.

<span class="mw-page-title-main">Urination</span> Release of urine from the urinary bladder

Urination is the release of urine from the bladder through the urethra to the outside of the body. It is the urinary system's form of excretion. It is also known medically as micturition, voiding, uresis, or, rarely, emiction, and known colloquially by various names including peeing, weeing, pissing, and euphemistically going number one. In healthy humans and other animals, the process of urination is under voluntary control. In infants, some elderly individuals, and those with neurological injury, urination may occur as a reflex. It is normal for adult humans to urinate up to seven times during the day.

<span class="mw-page-title-main">Urinary incontinence</span> Uncontrolled leakage of urine

Urinary incontinence (UI), also known as involuntary urination, is any uncontrolled leakage of urine. It is a common and distressing problem, which may have a large impact on quality of life. It has been identified as an important issue in geriatric health care. The term enuresis is often used to refer to urinary incontinence primarily in children, such as nocturnal enuresis. UI is an example of a stigmatized medical condition, which creates barriers to successful management and makes the problem worse. People may be too embarrassed to seek medical help, and attempt to self-manage the symptom in secrecy from others.

<span class="mw-page-title-main">Parasympathetic nervous system</span> Division of the autonomic nervous system

The parasympathetic nervous system (PSNS) is one of the three divisions of the autonomic nervous system, the others being the sympathetic nervous system and the enteric nervous system. The enteric nervous system is sometimes considered part of the autonomic nervous system, and sometimes considered an independent system.

<span class="mw-page-title-main">Retrograde ejaculation</span> Redirection of ejaculated semen into the urinary bladder

Retrograde ejaculation occurs when semen which would be ejaculated via the urethra is redirected to the urinary bladder. Normally, the sphincter of the bladder contracts before ejaculation, sealing the bladder which besides inhibiting the release of urine also prevents a reflux of seminal fluids into the male bladder during ejaculation. The semen is forced to exit via the urethra, the path of least resistance. When the bladder sphincter does not function properly, retrograde ejaculation may occur. It can also be induced deliberately by a male as a primitive form of male birth control or as part of certain alternative medicine practices. The retrograde-ejaculated semen, which goes into the bladder, is excreted with the next urination.

<span class="mw-page-title-main">Onuf's nucleus</span> Group of neurons

Onuf's nucleus is a distinct group of neurons located in the ventral part of the anterior horn of the sacral region of the human spinal cord involved in the maintenance of micturition and defecatory continence, as well as muscular contraction during orgasm. It contains motor neurons, and is the origin of the pudendal nerve. The sacral region of the spinal cord is the fourth segment of vertebrae in the spinal cord which consists of the vertebrae 26-30. While working in New York City in 1899, Bronislaw Onuf-Onufrowicz discovered this group of unique cells and originally identified it as “Group X.” “Group X” was considered distinct by Onufrowicz because the cells were different in size from the surrounding neurons in the anterolateral group, suggesting that they were independent.

<span class="mw-page-title-main">Urinary retention</span> Inability to completely empty the bladder

Urinary retention is an inability to completely empty the bladder. Onset can be sudden or gradual. When of sudden onset, symptoms include an inability to urinate and lower abdominal pain. When of gradual onset, symptoms may include loss of bladder control, mild lower abdominal pain, and a weak urine stream. Those with long-term problems are at risk of urinary tract infections.

<span class="mw-page-title-main">External sphincter muscle of male urethra</span>

The external sphincter muscle of male urethra, also sphincter urethrae membranaceae, sphincter urethrae externus, surrounds the whole length of the membranous urethra, and is enclosed in the fascia of the urogenital diaphragm.

<span class="mw-page-title-main">Stress incontinence</span> Form of urinary incontinence from an inadequate closure of the bladder

Stress incontinence, also known as stress urinary incontinence (SUI) or effort incontinence is a form of urinary incontinence. It is due to inadequate closure of the bladder outlet by the urethral sphincter.

<span class="mw-page-title-main">Bladder sphincter dyssynergia</span> Medical condition

Bladder sphincter dyssynergia is a consequence of a neurological pathology such as spinal injury or multiple sclerosis which disrupts central nervous system regulation of the micturition (urination) reflex resulting in dyscoordination of the detrusor muscles of the bladder and the male or female external urethral sphincter muscles. In normal lower urinary tract function, these two separate muscle structures act in synergistic coordination. But in this neurogenic disorder, the urethral sphincter muscle, instead of relaxing completely during voiding, dyssynergically contracts causing the flow to be interrupted and the bladder pressure to rise.

Neurogenic bladder dysfunction, or neurogenic bladder, refers to urinary bladder problems due to disease or injury of the central nervous system or peripheral nerves involved in the control of urination. There are multiple types of neurogenic bladder depending on the underlying cause and the symptoms. Symptoms include overactive bladder, urinary urgency, frequency, incontinence or difficulty passing urine. A range of diseases or conditions can cause neurogenic bladder including spinal cord injury, multiple sclerosis, stroke, brain injury, spina bifida, peripheral nerve damage, Parkinson's disease, or other neurodegenerative diseases. Neurogenic bladder can be diagnosed through a history and physical as well as imaging and more specialized testing. Treatment depends on underlying disease as well as symptoms and can be managed with behavioral changes, medications, surgeries, or other procedures. The symptoms of neurogenic bladder, especially incontinence, can have a significant impact on quality of life.

<span class="mw-page-title-main">Detrusor muscle</span> Muscle of the bladder which expels urine when it contracts

The detrusor muscle, also detrusor urinae muscle, muscularis propria of the urinary bladder and muscularis propria, is smooth muscle found in the wall of the bladder. The detrusor muscle remains relaxed to allow the bladder to store urine, and contracts during urination to release urine. Related are the urethral sphincter muscles which envelop the urethra to control the flow of urine when they contract.

<span class="mw-page-title-main">Urethral sphincters</span> Muscles keeping urine in the bladder

The urethral sphincters are two muscles used to control the exit of urine in the urinary bladder through the urethra. The two muscles are either the male or female external urethral sphincter and the internal urethral sphincter. When either of these muscles contracts, the urethra is sealed shut.

<span class="mw-page-title-main">External sphincter muscle of female urethra</span>

The external sphincter muscle of female urethra is a muscle which controls urination in females. The muscle fibers arise on either side from the margin of the inferior ramus of the pubis. They are directed across the pubic arch in front of the urethra, and pass around it to blend with the muscular fibers of the opposite side, between the urethra and vagina.

<span class="mw-page-title-main">Urodynamic testing</span> Assessment of bladder and urethra performance

Urodynamic testing or urodynamics is a study that assesses how the bladder and urethra are performing their job of storing and releasing urine. Urodynamic tests can help explain symptoms such as:

<span class="mw-page-title-main">Overflow incontinence</span> Medical condition

Overflow incontinence is a concept of urinary incontinence, characterized by the involuntary release of urine from an overfull urinary bladder, often in the absence of any urge to urinate. This condition occurs in people who have a blockage of the bladder outlet, or when the muscle that expels urine from the bladder is too weak to empty the bladder normally. Overflow incontinence may also be a side effect of certain medications.

Urethral resistance pressure is the pressure existing in urethra during urination or other conditions generated by the detrusor muscle. It forces urine into and through the urethra in order for micturition. In the urethra, part of that pressure is converted to dynamic (forward) pressure which helps voiding happen. On the other hand, static (lateral) pressure helps preventing involuntary dribbling. Decline in urethral resistance pressure is one of the contributing factors is some forms of incontinence for example stress incontinence as a result of atrophy in menopause.

References

PD-icon.svgThis article incorporates text in the public domain from page 429-431 of the 20th edition of Gray's Anatomy (1918)

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