Urinary Problems


Bladder function is controlled by the coordination of your autonomic nervous feedback system that loops between your bladder, spinal cord, and brain. Some nerves allow your conscious control of certain functions and others control involuntary actions. Urinary dysfunction is a common symptom of superficial siderosis patients. It often results from degeneration in the part of the brainstem that controls urination and small fiber autonomic neuropathy.

S2, S3 and S4 nerves of your spinal cord control when the upper part of your bladder contracts, the bladder neck relaxes and the external urethral sphincter  (voluntary urination). Sympathetic nerves at the T11-L2 levels of the spinal cord cause the upper section of the bladder to relax and the bladder neck to contract, letting your bladder store urine. This is a voluntary function. These nerves are also responsible for keeping the internal urethral sphincter tightened so urine can not pass. This is an involuntary function. Incontinence, leakage, and increased urinary frequency are common problems when these nerves are affected.

Parasympathetic nerves control the internal urethral sphincter. This is a reflex movement you can’t control. One of the ways bladder control fails is to not allow complete emptying of the bladder. When urine in your bladder hits around 8ozs or so (250ml), nerves in your bladder muscle start sending a signal to your brain. Hellooo, pay attention to me! You should feel a slight urge to pass urine. A healthy bladder should be able to hold a little more than double this amount of urine before you feel an urgent need to void.

When the bladder is full, stretch receptors will tell the nerves to start a subconscious reflex called the micturition reflex. Communication between the pons, cerebrum, and nerves allows you to control your external urethral sphincter. If your bladder is not emptying fully you will find yourself having to void again within minutes. An ultrasound can determine if your bladder is retaining urine and how much is being retained.

If your ultrasound shows a  residual volume of 100 ml or more than one-third of your bladder capacity, your doctor may prescribe scheduled self-catheterization. You or a caregiver will insert a flexible plastic tube, called a catheter, into the urethra and up to the bladder. This will allow your bladder to fully empty and reduce the risk of infection.

If self-catheterization doesn’t control the problem you may need a permanent catheter, known as a Foley catheter.

nerve bladder control


Updated: December 14, 2017

Sources: Superficial siderosis is a rare neurologic disease characterized by progressive sensorineural hearing loss, cerebellar ataxia, pyramidal signs, and neuroimaging findings revealing hemosiderin deposits in the spinal and cranial leptomeninges and subpial layer. The disease progresses slowly, and patients may present with mild cognitive impairment, nystagmus, dysmetria, spasticity, dysdiadochokinesia, dysarthria, hyperreflexia, and Babinski signs. Additional features reported include dementia, urinary incontinence, anosmia, ageusia, and anisocoria. Superficial siderosis MedGen UID: 831707 •Concept ID: CN226971 •Finding Orphanet: ORPHA247245
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