Micturition

Micturition refers to the physiological term of “Urination” which is the dispersion of urine from the urinary bladder to the outside of the body through the urethra. 

Or 

It refers to the process by which the urinary bladder empties when it is filled. 

Micturition involves two main types:- 

  • The urinary bladder fills first progressively until and unless, the tension in its walls rises above an optimum or threshold level. 
  • Secondly, the nervous reflex, also called the micturition reflex, empties the bladder or causes a conscious desire to urinate. 

However, the micturition reflex is an autonomic spinal cord reflex that can be inhibited or facilitated by centers in the cerebral cortex or brainstem of the human brain. 

Micturition reflex 

  • Micturition is a highly distributed process that involves pathways at multiple levels of the brain, spinal cord and parasympathetic nervous system in addition with multiple neurotransmitters. 
  • Micturition reflex is triggered when the urinary bladder fills with urine as the detrusor muscle remains relaxed until the urine fills upto 850 mL, and when the bladder exceeds the threshold amount ,the detrusor muscle starts to contract which ultimately increases the pressure within the bladder. 
  • The stretch receptors are stimulated within the detrusor and excites the parasympathetic fibres relaying this information to the sacral nerves of the spine. This helps us to convey a bladder degree of fullness. 
  • These signals are integrated to the brain via neurons and the brain then determines the urgency and responds by sending command signals either to hold or release out . 
  • The parasympathetic motor neurons stimulated by fibres in the pelvic nerve cause the detrusor to contract and cause emptying of the bladder. 
  • Ultimately, the bladder is emptied through the urethra and urine as usual is removed out of the body. 

How is the micturition reflex controlled?

Micturition reflex is counted in among the autonomic reflexes. The urine released from the body is regulated by voluntary neural mechanisms that involve centers in our major coordinating centers which are the brain and the spinal cord. 

What are the abnormalities of micturition?

Abnormality of micturition is any kind of difficulty during the passage of urine. Abnormalities of micturition are usually present with the symptoms like dysuria, dribbling, and suprapubic tenderness. Different causes of it include cystitis, pyelonephritis, cervicitis, prostatic, and benign prostatic hyperplasia. 

What is a micturition Diary?

A micturition Diary is a chart that maintains or shows your pattern of urinating. It is important for the patient to fill accurately so that the health professional assists your daily activity of micturition and can easily manage the symptoms. You can maintain it for 3 days or more, however, maintaining a fully completed 24-hour diary is a suitable minimum. 

What do you need to record in your micturition Diary?

In your micturition Diary provided by the health professional, you have to mention the activities along with them doing it. This includes:- 

  • Your walking time. Write like “got out of bed” in the comments column when you get out of the bed in the morning. 
  • Enter the time , amount of kind of all drinks that you have during the day . For example at 7 am , “ two cups of tea or coffee( total 500 mL) “.
  • You should also mention the time of your passing urine every time along with the mentioned time. Do this every time when you urinate during the day and night. 
  • Try to collect your urine every time you pass to keep a measurement of it. Place a large plastic container in the toilet bowl to catch the urine. You can manage to do it very easily. 
  • Every time you pass urine, write down the urgency needed to pass urine. For example:-

          0= Not Urgent.

          0+ = You had to go within 10 minutes approximately. 

         0++= You had to go to the toilet urgently. 

  • Record the accidental leak column that is , if 

Any time you face any kind of leaks. 

You have to change the pad.

You have to change the underclothes or outer clothes due to major leaks. 

You have to wet the bed. 

  • You can also include in the column “ small leak” like there was a small leak when you sneezed , coughed or exercised. 
  • Record the bowel movements in the “ comments” column in the micturition Diary as well. 
  • Mention the time of your sleeping. You can write in the diary simply “ Went to bed”. 

Benefits of maintaining a Micturition Diary

  • It is a self monitoring pattern that enhances the awareness of micturition habits as well as any leakage pattern in the patient.
  • Makes it easy for the health care professionals to assess its symptoms.
  • It provides accurate information about the patients. It is also useful in identifying potential causes in the patients.

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