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The pelvic floor muscles, also known as the 'core', play a crucial role in controlling urination. These muscles support the bladder, bowel, and uterus (in women) or bladder and bowel (in men). The pelvic floor muscles work in conjunction with the deep abdominal muscles, back muscles, and diaphragm to maintain spinal stability and control intra-abdominal pressure. When it comes to urination, the pelvic floor muscles contract to lift the internal organs of the pelvis and tighten the urethra, preventing the release of urine. Relaxation of these muscles, along with contraction of the bladder wall muscles, allows urine to flow out through the urethra. Additionally, the detrusor muscle, located within the bladder walls, and the internal and external urethral sphincters play a significant role in controlling urination. Any damage to these muscles or surrounding nerves can lead to urinary incontinence.
| Characteristics | Values |
|---|---|
| Muscle that gives control over urination | Pelvic floor muscles |
| Location of pelvic floor muscles | Base of the group of muscles called the 'core'; stretches from pubic bone to coccyx and from one ischeal tuberosity to the other |
| Function of pelvic floor muscles | Support the bladder, bowel, and uterus; control the release of urine, faeces, and flatus |
| Pelvic floor muscles in women | Support the baby during pregnancy and need to be relaxed during childbirth |
| Pelvic floor muscles in men | Important for erectile function and ejaculation |
| Risk factors for weak pelvic floor muscles in women | Childbirth, obesity, and age |
| Risk factors for weak pelvic floor muscles in men | Prostate surgery and radiation therapy |
| Other muscles involved in urination | Detrusor muscle, urethral sphincter muscle, and bladder wall muscles |
| Function of detrusor muscle | Contracts to excrete urine and relaxes to hold urine |
| Function of urethral sphincter muscle | Remains contracted to hold urine in the bladder and relaxes to allow urine to flow out |
| Function of bladder wall muscles | Contract to push urine out of the bladder |
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What You'll Learn
Pelvic floor muscles control the release of urine
The pelvic floor muscles are a group of muscles that form the base of the core muscles. They work with the deep abdominal muscles, back muscles, and the diaphragm to support the spine and control the pressure inside the abdomen. The pelvic floor muscles are normally firm and thick, and they stretch from the pubic bone at the front to the coccyx (tailbone) at the back, and from one ischial tuberosity (sitting bone) to the other.
The pelvic floor muscles support the bladder, bowel, and, in women, the uterus (womb). The urethra, anus, and, in women, the vagina, all pass through the pelvic floor muscles. These muscles give you the ability to control the release of urine, faeces, and flatus, and to delay emptying until it is convenient. When you contract the pelvic floor muscles, they lift the internal organs of the pelvis and tighten the openings of the vagina, anus, and urethra. Relaxing the pelvic floor muscles allows the passage of urine and faeces.
Pelvic floor muscles can weaken over time due to injury, being overweight, or the normal ageing process, leading to conditions like incontinence or pelvic organ prolapse. In some cases, the internal organs supported by the pelvic floor, including the bladder and uterus, can slide down into the vagina. This is called a prolapse. Pelvic floor muscles can also become too tight, causing the bladder and bowel not to empty properly—a condition called a hypertonic pelvic floor.
Pelvic floor exercises, or Kegels, can be used to strengthen pelvic floor muscles and treat incontinence issues. These exercises can be done lying down, sitting, or standing, and aim to improve muscle tone and prevent the need for corrective surgery. Each section (vaginal, urethral, anal) can be exercised. To identify your urethral sphincter, imagine you are passing urine and try stopping the flow midstream.
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The detrusor muscle contracts the bladder to excrete urine
The detrusor muscle is a smooth muscle found in the wall of the bladder. It is responsible for the contraction of the bladder during urination, allowing urine to be released from the body. When the bladder is full, the M3 receptors located within the bladder become stretched and stimulated, leading to the contraction of the detrusor muscle for urination. This process is controlled by the autonomic system, specifically the parasympathetic nervous system, which stimulates the bladder through pelvic nerve fibres.
The detrusor muscle works in conjunction with the internal urethral sphincter, which is also composed of smooth muscle. During urination, the detrusor muscle contracts while the urethral sphincter relaxes, allowing urine to flow out through the urethra. The urethral sphincter is encircled by the lowest part of the bladder (the neck) and remains contracted to prevent urine from flowing out until the bladder is full. When the decision is made to urinate, the sphincter muscle relaxes, and the detrusor muscle contracts, pushing the urine out of the bladder.
The pelvic floor muscles also play a role in controlling urination. These muscles support the bladder, bowel, and uterus in women, and the bladder and bowel in men. They can be contracted voluntarily to increase pressure on the bladder and delay urination. Pelvic floor muscles can also be tightened to control the release of urine, faeces, and flatus, and relaxed to allow passage.
Disorders or abnormalities of the detrusor muscle can lead to urinary retention, incontinence, or a combination of both. If left untreated, these issues can result in the deterioration of the upper urinary tracts. Similarly, a weakened pelvic floor can cause urine leaking, while a hypertonic pelvic floor can lead to improper emptying of the bladder and bowel.
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The urethral sphincter controls the flow of urine
The urethral sphincter is a muscle that controls the flow of urine. The urethra is a tube that allows urine to leave the body. The urethra is part of the urinary system, which includes the kidneys, bladder, ureters, and urethra. The kidneys produce urine, which flows through the ureters to the bladder, where it is stored until urination. During urination, urine leaves the body through the urethra.
The urethral sphincter is located at the inferior end of the bladder and controls the flow of urine through the urethra. It is composed of two muscles: the internal urethral sphincter and the external urethral sphincter. The internal urethral sphincter is made of smooth muscle and is under involuntary or autonomic control. It functions to prevent the involuntary release of urine from the bladder into the urethra. The external urethral sphincter, on the other hand, is made of skeletal muscle and is under voluntary control. It controls the voluntary release of urine from the bladder to the urethra.
In females, the external urethral sphincter is located in the deep perineal pouch at the distal inferior end of the bladder. It is composed of three parts: the sphincter urethrae, the urethrovaginal muscle, and the compressor urethrae. The urethrovaginal muscle fibres wrap around the vagina and urethra, and contraction leads to the constriction of both. The compressor urethrae muscle originates from the right and left inferior pubic ramus and wraps around the urethra, squeezing it against the vagina when contracted.
In males, the external urethral sphincter is located inferior to the prostate at the level of the membranous urethra. The internal urethral sphincter also has the additional function of preventing the flow of semen into the bladder during ejaculation. The urethra in males passes through the prostate and into the penis, while in females, it runs from the bladder to open in front of the vagina.
The pelvic floor muscles also play a role in controlling the release of urine. These muscles support the bladder, bowel, and uterus in females, and the bladder and bowel in males. The urethra passes through the pelvic floor muscles, and when these muscles are contracted, they tighten the urethral opening. Relaxing the pelvic floor muscles allows the passage of urine. Weak pelvic floor muscles or damage to the urethral sphincter can lead to stress urinary incontinence.
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The bladder's stretch receptors trigger the micturition reflex
The process of urination involves a complex neural circuitry that is highly distributed. The bladder is encircled by a muscle called the urinary sphincter, which remains contracted to prevent urine from flowing out of the body. When the bladder is full, messages travel along nerves from the bladder to the spinal cord, and then to the brain, making the person aware of the urge to urinate.
The bladder wall is made up of a muscle called the detrusor muscle, which is under control from the autonomic system. The parasympathetic nervous system stimulates the M3 muscarinic stretch receptors in the bladder through the pelvic nerve fibres. When urine fills the bladder, these M3 receptors become stretched and stimulated, leading to the contraction of the detrusor muscle for urination. This is known as the micturition reflex.
The micturition reflex involves both the storage and evacuation of urine, and it is a complex integration of parasympathetic, sympathetic, and somatic pathways extending from the sacral segments of the spinal cord to the brainstem and cerebral cortex. The micturition reflex is triggered by the filling threshold, which stimulates the detrusor reflex, specifically involved with the evacuation of urine in response to the stretch of the bladder.
The pelvic floor muscles also play a role in controlling urination. These muscles can be contracted voluntarily to increase pressure on the bladder and prevent the release of urine. In addition, the pelvic floor muscles support the bladder, bowel, and uterus in women, and the bladder and bowel in men.
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Disorders that interfere with urination control
Urination is controlled by the pelvic floor muscles, which support the bladder, bowel, and uterus. These muscles work with the abdominal and back muscles and the diaphragm to support the spine and control the pressure inside the abdomen. The pelvic floor muscles can be contracted to increase the pressure on the bladder and tighten the urethra, preventing the release of urine.
Stress Incontinence
Stress incontinence occurs when urine leaks during activities that put pressure on the bladder, such as coughing, sneezing, laughing, or physical activity. It is usually caused by weak or damaged pelvic floor muscles or the urethral sphincter. Stress incontinence can be more common in women due to pregnancy and giving birth, which can weaken the pelvic floor muscles. Being overweight or obese can also increase the risk of stress incontinence by placing greater stress on the pelvic floor.
Urge Incontinence
Urge incontinence, or urgency incontinence, happens when urine leaks as a person feels a sudden, intense urge to urinate. It is typically caused by the overactivity of the detrusor muscles, which control the bladder. Urge incontinence can be treated with surgery, such as enlarging the bladder or implanting a device that stimulates the nerve controlling the detrusor muscles.
Overflow Incontinence
Overflow incontinence, or chronic urinary retention, occurs when a person is unable to fully empty their bladder, leading to frequent leaking. It is often caused by an obstruction or blockage in the bladder. An enlarged prostate in men, for example, can squeeze the urethra and prevent complete bladder emptying.
Total Incontinence
Total incontinence is a severe condition where the bladder cannot store any urine, resulting in constant urine leakage. It can be caused by a problem with the bladder from birth, a spinal injury, or a fistula (a tunnel-like hole near the bladder).
It is important to consult a healthcare professional if you experience any symptoms of urinary incontinence, as they can recommend lifestyle changes, medications, or surgical treatments to improve urination control.
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Frequently asked questions
The pelvic floor muscles, detrusor muscles, and urinary sphincter muscles all play a role in controlling urination. The pelvic floor muscles support the bladder, bowel, and uterus or internal reproductive organs, and allow you to control the release of urine. The detrusor muscle is located within the walls of the bladder and allows the bladder to contract to excrete urine or relax to hold it in. The urinary sphincter encircles the lowest part of the bladder and remains contracted to prevent urine from exiting the body until the person is ready to urinate.
The pelvic floor muscles work with the abdominal muscles, back muscles, and diaphragm to support the spine and control the pressure inside the abdomen. These muscles can be contracted to increase pressure on the bladder and prevent urine from passing through the urethra. Relaxing these muscles allows urine to pass through the urethra.
Yes, you can control your pelvic floor muscles deliberately, much like flexing a bicep. Exercising these muscles can give you more control over your bladder and bowel function.
