This hollow organ consists of 3 layers of smooth muscle, which are protected on the inner surface by 2 stretchy layers – the submucosal and mucosal layers. These inner layers protect the bladder muscles from the acids, toxins and salts in the urine.
The outside of the bladder is covered and supported by connective tissue (fascia). In front it’s separated from the pubic bone by the retropubic fatty pad and behind, the bladder fascia connects with the fascia of the levator ani and obturator internus (pelvic floor muscles).
The urethra extends from the base of the bladder to the external opening (the urethral orifice) located in front of and above the vaginal opening and is about 4 cm. long in females. Where the bladder empties into the urethra (the bladder neck) the internal urethral sphincter (the ring of muscular tissue), keeps urine from entering the tube. The middle third of the urethra is surrounded by the rhabdosphincter and the lower third by the urethrovaginal sphincter. Tightening the pubococcygeus muscle constricts the urethra - if the muscle fibers are stretched or torn during childbirth, urine may be lost when running or sneezing.
The urethra lies against the anterior vaginal wall and its inner layers are highly oestrogen sensitive. Often, postmenopausal women find using vaginal oestrogen cream or suppositories controls symptoms of urge.
Although passing urine is a common event it’s quite complicated. The bladder and urethral sphincter muscles, abdominal and pelvic floor muscles along with the diaphragm are involved in building pressure within the bladder then relaxing once the nerves pass the message to void.
Usually urine doesn’t have a very strong smell so ammonia like odours can be indicative of infection or urinary stones. Excess sugar may cause diabetics urine to smell sweet or some foods; particularly asparagus change the urine odour due to the breakdown of a sulphur compound.
If you’re constantly feeling the urge to urinate causes may be due to:
- Caffeine, alcohol or diet drinks
- Urinary tract infection
- Supplementary vitamin C intake, acidic diets
- Interstitial cystitis – a condition where the bladder walls become inflamed
- Urethral diverticulum - enlargement of obstructed periurethral glands
- Scar adhesions, pelvic organ prolapse, excessive pelvic floor muscle tension and pelvic pain syndromes
- Neurological disease – stroke, Parkinson’s, diabetes
The opposite problem – not urinating often enough can occur due to a blockage or as a result of poor bladder habits. Sometimes teachers, bank workers, truck drivers, even surgeons ‘hold on’ with strong pelvic floor muscle contractions. This leads to bladder over distension and if done habitually will cause a ‘floppy bladder’ and emptying problems.
Ask your doctor for a mid stream urine test to identify infection; a urologist will detect bladder lining inflammation with a cystoscopic bladder view and a women’s health physiotherapist will advise on muscular, postural and breathing dysfunctions and pelvic organ prolapse (also viewed on ultrasound).
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- The Potential of Pessaries
- Great Pessary Workshop
- Prolapse and Pelvic Floor Muscles
- What is a 'relaxed vaginal outlet'?