bladder or a mass growing into the ureters, you will not feel pain despite
the obstruction. Without special testing, the blockage could go unrecognized.
If it is a long-standing obstruction, even with elimination of the
causative factor, the ureter will remain dilated.As long as the urine is passing
from the kidneys into the bladder, the way the ureter looks is not
important.
Finally, the urine enters the bladder, where it sits until it is eliminated.
Urologists used to think that the bladder was an inactive organ that served
only as a holding vessel. However, with more attention being paid to conditions
that cause bladder pain, researchers are finding that the bladder is a
vital, active organ, with a complex neurological and vascular system.
The urinary bladder (we are not talking about the gall bladder, which
is a small sac that sits under the liver and can fill with stones and cause pain)
is composed of four distinct layers. The lining is called the mucosa.A watertight
system, it protects the inner layers from the toxins that enter the organ.
This active layer of cells gets replaced by new cells on a regular basis. Defects
in the lining that allow urine to penetrate into the deep recesses of the
bladder can cause pain, irritability of the bladder, and frequent urination.
Recurrent infections and chronic pain syndromes may possibly be caused
by these defects.
The next layer is called the submucosa (“under the mucosa”). It is a
thin, indistinct layer through which the blood vessels and nerve endings
enter and supply the other layers. One can see that if the mucosal layer is
imperfect, the urine can easily affect the nerve and blood supply to the
bladder since that is the next layer of exposure.
The third layer of the bladder is the real business end of the organ. It
is the muscle layer, and is formally called the detrusor. The exact character
of the muscle is not known, but it does get thick and muscular when it works
hard to empty against a resistance, just like the biceps muscle gets larger
from weight lifting. However, voluntary control of the detrusor does not
seem possible in the same way that we can control our biceps muscle. There
is a direct, although subconscious, effect that our brains have on the bladder.
In women with certain types of bladder control problems, the detrusor will
contract and cause uncontrollable loss of urine if the brain senses cold,
anxiety, or proximity to a bathroom. As many of you know, suppression of
these impulses is very difficult, making the reaction involuntary but certainly
under some sort of conscious control.
The complex detrusor muscle is different from any other muscle in the
body in that it can expand to huge proportions (like the uterus) and deflate
within seconds (unlike the uterus). It can be controlled by the brain
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