[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Anatomy](https://durgical.com/en/anatomy/) › [Pelvis](https://durgical.com/en/anatomy/region/pelvis/) › Urinary bladder [Urinary system](https://durgical.com/en/anatomy/system/urinary-system/) · [Pelvis](https://durgical.com/en/anatomy/region/pelvis/) # Urinary bladder The urinary bladder is the muscular bag behind the pubic bone that stores urine, about 400-600 ml, and empties it through the urethra. [See in 3D →](https://durgical.app/?from=durgipedia&lang=en#region=pelvis&select=urinary_bladder&side=r) Opens in the Durgical app, no sign-up needed. ## What it is A hollow muscular bag behind the pubic bone that stores urine. In the female it sits in front of the uterus and the vagina. ## What it does Holds about 400-600 ml and empties through the urethra. ## Key points - As it fills, the bladder rises above the pubic symphysis behind the abdominal wall without peritoneum in front of it: the basis of suprapubic catheterisation - Rupture: extraperitoneal (usually with a pelvic fracture; urine in the retropubic space) versus intraperitoneal (a blow to a full bladder tears the dome; urine in the peritoneal cavity) - Storage is sympathetic plus voluntary (pudendal); voiding is parasympathetic; the pontine micturition centre makes the detrusor contract as the sphincters relax - Only the superior surface (dome) carries peritoneum; the [ureters](https://durgical.com/en/anatomy/ureter/) pass obliquely through the wall, which closes them like a valve as the bladder fills ## Key facts **Where** [Pelvis](https://durgical.com/en/anatomy/region/pelvis/) behind pubic symphysis, rising into [abdomen](https://durgical.com/en/anatomy/region/abdomen/) when full; trigone between ureteric orifices and internal urethral orifice **Blood supply** Superior and inferior vesical arteries (internal iliac; in females vaginal arteries); vesical venous plexus **Nerve** Pelvic splanchnics (S2–S4) contract detrusor; sympathetic (T11–L2) relaxes it; [pudendal nerve](https://durgical.com/en/anatomy/pudendal-nerve/) (S2–S4) to [external urethral sphincter](https://durgical.com/en/anatomy/female-external-urethral-sphincter/) **Function** Stores urine (about 400–600 ml) and empties it by detrusor contraction (micturition reflex) ## Relations **In front** [Pubic symphysis](https://durgical.com/en/anatomy/pubic-symphysis/) and the retropubic space (of Retzius), filled with fat and the vesical venous plexus **Above** [Peritoneum](https://durgical.com/en/anatomy/peritoneum/) over the dome; in the female the body of the uterus leans forward on it across the [vesicouterine pouch](https://durgical.com/en/anatomy/vesicouterine-pouch/); in the male small bowel and [sigmoid colon](https://durgical.com/en/anatomy/sigmoid-colon/) **Behind** Female: the [cervix](https://durgical.com/en/anatomy/cervix-of-uterus/) and the anterior wall of the [vagina](https://durgical.com/en/anatomy/vagina/). Male: the seminal glands and the ends of the [ductus deferens](https://durgical.com/en/anatomy/ductus-deferens/), with the [rectum](https://durgical.com/en/anatomy/rectum/) behind and the [rectovesical pouch](https://durgical.com/en/anatomy/rectovesical-pouch/) above **Below** Female: the neck rests on the [pelvic floor](https://durgical.com/en/anatomy/levator-ani/) beside the urethra. Male: the neck sits on the base of the [prostate](https://durgical.com/en/anatomy/prostate/) **Lateral** Levator ani and [obturator internus](https://durgical.com/en/anatomy/obturator-internus/), with the [obturator nerve](https://durgical.com/en/anatomy/obturator-nerve/) and vessels on the side wall ## How to find it Empty, it hides behind the pubic symphysis and cannot be felt. In urinary retention it rises out of the pelvis as a smooth, tender midline mass above the pubis, dull to percussion, sometimes reaching toward the umbilicus. A suprapubic catheter goes in the midline just above the symphysis, into a full bladder, so the needle passes below the peritoneal reflection. ## On imaging Ultrasound shows wall thickness and the volume left after voiding; a full bladder is the window for transabdominal pelvic ultrasound. For suspected rupture, CT cystography (the bladder filled through a catheter): contrast around bowel loops means intraperitoneal; flame-shaped streaks in the perivesical fat mean extraperitoneal. ## Common problems - Bladder infections (cystitis), much more common in women. - Overactive bladder and incontinence. - Cystocele: the bladder bulges into the front wall of the vagina. - Injury risk in a caesarean section or hysterectomy, so it is moved away and emptied with a catheter. ## How it is diagnosed Urine test and culture; bladder diary; ultrasound; cystoscopy in some cases. ## Treatment - Antibiotics for infections; bladder training and medicines for overactive bladder. - Anterior repair for a cystocele. ## Clinical notes - Extraperitoneal rupture is usually managed with catheter drainage; intraperitoneal rupture usually needs surgical repair - [Spinal cord](https://durgical.com/en/anatomy/spinal-cord/) injury above the sacral segments gives a spastic, reflex bladder; damage to S2–S4 or the [cauda equina](https://durgical.com/en/anatomy/cauda-equina/) gives a flaccid bladder that overflows - Male: an enlarged prostate obstructs outflow; the detrusor thickens and trabeculates and diverticula can form - Part of the bladder wall can slide into an inguinal or femoral hernia, more often in men, and is at risk when the hernia sac is opened ## Development Forms from the urogenital sinus after the urorectal septum divides the cloaca. The urachus runs from the dome to the umbilicus and normally closes into the median umbilical ligament; if it stays open, urine can leak at the umbilicus, or a urachal cyst or sinus forms. ## Memory aid Parasympathetic makes you Pee; Sympathetic helps you Store. ## Related conditions - [Kidney stones (urolithiasis)](https://durgical.com/en/conditions/kidney-stones/) - [Acute kidney injury](https://durgical.com/en/conditions/acute-kidney-injury/) - [Urinary tract infection (acute cystitis)](https://durgical.com/en/conditions/urinary-tract-infection/) - [Pelvic organ prolapse](https://durgical.com/en/conditions/pelvic-organ-prolapse/) - [Stress urinary incontinence](https://durgical.com/en/conditions/stress-urinary-incontinence/) - [Bladder cancer](https://durgical.com/en/conditions/bladder-cancer/) - [Anticholinergic toxicity (incl. scopolamine «burundanga»)](https://durgical.com/en/conditions/anticholinergic-toxicity/) - [Urinary incontinence in older adults (urge, overflow, functional)](https://durgical.com/en/conditions/urinary-incontinence-in-older-adults/) - [Healthcare-associated infections (CLABSI, CAUTI, VAP)](https://durgical.com/en/conditions/healthcare-associated-infections/) - [Schistosomiasis](https://durgical.com/en/conditions/schistosomiasis/) - [Hydronephrosis and obstructive uropathy](https://durgical.com/en/conditions/hydronephrosis-and-obstructive-uropathy/) - [Acute urinary retention](https://durgical.com/en/conditions/acute-urinary-retention/) - [Catheter-associated urinary tract infection](https://durgical.com/en/conditions/catheter-associated-urinary-tract-infection/) - [Overactive bladder and urge incontinence](https://durgical.com/en/conditions/overactive-bladder-and-urge-incontinence/) - [Neurogenic bladder](https://durgical.com/en/conditions/neurogenic-bladder/) - [Vesicoureteral reflux](https://durgical.com/en/conditions/vesicoureteral-reflux/) - [Interstitial cystitis (bladder pain syndrome)](https://durgical.com/en/conditions/interstitial-cystitis/) - [Asymptomatic bacteriuria](https://durgical.com/en/conditions/asymptomatic-bacteriuria/) - [Placenta accreta spectrum](https://durgical.com/en/conditions/placenta-accreta-spectrum/) - [Obstetric fistula (vesicovaginal and rectovaginal)](https://durgical.com/en/conditions/obstetric-fistula/) - [Nocturnal enuresis](https://durgical.com/en/conditions/nocturnal-enuresis/) - [Posterior urethral valves](https://durgical.com/en/conditions/posterior-urethral-valves/) - [Pelvic fracture](https://durgical.com/en/conditions/pelvic-fracture/) - [Bladder and urethral injury](https://durgical.com/en/conditions/bladder-and-urethral-injury/) ## Test yourself Think of the answer, then tap the question to see it. ## Why can a suprapubic catheter be placed into a full urinary bladder without entering the peritoneum? As it fills, the bladder rises above the symphysis with no peritoneum in front, so the needle passes below the peritoneal reflection. ## How do extraperitoneal and intraperitoneal bladder ruptures differ in cause? Extraperitoneal: usually with a pelvic fracture, urine in the retropubic space. Intraperitoneal: a blow to a full bladder tears the dome. ## How do extraperitoneal and intraperitoneal bladder ruptures differ in management? Extraperitoneal is usually managed with catheter drainage; intraperitoneal usually needs surgical repair. ## Which autonomic divisions control storage and voiding of the urinary bladder? Storage: sympathetic plus voluntary (pudendal). Voiding: parasympathetic, coordinated by the pontine micturition centre. ## What type of bladder results from damage to S2–S4 or the cauda equina? A flaccid bladder that overflows; injury above the sacral segments gives a spastic, reflex bladder. [Add to my cards (5)](https://durgical.app/estudiar/?add=/en/anatomy/urinary-bladder/) Educational information, not medical advice. For any symptom, see a health professional. ## Its names **Official Latin (TA2)** vesica urinaria TA2 3401 **Official Spanish (DeCS)** Vejiga urinaria DeCS D001743 **English (TA2)** Urinary bladder ## Related - [Vesicouterine pouch](https://durgical.com/en/anatomy/vesicouterine-pouch/) - [Urethra (female)](https://durgical.com/en/anatomy/female-urethra/) - [Internal iliac arteries](https://durgical.com/en/anatomy/internal-iliac-artery/) Sources: Terminologia Anatomica (TA2); [DeCS](https://decs.bvsalud.org/es/ths/resource/?id=1768); [Anatomy, Abdomen and Pelvis: Bladder](https://www.ncbi.nlm.nih.gov/books/NBK531465/). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/anatomy/urinary-bladder/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/anatomy/urinary-bladder/