Osteopathy Complete
Elmer D. Barber, D. O.

    The bladder is a musculo-membranous sac situated in the pelvis, behind the pubes, and in front of the rectum in the male, and serving as the reservoir for the urine.  In the female the cervix uteri and upper part of the vagina intervening between the bladder and the rectum.  The shape, position, and relations of the bladder are largely influenced by age, sex, and the degree of distension of the organ.  During infancy it is conical in shape, and projects above the upper border of the os pubis into the hypogastric region.  In the adult when quite empty and contracted, it, together with the urethra, in a median vertical section, is Y-shaped, the urethra forming the stem of the Y. It is placed deeply in the pelvis, flattened from before backward, reaching as high as the upper border of the symphysis pubis.  When slightly distended, it has a rounded form, still being contained within the pelvic cavity.  When greatly distended, it may reach nearly as high as the umbilicus.  The bladder, when distended, is slightly curved forward toward the anterior wall of the abdomen, so as to be more convex behind than in front.  In the female it is larger in the transverse than in the vertical diameter, and its capacity is greater than in the male.  When moderately distended, it contains about a pint.
    The base of the bladder is directed downward and backward.   It varies in extent according to its state of distension, being very broad when full, but much narrower when empty.
    In the male it rests upon the second portion of the rectum, from which it is separated by a reflexion of the recto-vesical fascia.
    The portion of the bladder in relation with the rectum corresponds to a triangular space, bounded in front by the prostate gland, and on each side by the vesieula seminalis and vas deferens.
    In the female the base of the bladder lies in contact with the cervix uteri and upper part of the anterior wall of the vagina.
    The neck of the bladder is the point of commencement of the urethra.  The portion of the bladder immediately surrounding it is in relation with the prostate gland.
    Ligaments. - The bladder is retained in its place by ligaments, which are divided into true and false, there being five of each.
    Blood Vessels. - The arteries supplying the bladder are the middle, superior, and inferior vesical in the male, with additional branches from the uterine and vaginal in the female.  They are all derived from the anterior trunk of the internal iliac.  The obturator and sciatic arteries also send small branches to the bladder.
    The veins form a complicated plexus around the neck, sides, and base of the bladder, and terminate in the internal iliac vein.
    Nerves. - The nerves are derived from the pelvic plexus of the sympathetic, and from the third and fourth sacral nerves, the former supplying the upper part of the bladder, the latter its base and neck.
    Closure. - The internal vesical sphincter, which consists of non-striped muscle, is an integral part of the muscular coat of the bladder, and surrounds the orifice of the urethra as far down as the prostatic portion, just above the colliculus seminalis.  It is, however, not the sphincter muscle; the proper sphincter urethra lies below the latter.  It is a circular muscle disposed around the urethra, close above the entrance of the urethra into the septum urogenitale at the apex of the prostate, where it exchanges fibers with the deep transverse muscle of the perineum which lies under it.
    Urine Accumulation and Micturition. - After emptying the bladder, the urine slowly collects again, the bladder being thereby gradually distended.  As long, as there is a moderate amount of urine in the bladder, the elasticity of the elastic fibers surrounding the urethra, and that of the sphincter of the urethra (and the prostate in the male), suffices to retain the urine, in the bladder.  If the bladder be greatly distended, so that its apex projects above the pubes, the sensory nerves in its walls are stimulated and cause a feeling of a full bladder, while at the same time the urethral opening is dilated, so that a few drops of urine pass into the urethra.  Besides the subjective feeling, of a full bladder, this tension of the walls of the bladder causes a reflex effect, so that the urinary bladder contracts periodically upon its fluid contents, and so do the sphincter of the urethra and the muscular fibers of the urethra, thus closing the urethra against the passage of these drops of urine.  As long, as the pressure within the bladder is not very high, the reflex activity of the transversely striped sphincter overcomes the other (as during sleep); as the pressure rises and the distention increases, the contraction of the walls of the bladder overcomes the closure produced by the sphincter ,and the bladder is emptied, as occurs normally in young children.
    As age advances, the sphincter urethra comes under the control of the will, so that it can be contracted voluntarily, as occurs in man when he forcibly contracts the bulbo-cavernosus muscle to retain urine in the bladder.  The sphincter ani usually contracts at the same time.  The reflex activity of the sphincter may also be inhibited voluntarily, so that it may be completely relaxed.  This is the condition when the bladder is emptied voluntarily.
    The Nerves Concerned in the Retention and Evacuation of the Urine are: (1) the motor nerves of the sphincter urethra, which lie in the pudendal nerve from the anterior roots of the third and fourth sacral nerves; (2) the sensory nerves of the urethra, which excite these reflexes, and leave the spinal cord by the posterior roots of the third, fourth, and fifth sacral nerves.  Section or paralysis of these nerves causes incontinence of urine.  Stimulation of the sensory nerves causes reflex contraction of the bladder and evacuation of the urine.

(Inflammation of the mucous membrane of the bladder.  Due to local irritation or to infection.  May be acute or chronic.)

    Frequent desire to micturate; evacuation of small quantity of urine, with burning pain; pain in the epigastric region; in acute form, urine acid reaction, alkaline in chronic.

    1.  Place the patient on the side; beginning at the eighth dorsal vertebra, move the muscles     Upward and outward thoroughly and deep, to the lower extremity of the sacrum.  Treat the opposite side in a similar manner.
    2.  Place the hand against the sacrum , the patient lying on the side; with the disengaged hand draw the limbs slowly backward as far as patient can stand without too much pain.  Treat the opposite side in a similar manner.
    Place the hand lightly over the bladder, and give gentle but strong, vibration two minutes.
    Treatment will occupy ten minutes, and should be given each day until recovery.

(Inflammation of the walls of the bladder between the! mucous membrane and peritoneum.)

    Same as Cystitis, with peritoneal complications.

    See Cystitis.

(Stone in the bladder.)

    Similar to Cystitis, with vesical tenesmus; obstruction to discharge of urine, which may contain blood.

    This disease is sometimes benefited and cured by osteopathic treatment, but is not treated very successfully.
    See Cystitis.

(New growths or tumor in the bladder.)

    Paroxysms of vesical tenesmus, and hemorrhage; urine may contain cellular evidence.

    See Cystitis.

(Inability to expel urine from the bladder.)

    May be due to calculus, tumor, stricture, enlarged prostate, congestion, vesical paralysis, hysteria, etc.

    Tumor in hypogastric region, tender to the touch, dullness on percussion; respiration short and shallow; flashes of heat; hot dry skin.

    1.  This trouble, except when due to calculus, stricture, tumor, or paralysis, is usually quickly relieved by thorough manipulation and stimulation of the spinal muscles and nerves from the eighth dorsal to the end of the sacrum, stimulating especially in the sacral regions, together with thorough vibration of the bladder.
    2.  It is also advisable to flex the limbs very strongly against the abdomen, holding them a few seconds in this position, thus stretching the muscles in the lumbar region.
    3.  In case of enlargement of the prostate gland, in addition to the above treatment, which should be given each day, the prostate should be treated locally once each week.  The finger should be thoroughly oiled with vaseline and passed carefully up the rectum, after which the prostate should be manipulated in a careful manner, with a view of freeing the circulation.  It is remarkable how soon the prostate gland can be reduced by this method of treatment.
    Cases of calculus, stricture, paralysis, and tumor have also been benefited, and occasionally cured, by the above treatment.  The results, however, in those troubles are not so pronounced.

(Involuntary discharge of the urine.  May be due to paralysis or relaxation of the compressor
urethrae muscle.)

    Children who have no control over their urine can usually be cured entirely of this annoying habit, in one or two treatments, by pressing on the sacrum, close to the last lumbar vertebra, and raising the limbs slowly, but as high as the patient can stand without pain (cut 28).  This treatment is as reliable as mathematics.
    Adults who from infancy have been troubled with this disease can almost always be cured in from one to four weeks by the above treatment.
    Among the many eases cured by us of this trouble we will mention our first experience in this line.   A young man of Kirksville, Mo., hearing that we were investigating this subject, called at our office, and, after explaining that he had no control over his urine and had been expending all his earnings in vain hope of relief, asked us to take his case.  Not having a table at that time, we caused him to lie on his stomach on the floor, and, placing, the right foot between his thighs and the left on the sacrum, with an ankle in either hand, we raised the limbs, sprung down the sacrum, and asked him to call again on the second day.  While administering the third treatment we inquired as to results, and were not only gratified, but surprised, to learn that he had had no trouble since the first treatment.  Two years later the young man was still in perfect health.  We might mention also a gentleman 82 years of age, of Lewistown, Mo., troubled with this disease for over thirty years.  He was entirely cured in four weeks by this method of treatment.

(Difficult and painful micturition.)

    See Cystitis.