The Urinary bladder

  • In the adult, the bladder lies in the minor pelvis, posterior to the pubis.

  • It is separated by the retropubic space with fat.

  • In infants and children, the bladder is in the abdomen, beginning to enter the pelvis major at about 6yrs.

  • It reaches the pelvis at puberty.

  • The shape, size, positions and relations vary with the amount of urine it contains and with age.

Peritoneal relations


  • The superior part is covered posteriorly, cranially and anteriorly
  • vesico uterine pouch in the females and the recto vesical pouch in the male.






  • Retropubic pad of fat
  • Levator ani
  • Obturator internus
  • Pad of fat
  • Levator ani
  • Obturator internus


  • Uterus
  • Vagina
  • Vas deferens
  • Seminal vesicles
  • Rectum


  • Coils of small intestine (when full)
  • Body of uterus (when empty)
  • Coils of small intestine


  • Pelvic
  • Urogenital diaphragm
  • Urogenital diaphragm
  • Pelvic diaphragm
  • Prostate surrounds the urethra


  • Superior surface, facing upwards
  • Two inferior lateral surfaces, facing inferiorly
  • Posterior surface facing posteriorly and inferiorly. This is also called the base
  • Where the base and infero lateral surfaces converge, is called the neck of bladder.
  • This is where the lumen of the bladder opens into the urethra and rests on the prostate gland in the male.

  • The entire organ is enveloped by vesical fascia, a layer of loose connective tissue in which there is the vesical venous plexus

  • The neck is held firmly by pubo prostatic ligaments in males and the pubo vesical ligament in the female.

  • Major support is derived from the pelvic and urogenital diaphragms.

Blood supply


  • Superior vesical arteries from the umbilical artery

  • Inferior vesical arteries from the internal iliac

  • Small branches from obturator and inferior gluteal arteries

  • In females, uterine and vaginal arteries give branches to the bladder.

  • The veins correspond to  the arteries. From the vesical venous plexus  and are tributaries of the internal iliac vein.

  • Note: The vesical venous plexus in males envelopes the base of the bladder and prostate. The seminal vesicles, ductus deferens and inferior ends of the ureters

  • It is connected to the prostatic venous plexus

  • It may drain via sacral veins into the vertebral venous plexus

  • In females it envelopes the pelvic part of the urethra and the bladder neck. It receives blood from the dorsal vein of the clitoris.

  • It communicates with the vaginal plexus



  • From the superior part – external iliac nodes

  • From the inferior part- internal iliac nodes

  • Some from the neck- sacral and / or common iliac nodes



  • Parasympathetic fibres from the pelvic splanchnic nerves are motor to the detrusor muscle and inhibitory to the internal sphincter of the bladder

  • Sympathetic fibres are derived form T11- L2.

  • These fibres are inhibitory to the bladder and excitatory to the internal sphincter muscles.

  • The nerves form a vesical plexus consisting of both sympathetic and parasympathetic fibres. It is continuous with the inferior hypogastric plexus.

  • The external sphincter with other perineal muscles is supplied by pudendal nerve.

Summary of pelvic viscera