Evaluation of the impact of ethanol on the nervous control of micturition - the analysis of the link between the concentration of alcohol in the blood and the volume of urine in the bladder.
Abstract
Numerous biochemical and electrophysiological studies have identified receptors and ion channels whose function is somehow affected by ethanol. Some of them are involved in the neural control of micturition, which raises the question about the possibility of causing urinary retention by ethanol. The aim of this study was to analyze the relationship between the concentration of alcohol in the blood and the volume of urine in the bladder measured during autopsy. The study was based on autopsy protocol data from 702 people. Criteria for inclusion were age not exceeding 50 years and a blood alcohol level of at least 0.5 parts per thousand. A correlation between the blood alcohol concentration and a bladder urine volume over 200ml can be portrayed as part of a range limited by curves asymptotically converging to the value of 3 per mil. This phenomenon may be explained by the effect that alcohol has on receptors involved in the micturition reflex, which should be typically be engaged at approximately 200 ml of urine in the bladder. The lower limit of this range can be explained by stimulation of GABA-A as well as the inhibition of NMDA receptors or by decreasing influx through calcium channels. Both of these effects result in the inhibition of the micturition reflex. However, the upper limit, which indicates reduced urine retention, may be caused by the action of high concentrations of ethanol at the end of the adrenergic fibers causing their dysfunction or by changing in intracellular calcium ion concentration.
References
Selius BA, Subedi R. Urinary retention in adults: diagnosis and initial management. Am Fam Physician. 2008; 77(5):643-50.
Iga J, Taniguchi T, Ohmori T. Acute abdominal distension secondary to urinary retention in a patient after alcohol withdrawal. Alcohol Alcohol. 2005; 40(1):86-7.
Fowler CJ, Griffiths D, de Groat WC. The neural control of micturition. Nat Rev Neurosci. 2008; 9(6):453-66.
Jiang CH, Lindstrom S. Prolonged enhancement of the micturition reflex in the cat by repetitive stimulation of bladder afferents. J Physiol. 1999; 517 ( Pt 2):599-605.
Spanagel R. Alcoholism: a systems approach from molecular physiology to addictive behavior. Physiol Rev. 2009; 89(2):649-705.
Yokoi K, Ohmura M, Kondo A, Miyake K, Saito M. Effects of ethanol on in vivo cystometry and in vitro whole bladder contractility in the rat. J Urol. 1996; 156(4):1489-91.
Sanna E, Harris RA. Recent developments in alcoholism: neuronal ion channels. Recent Dev Alcohol. 1993; 11:169-86.
Weight FF, Lovinger DM, White G. Alcohol inhibition of NMDA channel function. Alcohol Alcohol Suppl. 1991; 1:163-9.
Lovinger DM, White G, Weight FF. Ethanol inhibition of neuronal glutamate receptor function. Ann Med. 1990; 22(4):247-52.
Weight FF. Cellular and Molecular Physiology of Alcohol Actions in the Nervous System. In: Smythies JR, Bradley RJ. International review of neurobiology. / Volume 33. San Diego: Academic Press, 1992: 289-348
Fleming RL, Wilson WA, Swartzwelder HS. Magnitude and ethanol sensitivity of tonic GABAA receptor-mediated inhibition in dentate gyrus changes from adolescence to adulthood. J Neurophysiol. 2007; 97(5):3806-11.
Akk G, Steinbach JH. Low doses of ethanol and a neuroactive steroid positively interact to modulate rat GABA(A) receptor function. J Physiol. 2003; 546(Pt 3):641-6.
Göthert M, Thielecke G. Inhibition by ethanol of noradrenaline output from peripheral sympathetic nerves: possible interaction of ethanol with neuronal receptors. Eur J Pharmacol. 1976; 37(2):321-8.
Utkan T, Erden F, Yildiz F, Ozdemirci S, Ulak G, Gacar MN. Chronic ethanol consumption impairs adrenoceptor- and purinoceptor-mediated relaxations of isolated rat detrusor smooth muscle. BJU Int. 2001; 88(3):278-83.
Rabe CS, Weight FF. Ethanol's effects on neurotransmitter release and intracellular free calcium in PC12 cells. Adv Alcohol Subst Abuse. 1988; 7(3-4):95-7.
Ohmura M, Kondo A, Saito M. Effects of ethanol on responses of isolated rabbit urinary bladder and urethra. Int J Urol. 1997; 4(3):295-9.
Yoshimura N. Bladder afferent pathway and spinal cord injury: possible mechanisms inducing hyperreflexia of the urinary bladder. Prog Neurobiol. 1999; 57(6):583-606.
Matsumoto G, Hisamitsu T, de Groat WC. Role of glutamate and NMDA receptors in the descending limb of the spinobulbospinal micturition reflex pathway of the rat. Neurosci Lett 1995; 183:58 – 61.
Pehrson R, Andersson K-E. Effects of tiagabine, a gamma-aminobutyric acid re-uptake inhibitor, on normal rat bladder function. J Urol 2002; 167:2241–2246.
Costa LG, Guizzetti M. Muscarinic cholinergic receptor signal transduction as a potential target for the developmental neurotoxicity of ethanol. Biochem Pharmacol. 1999; 57(7):721-6.
Caron M, Larsson C, Alling C. Chronic effects of ethanol on muscarinic acetylcholine receptors are modulated by protein kinase C. Addict Biol. 1999; 4(2):163-8.
Kondo A. Response of urinary bladder to cholinergic and adrenergic agents. Nagoya Journal of Medical Science 1977; 39(1-2): 37-4