Acute and chronic retention of urination: what to do, first aid

Great inconveniences and unpleasant sensations to the person deliver urological pathological processes because of which he is forced to often run to the toilet, but even more suffering brings the impossibility of emptying with a full bladder. The delay in urinating in medicine is called ishuria and is more common in men than in children and women.

[1], [2], [3]

Causes of the retention of urination

There are a number of reasons for the delay in urination and can be divided into the following:

• Mechanical, associated with the occurrence of obstacles to urinary diversion:
  • stone in the urethra or bladder;
  • malignant or benign prostate tumors in men;
  • acute prostatitis;
  • tumors of the rectum and uterus;
  • congenital anomalies and urethral trauma;
  • prolapse of the uterus;
• are associated with diseases of the nervous system:
  • pathologies leading to a disruption in the formation of the nerve shell (myelin);
  • damage, tumor of the brain or spinal cord;
• conditioned by reflex factors, which inhibit nerve signals that participate in the emptying of the bladder:
  • operations on the abdomen, pelvic organs;
  • long forced lying (sick, bedridden);
  • fear or a strong emotional shock;
  • alcohol;
• the reception of certain medicines (analgesics, antiallergic, hypnotics, antispasmodics, etc.).

[4], [5], [6], [7]

Delayed urination after surgery

According to studies, the delay in urination occurred after even small and far from bladder operations. Among more than 5,000. Such complications occurred in 4% operated. Their danger lies in the emergence of acute pyelonephritis, kidney failure, increased blood pressure, cerebral circulation and, finally, heart failure, strokes. Most often, an obstruction to urinary output is a spasm of the smooth muscles of the sphincter of the urethra. Cataractization of the bladder and the use of alpha1-adrenoblockers serve as a cure for this condition.

[8], [9], [10], [11], [12], [13]

Delayed urination with multiple sclerosis

Violations of urination with multiple sclerosis are experienced by the vast majority of patients. This is due to the fact that this ailment causes a slowing or interruption of signals from the brain to the peripheral nerve endings and vice versa, including to the muscles involved in the act of urination. This pathology leads to various failures, manifested in urinary incontinence, frequent and urgent urges, etc. Delayed urination with multiple sclerosis is one of them.

[14]

Risk factors

Risk factors are traumatic situations that can lead to damage to the organs of the urinary system, spinal cord, brain, the appearance of tumors, hernias, strokes, hypothermia, constant stress. The factors contributing to the retention of urination include advanced age (after 60 and older), and a sedentary lifestyle.

[15], [16], [17],

Pathogenesis

The pathogenesis of urinary retention is the following mechanism. In the case of squeezing the urethra or its obstruction, urination becomes more frequent, the bladder membrane has to increase contractile activity, resulting in its hypertrophy. It looks like "protrusion" of its individual sections over the rest of the surface. All this disturbs the circulation of the body and leads to its incomplete emptying, and further to a complete delay in urination. In most cases, this also violates the outflow of urine from the kidneys, which is dangerous for the defeat of a vital organ.

[18], [19], [20], [21], [22], [23],

Epidemiology

The statistics of urine retention does not inspire optimism. Thus, in 80% of patients with multiple sclerosis there are violations in urination, including its delay. After operations of inguinal and femoral hernia, 14% develops ishuria, surgical intervention for rectal cancer in 13-30% leads to this. Neurogenic bladder in pediatric urology is found in 10% of children.

[24], [25], [26], [27], [28], [29], [30]

Symptoms

The symptoms of urinary retention are the impossibility of emptying the bladder when it overflows or small doses of urine output. The first signs can appear quite unexpectedly, and besides the delay of urination, there are also pains in the lower abdomen and even during movement. Another variant of the development of the disease is a gradual increase in unpleasant symptoms. In addition, there may be nausea, vomiting, weakness, fever, insomnia, spotting in the urine. Delayed urination is manifested especially frequent urges at night, while a swollen bladder visually noticeable swelling, protrusion of the abdomen.

The delay of urination in men happens more often than in women, and occurs due to obstruction of the urinary tract by the stone, constriction or inflammation of the foreskin, prostatitis, adenoma, urinary tract infections, various bladder and urethral injuries, tumors in the pelvis.

The delay of urination in women can occur for the same reasons as in men, but there are also those who because of the anatomical structure are inherent only in women. One of them is the weakness of the muscles between the bladder and the vagina, as a result of which a part of the urethra or bladder sag, causing either incontinence or urinary retention. Causes such pathological symptoms of fibroids of large size and other tumors. There is a delay in urination during pregnancy. Often this occurs in late pregnancy before delivery because the enlarged uterus presses on the organ. Delayed urination after childbirth is also possible, because weakened muscle tone, there may be swelling of the neck of the bladder or its trauma during passage of the fetus through the birth canal.

The delay of urination in the elderly may depend on the sex. In women, this is due to the loss or removal of the uterus, resulting in the formation of a void, the bladder is deformed. In older men, prostate and other disorders of the urinary system often develop, including dysfunction of the nervous regulation of the process.

It is the violation of the mechanism of nervous regulation or a neurogenic bladder that most often explains the retention of urination in children. This is due to the fact that they have not yet developed a reflex, that is, the actions of the nervous system with its endings on the walls and sphincter of the bladder are not coordinated. Other causes include various infections, cerebral palsy, birth trauma. This pathology is more susceptible to girls.

Stages

The initial stage of urinary retention with its neostromous development does not cause much inconvenience and painful sensations. The inflammatory process extends only to the mucous membrane of the organ. Emptying occurs, but is incomplete, part of the urine remains in the bladder. Often over time, in the late stages, there is a complete delay in urination, and the deeper layers become involved in the inflammation: submucosal, muscular, which is fraught with complications.

[31], [32], [33], [34], [35]

Forms

By types of ishuria is divided into acute, chronic and paradoxical. Acute urinary retention occurs suddenly, it is characterized by the inability to empty the bladder, acute pain in the lower abdomen.

Chronic delay of urination develops gradually, for some time the patient is able to urinate, but part of the urine remains in the bladder. It is detected with the introduction of a catheter, ultrasound and during radioisotope renography.

In the case of paradoxical ishuria, when the bladder overflows, a spontaneous urine outflow occurs, and its incontinence.

[36], [37], [38],

Diagnostics of the retention of urination

The diagnosis of urinary retention is based on the patient's anamnesis, tactile examination (palpation gives a feeling of condensation above the bosom), laboratory and instrumental studies.

With the delay of urination, the following tests are performed:

• a common blood test (elevated white blood cells and ESR indicate inflammation);
• general urine analysis (leukocytes and erythrocytes above the norm indicate the presence of inflammatory processes in the kidney and urinary tract);
• biochemical blood test (deviations in such indicators as urea, uric acid, creatinine - a sign of urological disorders).

Instrumental diagnostics includes:

• cystomanometry (determines the pressure inside the bladder to detect the condition of the muscles of its walls);
• profilometriju urethras (checks ability of a sphincter to carry out the closing functions);
• X-ray of kidney and bladder with contrast medium;
• radioisotope renography (fluoroscopic study using a radioactive marker);
• ultrasonography.

[39], [40], [41]

Differential diagnosis

Differential diagnosis of urinary retention is performed with anuria, in which there is no outflow from the kidneys and the bladder is empty, and therefore there is no urge to empty it. For urine is characterized by frequent urge to urinate.

[42], [43], [44],

Treatment of the retention of urination

Treatment for urinary retention is carried out in several stages and primarily consists in conducting emergency care in the form of bladder release. This task is handled by cathurisation - removal of urine by inserting a catheter into the urethra. Another method is cystostomy, which is most often used in men with the inability to insert a catheter. It is a puncture, a puncture of the bladder to establish a tube.

The next stage of treatment is directed to the causes that caused pathology, and to prevent the development of inflammatory processes.

Medicinal treatment

Drug treatment depends on the diagnosis that led to a delay in urine, as well as with their help relieve the pain, it is easier to remove fluid from the body. Thus, antispasmodics with a delay in urination are used in the case of reflex, medical or mechanical ishuria. They relax the muscles of the sphincter of the bladder. It can be no-shpa, drotaverin.

Drotaverin - exists in tablets and injectable solutions. The dose is prescribed individually, the tablets are swallowed without chewing, regardless of food. The recommended dose for children 2-6 years is a quarter whole one or two per day. Older children (6-12 years) - 1-2 tablets with the same frequency. Teenagers after 12 years and adults are prescribed the same, but more often - 2-3 times a day. Injections are administered intramuscularly (2-4 ml 1-3 times in adults, children older than 12 - 1-2 ml). There were isolated cases of side effects in the form of nausea, stool, headache, tachycardia. Contraindicated in people with hypersensitivity to compound preparations, with renal, hepatic, cardiac insufficiency, arterial hypertension.

When urine retention, diuretics furosemide, hypothiazide, lasix, veroshpiron are used.

Furosemide - is available in tablets and liquids in ampoules, which are administered intramuscularly and intravenously. The daily dose - 40 mg, if necessary, can be increased 2-4 times and divided into 2 receptions. The drug can cause nausea, itching and redness of the skin, thirst, depression, lowering of pressure. Contraindicated in the mechanical closure of the urinary tract, in the first half of pregnancy.

In most cases, when urine retention is prescribed, α-blockers. It can be tamsulosin or alfuzosin.

Alfuzozin - tablets (5 mg), coated. Assign to men with prostate adenoma. In a day, the reception is 2.5mg three times, for patients over 65 years old - twice, in the morning and in the evening. Side effects can appear as rashes on the skin, swelling, tinnitus, dizziness, tachycardia, diarrhea. Do not recommend with hypersensitivity to the components of the drug, severe liver and kidney disease. It is not prescribed for women with angina and ischemic heart disease.

Prevent the development of infectious processes due to prolonged use of the catheter antibiotics. In modern pharmacology there are many such drugs, to determine the necessary samples are made for sensitivity to pathogens. Assign antibiotics of different generations: oxacillin, ampicillin, ampiox, cefixime - tetracycline; cefazolin, cefaclor, cefepin - cefelasporin; ofloxacin,

Lomefloxacin, norfloxacin - fluoroquinolone; azithromycin, clarithromycin - macrolides; streptomycin, amikacin - aminoglycosises; tetracycline, chlortetracycline - tetracyclines.

Ofloxacin is a broad-spectrum antibiotic, tablets. Dose intake - on a tablet 2 times a day. The course of treatment is 7-10 days. Possible allergic reaction, manifested by rash and itching, nausea, diarrhea, vomiting, anorexia, a change in the blood formula. Contraindicated for children under 15 years, pregnant and lactating women, epileptics.

In the case of neurogenic causes of the pathology, proserine, acetylidine is used.

Aceclydine - has a liquid dosage form for subcutaneous administration. One-time inject 1-2 ml of 0.2% solution. If necessary, repeat 2-3 times with half-hour intervals. Contraindicated in pregnant, lactating, epileptics, patients with gastric bleeding, inflammation of the abdominal cavity. There may be side effects, manifested by allergies, conjunctivitis.

Vitamins

A known antiseptic among vitamins is ascorbic acid, it activates the functions of the urethra, so it will help in the treatment of ishuria. Raise immunity together with vitamin C and vitamins A, B, E.

Physiotherapeutic treatment

Physiological treatment includes those methods that will be effective for a particular case of the disease. In the neurogenic nature of ishuria, electrostimulation of both superficial and intravesical, acupuncture, electrophoresis is used. For the treatment of prostate adenoma, along with medicamental treatment, such physiological methods as massage, peat mud, mud mud as applications, inducto-, magneto-, laser therapy, and exercise therapy are used.

LFK at a delay of an emiction consists in strengthening of pelvic muscles, training of a bladder. Kegel's well-known method includes slow muscle contraction, alternation of rapid contraction and relaxation, ejection, imitating labor or labor during defecation.

Alternative treatment

Alternative treatment can be used only after consulting a doctor. These methods include the way to relieve bladder spasms with the help of warm compresses and relaxing baths. If there are no contraindications to thermal procedures, then you can let the warm bath, lie down and stiffen, try to urinate. Warm compresses on the crotch, lumbar region of the back, lower abdomen will help to relax the muscles of the urinary tract. The lower part of the abdomen is warmed with a rubbed raw onion, wrapped in gauze. Apply also tinctures, teas, decoctions of herbs that have a diuretic effect.

[45], [46], [47]

Herbal Treatment

In nature, there are many natural diuretics that will be useful in combating the pathologies of the bladder and kidneys. These are plants such as celery, parsley, birch buds, field horsetail, bear ears, dill seeds, chicory, etc. Here are a few recipes:

• 50g of green stalks of oats pour 1 l of water, boil 20min., Drink in a cooled form half a glass three times a day;
• a tablespoon of berries of mountain ash for a glass of boiling water, insist, drink 2 tablespoons 3 times a day;
• Root the celery root in a meat grinder, squeeze the juice, take two spoons several times a day before meals.

Homeopathy

In the complex therapy of problems associated with delayed urination, homeopathy is also used. Homeopathic preparations are taken half an hour before meals or an hour after.

Aconite - has the form of grains, packaged in vials. The dose for acute conditions is 8 granules 5 times a day, after a few days the frequency of reception is reduced to three times. The course of treatment for this scheme - 2 weeks, as many as twice a day. Possible side reaction of the body in the form of allergies. Contraindications are low blood pressure, hypersensitivity to the drug.

Arnika - drops, are appointed at a delay of an emiction owing to bruises, traumas. The recommended dose is 10 drops directly under the tongue or on a spoonful of water. Before swallowing it is necessary to hold in the mouth. It is not prescribed for children, pregnant and during lactation. Contraindicated in people with an allergy to the drug. There were single side effects: dyspeptic phenomena, allergic manifestations.

Belladonna - homeopathic granules in the breeding of C6. Accepted in two days for 3 pieces once. No side effects were found.

Camphor is an oily 20% solution in ampoules for subcutaneous administration. The dose of the drug is 1-5 ml, before entering it, it is necessary to warm up to body temperature. If it enters the lumen of the vessel, it may become blocked. There may be itching, hives, convulsions. Contraindicated in epileptics, with heart problems, aneurysm.

Surgery

Surgical treatment is needed in the presence of tumors, prostate adenoma, narrowing of the foreskin, a stone in the ureter and all other pathologies leading to the closure of the urethra and the inefficiency of conservative treatment. Endoscopic manipulations are also possible with funnel-shaped excision of the bladder, an incision of the sphincter, plasty of the bladder tissue - methods that facilitate its emptying.

Complications and consequences

The consequences and complications of the ishuria are serious enough, even a bladder rupture is possible as a result of a fall or blow to the abdomen, followed by a flow of urine into the peritoneum, which is dangerous by the development of peritonitis, sepsis. Stagnation of urine in the bladder leads to inflammation in it and kidney damage.

[48], [49], [50], [51], [52]

Prevention

Preventive measures include avoiding injuries, hypothermia, excessive consumption of alcoholic beverages, uncontrolled intake of medications. A visit by men to a urologist, and women of a gynecologist, the regular delivery of tests, especially after the age of 50, will help to identify the problem in time, and even avoid it.

[53], [54], [55], [56], [57]

Forecast

The prognosis for patients not dealing with treatment of urinary retention is unfavorable. They die of kidney failure, purulent pyelonephritis, urosepsis. With timely detection and elimination of the causes of the ishuria, recovery comes.