Acute and chronic urinary retention: what to do, first aid

Urological pathological processes cause great inconvenience and unpleasant sensations to a person, because of which he is forced to run to the toilet often, but even more suffering is caused by the inability to empty with an overflowing bladder. Urinary retention in medicine is called ischuria and is more common in men than in children and women.

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Causes urinary retention

There are a number of reasons for urinary retention and they can be divided into the following:

• mechanical, associated with the occurrence of obstacles to the passage of urine:
  • stone in the urethra or bladder;
  • malignant or benign tumors of the prostate in men;
  • acute prostatitis;
  • tumors of the rectum and uterus;
  • congenital anomalies and injuries of the urethra;
  • uterine prolapse;
• associated with diseases of the nervous system:
  • pathologies leading to disruption of the formation of the nerve sheath (myelin);
  • damage, tumors of the brain or spinal cord;
• caused by reflex reasons that inhibit the nerve signals involved in emptying the bladder:
  • operations on the abdomen, pelvic organs;
  • prolonged forced lying down (patients confined to bed);
  • fright or strong emotional shock;
  • alcohol;
• taking certain medications (analgesics, antiallergics, sleeping pills, antispasmodics, etc.).

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Urinary retention after surgery

According to research, urinary retention occurred even after minor and distant operations from the bladder. Among more than 5 thousand operated, 4% had such complications. Their danger lies in the occurrence of acute pyelonephritis, renal failure, increased blood pressure, cerebrovascular accident and, finally, heart failure, strokes. Most often, the obstruction of urine flow is a spasm of the smooth muscles of the urethral sphincter. Catheterization of the bladder and the use of alpha1-adrenergic blockers serve as a cure for this condition.

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Urinary retention in multiple sclerosis

The vast majority of patients with multiple sclerosis experience urination disorders. This is due to the fact that this disease causes a slowdown 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. Urinary retention in multiple sclerosis is one of them.

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Risk factors

Risk factors include traumatic situations that can lead to damage to the urinary system, spinal cord, brain, the occurrence of tumors, hernias, strokes, hypothermia, constant stress. Factors that contribute to urinary retention also include old age (after 60 and older), as well as a sedentary lifestyle.

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Pathogenesis

The pathogenesis of urinary retention is as follows. In case of compression of the urethra or its blockage, urination becomes more frequent, the bladder lining has to increase contractile activity, resulting in its hypertrophy. This looks like a "bulging" of its individual sections over the rest of the surface. All this disrupts the blood circulation of the organ and leads to its incomplete emptying, and subsequently to complete urinary retention. In most cases, the outflow of urine from the kidneys is also disrupted, which is dangerous due to damage to a vital organ.

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Epidemiology

Statistics on urinary retention are not encouraging. Thus, 80% of patients with multiple sclerosis have problems with urination, including urinary retention. After operations on inguinal and femoral hernias, 14% develop ischuria, and surgical interventions for rectal cancer lead to this in 13-30%. Neurogenic urinary bladder in pediatric urology occurs in 10% of children.

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Symptoms

Symptoms of urinary retention include the inability to empty the bladder when it is full or when small amounts of urine are excreted. The first signs may appear completely unexpectedly, and in addition to urinary retention, they are also manifested by pain in the lower abdomen and even during movement. Another variant of the disease development is a gradual increase in unpleasant symptoms. In addition, nausea, vomiting, weakness, fever, insomnia, and bloody discharge in the urine may be observed. Urinary retention is manifested by particularly frequent urges at night, while swelling and protrusion of the abdomen are visually noticeable from the overfilled bladder.

Urinary retention in men occurs more often than in women and occurs due to blockage of the urinary tract by a stone, narrowing or inflammation of the foreskin of the glans penis, prostatitis, adenoma, urinary tract infections, various injuries to the bladder and urethra, and tumors in the pelvis.

Urinary retention in women can occur for the same reasons as in men, but there are also some that are specific to women due to their anatomical structure. One of them is weakness of the muscles between the bladder and vagina, causing part of the urethra or bladder to sag, causing either incontinence or urinary retention. Such pathological symptoms are caused by large fibroids and other tumors. Urinary retention occurs during pregnancy. This often occurs in the later stages of pregnancy before childbirth due to the fact that the enlarged uterus presses on the organ. Urinary retention after childbirth is also possible, since the muscle tone is weakened, there may be swelling of the neck of the bladder or its injury during the passage of the fetus through the birth canal.

Urinary retention in the elderly may depend on gender. In women, this occurs due to prolapse or removal of the uterus, resulting in an empty space and deformed bladder. In elderly men, prostate and other urinary system disorders most often develop, including dysfunction of the nervous regulation of the process.

Urinary retention in children is most often explained by a disruption of the nervous regulation mechanism or a neurogenic bladder. This is due to the fact that they have not yet fully developed the reflex, i.e. 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 injuries. Girls are more susceptible to this pathology.

Stages

The initial stage of urinary retention, when it is not acute, does not cause much discomfort or pain, since the inflammatory process only affects the mucous membrane of the organ. Emptying occurs, but is incomplete, and some urine remains in the bladder. Often, over time, in the later stages, complete urinary retention occurs, and deeper layers are involved in the inflammation: submucosal, muscular, which is fraught with complications.

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Forms

By type, ischuria 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 urinary retention develops gradually, for some time the patient is able to urinate, but some urine remains in the bladder. It is detected by inserting a catheter, by ultrasound and during radioisotope renography.

In the case of paradoxical ischuria, when the bladder is overfilled, spontaneous urine outflow and incontinence occur.

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Diagnostics urinary retention

Diagnosis of urinary retention is based on the patient's medical history, tactile examination (palpation gives a feeling of a lump above the pubis), laboratory and instrumental studies.

In case of urinary retention, the following tests are performed:

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

Instrumental diagnostics includes:

• cystomanometry (determines the pressure inside the bladder to identify the condition of the muscles of its walls);
• urethral profilometry (checks the ability of the sphincter to perform its closing functions);
• X-ray examination of the kidneys and bladder using a contrast agent;
• radioisotope renography (X-ray examination using a radioactive marker);
• ultrasound examination.

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Differential diagnosis

Differential diagnostics of urinary retention is carried out with anuria, in which there is no outflow from the kidneys and the bladder is empty, which means there is no urge to empty it. Ischuria is characterized by frequent urges to urinate.

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Treatment urinary retention

Treatment of urinary retention is carried out in several stages and primarily involves emergency care in the form of emptying the bladder. Catheterization copes with this task - urine drainage by inserting a catheter into the urethra. Another method is cystostomy, most often used in men when it is impossible to insert a catheter. It is a puncture, a puncture of the bladder to install a tube.

The next stage of treatment is aimed at the causes that caused the pathology and preventing the development of inflammatory processes.

Drug treatment

Drug treatment depends on the diagnosis that led to urinary retention, and they also relieve pain and facilitate the removal of fluid from the body. Thus, antispasmodics for urinary retention are used in cases of reflex, medical or mechanical ischuria. They relax the muscles of the sphincter of the bladder. This can be no-shpa, drotaverine.

Drotaverine is available in tablets and injection solutions. The dose is prescribed individually, the tablets are swallowed whole, regardless of food. The recommended dose for children 2-6 years old is a quarter of a whole tablet once or twice a day. Older children (6-12 years old) - 1-2 tablets with the same frequency. Teenagers over 12 years old and adults are prescribed the same amount, but more often - 2-3 times a day. Injections are administered intramuscularly (2-4 ml 1-3 times for adults, children over 12 - 1-2 ml). There were isolated cases of side effects in the form of nausea, stool disorders, headache, tachycardia. Contraindicated in people with hypersensitivity to the components of the drug, with renal, hepatic, heart failure, arterial hypertension.

In case of urinary retention, diuretics are also used - furosemide, hypothiazide, lasix, veroshpiron.

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

In most cases, α-blockers are prescribed for urinary retention. This may be tamsulosin or alfuzosin.

Alfuzosin - film-coated tablets (5 mg). Prescribed for men with prostate adenoma. The recommended dose is 2.5 mg three times a day, for patients over 65 years old - twice, in the morning and in the evening. Side effects may include skin rashes, swelling, tinnitus, dizziness, tachycardia, diarrhea. Not recommended for hypersensitivity to the components of the drug, severe liver and kidney disease. Not prescribed for women with angina and coronary heart disease.

Antibiotics will prevent the development of infectious processes due to long-term use of a catheter. In modern pharmacology, there are many such drugs; to determine the necessary ones, sensitivity tests to pathogens are carried out. Antibiotics of different generations can be prescribed: oxacillin, ampicillin, ampiox, cefixime - tetracycline; cefazolin, cefaclor, cefepine - cefelasporin; ofloxacin,

Lomefloxacin, norfloxacin - fluoroquinolones; azithromycin, clarithromycin - macrolides; streptomycin, amikacin - aminoglycoses; tetracycline, chlortetracycline - tetracyclines.

Ofloxacin is a broad-spectrum antibiotic, tablets. The dose is one tablet 2 times a day. The course of treatment is 7-10 days. An allergic reaction is possible, manifested by a rash and itching, nausea, diarrhea, vomiting, anorexia, changes in the blood count. Contraindicated for children under 15, pregnant and lactating women, epileptics.

In case of neurogenic causes of the pathology, proserin and aceclidine are used.

Aceclidine — has a liquid dosage form for subcutaneous administration. 1-2 ml of 0.2% solution is administered once. If necessary, repeat 2-3 times at half-hour intervals. Contraindicated for pregnant women, lactating women, epileptics, patients with gastric bleeding, inflammation of the abdominal cavity. Side effects may occur, manifested by allergies, conjunctivitis.

Vitamins

A well-known antiseptic among vitamins is ascorbic acid, it activates the functions of the urinary organs, therefore it will help in the treatment of ischuria. Vitamins A, B, E will also boost immunity along with vitamin C.

Physiotherapy treatment

Physiological treatment includes those methods that will be effective for a specific case of the disease. In case of neurogenic ischuria, they resort to electrical stimulation, both superficial and intravesical, acupuncture, electrophoresis. For the treatment of prostate adenoma, along with drug treatment, they also use physiological methods such as massage, peat and silt mud as applications, inducto-, magnetic-, laser therapy, and therapeutic exercise.

Exercise therapy for urinary retention consists of strengthening the pelvic muscles and training the bladder. The well-known Kegel method includes slow muscle contraction, alternating rapid contractions and relaxations, pushing, simulating labor pains or efforts during defecation.

Folk remedies

Traditional medicine can be used only after consulting a doctor. Such methods include relieving bladder spasms with warm compresses and relaxing baths. If there are no contraindications to thermal procedures, you can run a warm bath, lie down and strain, try to urinate. Warm compresses on the perineum, lumbar region of the back, lower abdomen will help relax the muscles of the urinary tract. The lower abdomen is warmed with grated raw onion wrapped in gauze. Tinctures, teas, and decoctions of herbs with a diuretic effect are also used.

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Herbal treatment

There are many natural diuretics in nature that are useful in the fight against pathologies of the bladder and kidneys. These are plants such as celery, parsley, birch buds, horsetail, bearberry, dill seeds, chicory, etc. Here are some recipes:

• Pour 1 liter of water over 50 g of green oat stems, boil for 20 minutes, drink cooled, half a glass three times a day;
• a tablespoon of rowan berries per glass of boiling water, leave to infuse, drink 2 tablespoons 3 times a day;
• Grind the celery root in a meat grinder, squeeze out the juice, take two spoons several times a day before meals.

Homeopathy

Homeopathy is also used in complex therapy of problems associated with urinary retention. Homeopathic preparations are taken half an hour before meals or an hour after.

Aconite - has the form of grains, packaged in bottles. The dose for acute conditions is 8 granules 5 times a day, after a few days the frequency of administration is reduced to three times. The course of treatment according to this scheme is 2 weeks, another two weeks - twice a day. A side reaction of the body in the form of an allergy is possible. Contraindications are low blood pressure, hypersensitivity to the drug.

Arnica - drops, prescribed for urinary retention due to bruises, injuries. The recommended dose is 10 drops directly under the tongue or on a spoonful of water. Before swallowing, hold in the mouth. Not prescribed for children, pregnant women and during lactation. Contraindicated for people with allergies to the drug. There were isolated side effects: dyspeptic phenomena, allergic manifestations.

Belladonna - homeopathic granules in C6 dilution. Take 3 pieces once every two days. No side effects have been identified.

Camphor is an oil 20% solution in ampoules for subcutaneous administration. The dose of the drug is 1-5 ml, before administration it is necessary to warm it up to body temperature. If it gets into the lumen of the vessel, it can become blocked. Itching, urticaria, convulsions are possible. Contraindicated for epileptics, with heart problems, aneurysm.

Surgical treatment

Surgical treatment will be required in case of tumors, prostate adenoma, narrowing of the foreskin, ureteral stone and all other pathologies leading to urethral obstruction and ineffectiveness of conservative treatment. Endoscopic manipulations are also possible with funnel-shaped excision of the bladder, sphincter incision, bladder tissue plastic surgery - methods that facilitate its emptying.

Complications and consequences

The consequences and complications of ischuria are quite serious, even a rupture of the bladder is possible as a result of a fall or a blow to the stomach with subsequent leakage of urine into the peritoneum, which is dangerous due to the development of peritonitis and sepsis. Stagnation of urine in the bladder leads to inflammatory processes in it and kidney damage.

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Prevention

Preventive measures include avoiding injuries, hypothermia, excessive alcohol consumption, and uncontrolled medication use. Men visiting a urologist and women visiting a gynecologist, and regularly taking tests, especially after the age of 50, will help to identify the problem in a timely manner, or even avoid it.

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Forecast

The prognosis for patients who do not treat urinary retention is unfavorable. They die from renal failure, purulent pyelonephritis, urosepsis. With timely detection and elimination of the causes of ischuria, recovery occurs.