Acute urinary retention is a relatively common complication that is characteristic of various diseases. Therefore, many people are interested in questions about the features and the main causes of this condition. It is very important to know about the first manifestations of pathology, because first aid for acute urinary retention is extremely important for the continued well-being of a sick person. So what are the causes and first manifestations of this urination disorder? What methods of treatment can offer modern medicine? What are the complications of the violation of urine outflow?
What is urinary retention?
Acute urinary retention is a condition in which emptying of the filled bladder is not possible. This pathology is often confused with anuria, although these are completely different processes. With anuria, urination is absent due to the fact that the flow of urine into the bladder stops. With an acute delay, on the contrary, the bladder is filled, but under the influence of certain factors its secretion is impossible.
It should be noted that this problem develops much more often in men, which is associated with anatomical features. Nevertheless, it is possible in women. In addition, children often suffer from urinary retention.
The main reasons for the development of this state
Immediately it should be said that the causes of acute urinary retention can be very diverse, so in modern medicine they are divided into four main groups:
- mechanical (associated with mechanical obstruction or squeezing of the urinary tract);
- those that are caused by these or other disorders of the nervous system (the brain, for one reason or another, ceases to control the processes of emptying the bladder);
- reflex disorders that are associated with a partial violation of innervation or emotional state of the patient;
- medication (due to the impact on the body of a drug).
Now it is worth considering each group of factors in more detail. Acute urinary retention often develops with mechanical squeezing of the bladder or urinary tract, resulting in the evacuation of its contents is simply impossible. This is observed when there is a foreign body in the bladder or urethra. Also risk factors include neoplasms in the lower urinary tract, bladder neck sclerosis, stones in the neck or urinary ducts, and various injuries to the urethra. In men, urine outflow can be impaired with prostatitis or proliferation (hyperplasia) of the prostate gland, and in women with a prolapse of the uterus.
Urinary retention may be associated with impaired functioning of the central nervous system, which is observed in the presence of tumors, as well as injuries of the spinal cord or spine (including intervertebral hernia), shock, stroke, contusion of the brain.
If we are talking about reflex disorders, then the risk factors include injuries of the perineum, pelvis and lower extremities. In some cases, urinary retention develops against the background of partial denervation of the bladder as a result of operations on the female genital organs, rectum, etc. This group of causes may include a strong emotional shock, fear, hysteria, and alcohol intoxication.
There are also groups of drugs that, in some patients, can lead to disruption of urine outflow. These can be tricyclic antidepressants, benzodiazepines, adrenomimetics, anticholinergic drugs, narcotic analgesics, some antihistamines.
What can cause urine retention in children?
Even the smallest patients are not insured against such a violation. Naturally, acute urinary retention in children can occur against the background of the same problems and diseases as in adults. On the other hand, there are some differences.
For example, in boys, a violation of urine outflow can develop with phimosis, a strong constriction of extremely flesh. Such a pathology leads to constant inflammation and, accordingly, scarring of the tissues, as a result of which only a small pinhole remains in the foreskin – naturally, this prevents the normal emptying of the bladder.
Incompetent attempts to bare the head of the foreskin often lead to paraphimosis – pinching the head in a narrow ring. With such a condition, the urethra is almost completely blocked, which threatens with acute urinary retention – the surgeon’s help is necessary in this case.
In girls, urinary retention is much less common and may be associated with proliferation of ureterocele into the urethra — cysts of the distal ureter.
In addition, we should not forget that children in games are extremely active and careless, therefore various injuries of the perineum are not at all considered uncommon, and this can lead to urinary retention.
Retention of urine in women and its features
Naturally, acute urinary retention in women can occur for the reasons described above, which often happens. However, there are some additional risk factors that are worth considering.
In some girls, a violation of urine outflow develops against the background of hematocolpometers, which is associated with the anatomical features of the hymen. For most women, it has a ring-shaped or semi-lunar form. But for some girls, the hymen is a solid plate that almost completely closes the entrance to the vagina. With the appearance of menstruation, this anatomical feature creates problems. Excretions begin to accumulate, resulting in a hematocolppelling device that squeezes the bladder and urinary tract, leading to the development of urinary retention.
Risk factors include pregnancy. Disruption of normal urination may be the result of rapid growth and dislocation of the uterus, which blocks the pathways for urine excretion. It is worth noting that this pathology is one of the most difficult in modern obstetric-surgical practice, since it is not so easy to make a correct diagnosis in time.
Also, in women, urinary retention may be associated with ectopic, namely cervical pregnancy. In this condition, implantation and further development of the ovum occurs in the cervical uterus. Naturally, the appearance of expansion is extremely dangerous, since it leads to a violation of the outflow of urine, bleeding and other dangerous complications.
Acute urinary retention: symptoms
With a deterioration in well-being, an urgent need to see a doctor. The specialist may detect the presence of urine retention even during the general examination, since such a state is accompanied by a number of very characteristic symptoms.
Pathology is accompanied by an overflow of the bladder and a significant increase in its volume. A painful protrusion is formed above the pubis, rather hard to the touch – this is the bladder.
Patients complain of frequent urge to urinate, which do not lead to emptying of the bladder, but are often accompanied by severe pain in the lower abdomen. The pain can spread to the genitals, perineum, etc.
This pathology is also characterized by urethrorrhagia – the appearance of blood from the urethra. Sometimes it can only be a small bleeding, sometimes – rather massive bleeding. In any case, blood in the urethra is an extremely dangerous symptom that requires emergency care.
Other signs are directly dependent on the cause of a similar condition and the presence of certain complications. For example, if the urethra and bladder are damaged or ruptured, patients develop severe pain syndrome, which leads to traumatic shock.
If there was a rupture of the proximal urethra, then there is a urinary infiltration of the pelvic fiber, which often causes severe intoxication. In the case of a vaginal or rectal (in men) study in such patients, there is a pasty tissue and a sharp soreness under pressure. When intraperitoneal rupture of the bladder, urine freely spreads through the abdominal cavity, which leads to acute pain in the lower abdomen.
Features of pathology in men
Acute urinary retention in prostate adenoma is most commonly diagnosed in elderly patients. As a rule, it is preceded by other problems with urination, including frequent nocturnal urges and the inability to completely empty the bladder.
In acute prostatitis, there are also symptoms of intoxication, in particular fever, weakness, chills, and often severe nausea and vomiting. In the future, there are problems with urination. The pain in this case is more pronounced, as it is associated not only with bladder overflow, but also with inflammation and suppuration of the prostate gland.
What complications can a disease cause?
Acute urinary retention is an extremely dangerous condition, so you should never ignore it. In fact, the lack of timely assistance can lead to damage to the urethra and rupture of the walls of the bladder as a result of too much filling and stretching. In addition, with such a pathology, urine is often returned to the kidneys, which is also fraught with infections and serious violations of the excretory system.
If you do not eliminate the cause of the acute delay, and only empty your bladder, such episodes may be repeated in the future. In turn, this can lead to the development of acute and chronic pyelonephritis, cystitis. Often, against the background of disturbed outflow of urine in the bladder, the formation of stones begins, which again threatens with an acute delay in the future. Other complications include urinary tract infection, as well as chronic renal failure. Acute urinary retention in men can lead to the development of acute forms of orchitis, prostatitis and epididymitis.
As a rule, a simple examination and anamnesis is enough to determine if the patient has acute urinary retention. Treatment, however, largely depends on the cause of this pathology, so after the first aid is provided, additional research is being conducted.
In particular, a complete picture of the state of the body can be obtained after ultrasound, ultrasound, percussion, X-ray (if there is suspicion of a spinal cord injury), magnetic resonance or computed tomography.
Acute urinary retention: emergency
If there are suspicions and symptoms of such a condition, an ambulance team should be urgently called – in no case should this problem be ignored. First aid for acute urinary retention is an emergency emptying of the bladder. The method in this case directly depends on the cause of the occurrence.
For example, if problems with emptying arose due to squeezing of the urinary tract (say, prostate or adenoma), then bladder catheterization is performed using a standard rubber catheter soaked in glycerin. Since it is impossible to conduct such a procedure on your own, the help of medical staff is simply necessary.
First aid for acute urinary retention, which is caused by reflex disorders, may look different. For example, a warm sitz bath or shower can be recommended to the patient, which will help to relax the urethral sphincters. If such manipulations are ineffective or there is no time to conduct them, emptying the bladder can be medication. To this end, the patient is intraurethrally injected. "Novocaine"and intramuscularly – "Prozerin", "Pilocarpine" or others. In addition, catheterization will be effective.
What methods of treatment are used in modern medicine?
As already mentioned, emergency care for acute urinary retention is reduced to the evacuation of the contents of the bladder. As a rule, this is done using a catheter (preferably rubber, since a metal device can damage the walls of the urethra). This method is perfect if the reason for the delay is reflex or is associated with injuries of the nervous system.
Unfortunately, not every case can use a catheter to remove urine. For example, with acute prostatitis, the presence of stones in the urethra catheterization can be quite dangerous.
If the introduction of the catheter is not possible, the doctor may perform a cystostomy (application of the urinary fistula in the suprapubic area) or suprapubic puncture of the bladder.
Further therapy is directly dependent on the cause of the development of this condition and the degree of its severity. For example, in case of bladder injury, detoxification, hemostatic, antibacterial and anti-shock treatment helps.
What other activities require acute urinary retention in men? Treatment of this condition, which is caused by acute prostatitis, usually includes taking anti-inflammatory drugs and antibiotics with a wide range of effects (for example, Cephalosporin, Ampicillin). In most cases, a day after the start of therapy, urination returns to normal. The course of treatment also includes the use of rectal suppositories from belladonna, hot enemas with antipyrine, sedentary warm baths, warming compresses on the perineum. If all of these interventions have not yielded any results, catheterization with a thin flexible catheter is carried out and further studies are carried out.
In the presence of neurogenic dysfunction, medical treatment is carried out. To eliminate the bladder detonator atony, such drugs as Prozerin, Aceclidine, as well as a solution of papaverine hydrochloride or atropine sulfate are used (by the way, repeated repeated injections of atropine can lead to a spasm of the detrusor and again acute urinary retention, therefore this drug is used very careful).
If a violation of the outflow of urine occurred as a result of fright, emotional overstrain, or any mental disorders, the patients are also given medication, prescribed warm baths, bed rest, a soothing environment. Sometimes it is possible to take sedatives. In the most severe cases, an examination and consultation with a psychiatrist is required.
When is surgery necessary?
There are many unpleasant and even dangerous complications that can be caused by acute urinary retention. Emergency care and proper medical therapy, unfortunately, can not always fix the problem. In some cases, surgery is necessary. For example, the help of a surgeon is needed if there are ruptures of the urinary canals or bladder.
The operation is carried out in the event that the cause of the delay are stones that can only be removed surgically. In addition, with a strong proliferation of the prostate gland (hyperplasia), the only way to normalize the flow of urine is to remove excess tissue. The same applies to the presence of tumors or other neoplasms in the pelvis in women.
Of course, the decision on surgical intervention is made by the attending physician.