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 main causes of this condition. It is very important to know about the first manifestations of the pathology, because first aid for acute urinary retention is extremely important for the further well-being of a sick person. So what are the causes and first manifestations of this urinary disorder? What treatment methods can modern medicine offer? What are the complications of a violation of urine outflow?
What is urinary retention?
Acute urinary retention is a condition in which emptying of a full bladder is impossible. 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. In acute delay, on the contrary, the bladder becomes full, but under the influence of various factors, its secretion is impossible.
It is worth noting that a similar 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 condition
It is immediately worth saying that the causes of acute urinary retention can be very diverse, therefore, in modern medicine they are divided into four main groups:
- mechanical (associated with mechanical blockage or compression of the urinary tract);
- those that are caused by certain 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 the innervation or emotional state of the patient;
- medication (due to the effect on the body of a particular drug).
Now it is worth considering each group of factors in more detail. Acute urinary retention often develops with mechanical compression of the bladder or urinary tract, as a result of which evacuation of its contents is simply impossible. Similar is observed in the presence of a foreign body in the bladder or urethra. Also, risk factors include neoplasms in the lower urinary tract, sclerosis of the bladder neck, stones in the neck or urinary ducts, various injuries of the urethra. In men, the outflow of urine can be impaired with prostatitis or overgrowth (hyperplasia) of the prostate, and in women with prolapse of the uterus.
Urinary retention can be associated with impaired functioning of the central nervous system, which is observed in the presence of tumors, as well as injuries to the spinal cord or spine (including intervertebral hernia), shock, stroke, and brain contusion.
If we are talking about reflex disorders, then risk factors include injuries to 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. Strong emotional shock, fright, hysteria, and alcohol intoxication can be attributed to the same group of reasons.
There are also groups of drugs that in some patients can lead to impaired urine outflow. These can be tricyclic antidepressants, benzodiazepines, adrenergic agonists, anticholinergics, narcotic analgesics, and some antihistamines.
What can cause urinary retention in children?
Even the smallest patients are not immune from 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 the outflow of urine can develop with phimosis - a strong narrowing of the foreskin. Such a pathology leads to constant inflammation and, consequently, scarring of tissues, as a result of which only a small pinhole remains in the foreskin - naturally, this interferes with the normal emptying of the bladder.
Inept attempts to expose the head from the foreskin often lead to paraphimosis - an infringement of the head in a narrow ring. With this condition, the urethra is almost completely blocked, which threatens with acute urinary retention - the help of a surgeon in this case is necessary.
In girls, urinary retention is much less common and may be associated with prolapse of the urethrocele - a cyst of the distal ureter.
In addition, do not forget that children in games are extremely active and careless, so various crotch injuries are by no means considered a rarity, and this can lead to urinary retention.
Urinary retention in women and its features
Naturally, acute urinary retention in women can occur for the above reasons, which most often happens. However, there are some additional risk factors that are worth considering.
In some girls, a violation of the outflow of urine develops against the background of hematocolpometers, which is associated with the anatomical features of the hymen. In most women, it has a ring-shaped or lunate shape. But for some girls, the hymen is a continuous plate that almost completely closes the entrance to the vagina. With the appearance of menstruation, such an anatomical feature creates problems. Allocations begin to accumulate, as a result of which a hematocolcolometer develops, which compresses the bladder and urinary tract, leading to the development of urinary retention.
Risk factors include pregnancy. Violation of normal urination can be the result of rapid growth and displacement of the uterus, which blocks the route for excretion of urine. It is worth noting that this pathology is one of the most difficult in modern obstetric and surgical practice, since it is not so easy to make a correct diagnosis in time.
Also, in women, urinary retention may be associated with an ectopic, namely cervical pregnancy. With this condition, implantation and further development of the fetal egg occurs in the cervical uterus. Naturally, the appearance of the expansion is extremely dangerous, as it leads to a violation of the outflow of urine, bleeding and other dangerous complications.
Acute urinary retention: symptoms
If you feel worse, you need to urgently see a doctor. A specialist can detect the presence of urinary retention even during a general examination, since such a condition is accompanied by a number of very characteristic symptoms.
Pathology is accompanied by overflow of the bladder and a significant increase in its volume. A painful protrusion is formed above the pubic bone , which is rather hard to the touch - this is the bladder.
Patients complain of frequent urination, which does not lead to an empty bladder, but is often accompanied by severe pain in the lower abdomen. Pain can spread to the genitals, perineum, etc.
For this pathology, urethrorrhagia is also characteristic - the appearance of blood from the urethra. Sometimes it can be only small spotting, sometimes quite massive bleeding. In any case, blood in the urethra is an extremely dangerous symptom that requires urgent care.
Other signs directly depend on the cause of this condition and the presence of certain complications. For example, in case of damage or rupture of the urethra and bladder, patients develop severe pain syndrome, which leads to traumatic shock.
If there was a rupture of the proximal urethra, then urinary infiltration of the pelvic fiber is observed, which often causes severe intoxication. When a vaginal or rectal (in men) study in such patients, tissue pastiness and sharp pain with pressure are observed. With an intraperitoneal rupture of the bladder, urine freely spreads in the abdominal cavity, which leads to the appearance of acute pain in the lower abdomen.
Features of pathology in men
Acute urinary retention in prostate adenoma is most often diagnosed in elderly patients. As a rule, she is preceded by other problems with urination, including frequent nightly urges and the inability to completely empty the bladder.
In acute prostatitis, symptoms of intoxication are also present, in particular, fever, weakness, chills, 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 overflow of the bladder, 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 in no case should you ignore it. In fact, the lack of timely help 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 thrown back into the kidneys, which is also fraught with infections and serious disruption of the excretory system.
If you do not eliminate the cause of the acute delay, but just empty the bladder, such episodes may recur in the future. In turn, this can lead to the development of acute and chronic pyelonephritis, cystitis. Often, against the background of a violation of the outflow of urine in the bladder, stone formation 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.
Diagnostic Methods
As a rule, a simple examination and history is enough to determine if the patient has an acute urinary retention. Treatment, however, largely depends on the cause of this pathology, therefore, after providing first aid, additional studies are carried out.
In particular, a complete picture of the state of the body can be obtained after ultrasound, ultrasonography, percussion, radiography (if there is suspicion of a spinal injury), magnetic resonance or computed tomography.
Urinary urinary retention: emergency care
If there are suspicions and symptoms of such a condition, an ambulance team must be urgently called in - in no case should this problem be ignored. First aid for acute urinary retention is reduced to an urgent emptying of the bladder. The method in this case directly depends on the cause of the occurrence.
For example, if problems with emptying occurred due to squeezing of the urinary tract (say, with prostatitis or adenoma), then the bladder is catheterized using a standard rubber catheter soaked in glycerin. Since it is impossible to carry out 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 sitting bath or shower may be recommended to the patient, which will help relax the urethral sphincters. If such manipulations are ineffective or there is no time for them, emptying the bladder is caused by medication. For this purpose, Novocaine is administered intraurethrally to the patient, and Proserinum, Pilocarpineum, etc. are administered intramuscularly. In addition, catheterization will also be effective.
What treatment methods 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 a rubber one, since a metal device can damage the walls of the urethra). This method is perfect if the cause of the delay is reflex or is associated with injuries of the nervous system.
Unfortunately, not every case catheter can be used to remove urine. For example, with acute prostatitis, the presence of stones in the urethra, catheterization can be quite dangerous.
If the introduction of a catheter is not possible, the doctor may perform a cystostomy (application of a bladder fistula in the suprapubic region) or suprapubic puncture of the bladder.
Further therapy is directly dependent on the cause of the development of this condition and its severity. For example, with bladder injury detoxification, hemostatic, antibacterial and anti-shock treatment helps.
What other measures does acute urinary retention in men require? Treatment of this condition, which is caused by acute prostatitis, as a rule, includes the use of anti-inflammatory drugs and broad-spectrum antibiotics (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 these measures have not yielded any results, catheterization is performed using a thin flexible catheter and further studies.
In the presence of neurogenic dysfunction, drug treatment is performed. To eliminate the atony of the detrusor of the bladder, drugs such as Prozerin, Aceclidine, as well as a solution of papaverine hydrochloride or atropine sulfate are used (by the way, frequent repeated injections of atropine can lead to detrusor spasm and, again, acute urinary retention, therefore this drug is used very careful).
If the violation of the outflow of urine occurred as a result of a fright, emotional overstrain, or any mental disorders, patients are also given medications, prescribed warm baths, bed rest, and a calming environment. Sometimes sedation is possible. In the most severe cases, examination and consultation of a psychiatrist is required.
When is surgery necessary?
There are many unpleasant and even dangerous complications that can lead to acute urinary retention. Emergency care and proper medication, unfortunately, can not always fix the problem. In some cases, surgery is simply necessary. For example, surgeon help is needed if there are ruptures of the urinary tract or bladder.
An operation is performed if the cause of the delay is stones that can only be removed surgically. In addition, with a strong proliferation of the prostate gland (hyperplasia), the only way to normalize the outflow 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.