The urologist often hears the patient's complaint "I can not write." But urination disorders are a wider problem. Urinary retention can be associated not only with kidney or bladder problems, but also with diseases of the nervous system, prostate pathology in men. More about all these causes, clinical manifestations, methods of diagnosis and treatment of this problem later in the article.
General information
The patient’s complaint that he cannot write is described in the medical literature as urinary retention. This condition implies problems with the emptying of the bladder, despite its fullness. That is, urine is formed normally, the kidneys work, but for some reason, urine cannot spill out. Its constant presence in the bladder not only leads to the development of unpleasant symptoms, but is also a risk factor for pathogens and infection of the genitourinary system.
It is noteworthy that at a young age, the inability to urinate equally occurs in people of both sexes. But with age, men are more prone to this problem. This is due to the fact that they may develop pathology of the prostate gland (prostate), which is often accompanied by problems with urination.
Treatment should be aimed both at alleviating the symptoms, that is, emptying the bladder, and at eliminating the underlying cause. Otherwise, serious complications may develop.
Main reasons
Urinary retention is not an independent pathology. This is just one of the symptoms of other diseases. Therefore, if the patient is unable to urinate, you should always look for the cause.
One of the main reasons is a mechanical obstruction to the outflow of urine caused by obstruction (overlapping) of the urethral lumen. Blockade can occur due to the growth of a tumor, the presence of a stone in the lumen, strictures (adhesions) of the urethral opening, phimosis (adhesions of the foreskin) to a severe degree. In addition to changes in the urethra itself, blockade can occur due to the growth of neoplasms in neighboring organs. In men, this is most often a change in the prostate gland, both inflammatory and oncological in nature.
Another reason is a disorder of the innervation of the muscles of the bladder. With damage to the spinal cord, a spasm of sphincters and detrusor (the main muscle of the bladder) develops. As a result of this, a person cannot go to the toilet in a small way.
Another answer to the question "Why can not I urinate?" are stress factors and mental changes. An increase in the activity of the sympathetic nervous system leads to inhibition of the reflexes necessary for relaxing the muscles of the bladder and the process of urination.
Some medications also lead to urinary retention. These are narcotic drugs, anticholinergics, sedatives and sleeping pills. In this case, a complex effect is exerted on both the peripheral and central nervous system. Complex mechanisms develop that impede the process of urination.
The main links of pathogenesis
Pathogenesis - this period of the development of the disease from the very beginning to recovery. It is very important to know him for an absolute understanding of the reason for the “I can’t write” complaint. The pathogenetic development of the problem directly depends on the nature of its occurrence.
The simplest one to understand is mechanical obstruction of the urethral lumen. Blood clots that form after surgery, urethral stricture after surgery, compression of the urethra from the outside by an enlarged prostate - all these factors can lead to mechanical obstruction of the urine from the body. The function of the kidneys, muscles of the bladder is absolutely not impaired.
Elimination of the etiology - mechanical obstruction - will quickly lead to the restoration of the normal act of urination. The main thing is to quickly find the cause, since prolonged inaction of the bladder leads to its atrophy.
If the nature of the pathology is a disorder of the innervation of the muscles of the bladder, the pathogenesis is more complex. If the innervation of the detrusor suffers primarily, atony of the bladder occurs. He simply cannot contract with enough force to push urine out. With an increase in the tone of the external sphincter, urine does not pour out, since the necessary relaxation of the sphincter cannot be achieved.
Varieties of urinary retention
There are several types of urination disorders according to the type of delay. They differ from each other by the development mechanism and clinical manifestations. The main ones include:
- Acute delay - abruptly begins, most often due to mechanical obstruction, but may also be associated with neurogenic causes. With a complete delay in the allocation of urine is not observed at all, with incomplete - urine leaves weak drops.
- Chronic delay - worries the patient for a long period of time. Often associated with compression of the urethra from the outside by neoplastic processes of the prostate. If incomplete, a large amount of residual urine remains in the bladder - up to several hundred milliliters.
- Paradoxical Ischuria is the most rare species. It occurs with damage to the sacral spinal cord, where the center of urination is located. It is manifested by the constant allocation of urine in drops against the background of an almost completely filled bladder.
Symptoms that accompany urinary retention
The clinical manifestations of urinary retention can be divided into two large groups: symptoms associated with the main cause, and dysuric manifestations, which are accompanied by the complaint "I can not write."
When obstructing the urethra with a stone, urinary retention does not occur immediately. First, the patient complains that it hurts to urinate. This symptom appears when the stone goes through the ureters to the bladder and then enters the urethra. Actually, urinary retention develops when the stone stops moving and completely blocks the lumen of the urethra.
Violation of urination due to prostatitis (inflammation of the prostate gland) is also accompanied by a patient's complaint that it hurts to urinate. In this case, pain in the perineum is associated with swelling of the prostate and irritation of the nerve endings.
If urine output is difficult due to neurogenic causes, other clinical manifestations may be weakness in the limbs (paresis), impaired sensitivity (hypesthesia) or its complete absence (anesthesia).
Symptoms of prolonged urinary retention
But regardless of the initial cause, urinary retention for a long period of time is accompanied by the following symptoms:
- an increase in the size of the abdomen due to an increase in the size of the bladder;
- pain in the abdomen and over the pubis for the same reason;
- restless condition of the patient, throwing;
- deterioration in overall health;
- an increase in body temperature with the addition of a secondary infection.
Diagnostics
When searching for the cause of urination disorders, attention should be paid both to the clinical manifestations that accompany urinary retention and to data from additional laboratory and instrumental examination methods.
After a thorough conversation with the patient and his examination, it is possible to establish the fact of the presence of acute urinary retention, and sometimes to suggest its probable origin. Only after collecting complaints, medical history and examination, additional examination methods are prescribed:
- Ultrasound examination (ultrasound) - allows you to evaluate the structure of the bladder, prostate, urethra. With its help, mechanical obstruction of the urethra, inflammatory processes, neoplasms are clearly visible.
- Magnetic resonance imaging (MRI) of the spinal cord - performed with suspected neurogenic nature of urinary retention.
- Cystoscopy - examination of the bladder with a small camera. Allows you to visualize obstruction, change the walls of the bladder, set the amount of urine in it.
- Retrograde cystourethrography is an X-ray method for examining the organs of the urinary system.
In a diagnostic search, it is necessary to clearly differentiate urinary retention from anuria. The latter occurs when there is a violation of urine output by the kidneys.
Treatment methods
Do not urinate - what to do? The answer to this question depends on the cause of the problem. In any case, in the presence of urination disorders, consult a specialist. Moreover, doctors of several specialties are involved in this problem:
- urologist;
- neurologist;
- nephrologist;
- oncologist.
Therefore, it is advisable first of all to go to a therapist or family doctor, who will be able to determine which specialist is best to contact next.
But it takes some time to eliminate the cause of the disease. If you hear a “can't urinate” complaint, what should a man or woman do as quickly as possible? Regardless of gender, a bladder catheterization procedure is performed. A tube is inserted into the urethra, which reaches the bladder. In this way, a normal outflow of urine can be quickly ensured.
Forecast
The prognosis of recovery with urinary retention depends on many factors: the cause, the timeliness of seeking help, the correct diagnosis and treatment. But in most cases, the prognosis is favorable. The outflow of urine is quickly restored after the elimination of the etiological factor.