The urologist often hears the patient's complaint "I can't write". But urinary disorders are a broader problem. Urinary retention can be associated not only with kidney or bladder problems, but also with diseases of the nervous system, pathology of the prostate in men. More about all these causes, clinical manifestations, methods for diagnosing and treating this problem later in the article.
General information
The patient's complaint of not being able to write is described in the medical literature as urinary retention. This condition implies problems with emptying the bladder, despite its fullness. That is, urine is normally formed, the kidneys are working, but for some reason the urine cannot pour out. Its constant presence in the bladder not only leads to the development of unpleasant symptoms, but is also a risk factor for pathogenic microorganisms and infection of the genitourinary system.
It is noteworthy that at a young age the inability to urinateoccurs equally in both sexes. But with age, men are more susceptible 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 at both relieving the symptoms, i.e. emptying the bladder, and addressing the underlying cause. Otherwise, severe complications may develop.
Main reasons
Retention of urination is not an independent pathology. This is just one of the symptoms of other diseases. Therefore, if a patient is unable to urinate, one 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 tumor growth, the presence of a stone in the lumen, strictures (fusions) of the urethral opening, phimosis (foreskin adhesions) to a severe degree. In addition to changes in the urethra itself, the blockade may occur due to the growth of neoplasms in neighboring organs. In men, these are most often changes in the prostate gland, both inflammatory and oncological in nature.
Another reason is a disorder of innervation of the muscles of the bladder. When the spinal cord is damaged, a spasm of the sphincters and detrusor (the main muscle of the bladder) develops. As a result, a person cannot go to the toilet in a small way.
Another answer to the question "Why can't I urinate?" are stress factors and changes in the psyche. An increase in the activity of the sympathetic nervous system leads to inhibition of the reflexes necessary to relax the muscles of the bladder and initiate the process of urination.
Some medicines also cause urinary retention. These are narcotic drugs, anticholinergics, sedatives and hypnotics. In this case, there is a complex effect on both the peripheral and central nervous systems. Complex mechanisms develop that prevent the process of urination.
The main links of pathogenesis
Pathogenesis - this period of development of the disease from the very beginning until recovery. It is very important to know it for an absolute understanding of the reason for the complaint "I can not write." The pathogenetic development of the problem directly depends on the nature of its occurrence.
The easiest to understand is mechanical obturation 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 a mechanical obstruction of the exit of urine from the body. The function of the kidneys, the muscles of the bladder is absolutely not disturbed.
Elimination of the etiology - mechanical obturation - will quickly lead to the restoration of the normal act of urination. The main thing is to quickly find the cause, since prolonged inactivity 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 suffering in the firstthe turn of the innervation of the detrusor, there is atony of the bladder. It just can't contract with enough force to expel the urine. When the tone of the external sphincter is increased, urine does not flow out, since the relaxation of the sphincter necessary for this 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 mechanism of development and clinical manifestations. The main ones are:
- Acute delay - begins abruptly, most often due to mechanical obstruction, but may also be associated with neurogenic causes. With a complete retention of urine, no urine is observed at all, with an incomplete one, urine comes out in weak drops.
- Chronic delay - disturbs the patient for a long period of time. It is often associated with compression of the urethra from the outside by neoplastic processes in the prostate. With an incomplete form, a large amount of residual urine remains in the bladder - up to several hundred milliliters.
- Paradoxical ischuria is the most rare variety. It occurs when the sacral parts of the spinal cord are damaged, where the center of urination is located. It is manifested by the constant release of urine in drops against the background of an almost completely filled bladder.
Symptoms that accompany urinary retention
Clinical manifestations of urinary retention can be divided into two large groups: symptoms associated withthe main cause, and dysuric manifestations, which are accompanied by the complaint "can not write".
When obstructing the urethra with a stone, urinary retention does not occur immediately. At 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.
Impaired urination due to prostatitis (inflammation of the prostate gland) is also accompanied by the patient's complaint that it hurts to urinate. In this case, the pain in the perineum is associated with swelling of the prostate and irritation of the nerve endings.
If urine output is obstructed due to neurogenic causes, other clinical manifestations may include weakness in the limbs (paresis), loss of sensation (hypesthesia) or no sensation at all (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 above the pubis for the same reason;
- restlessness of the patient, throwing;
- deterioration of general well-being;
- an increase in body temperature when a secondary infection is attached.
Diagnosis
When looking for a reasonurination disorders should pay attention both to the clinical manifestations that accompany urinary retention, and to the data of additional laboratory and instrumental examination methods.
Already after a thorough conversation with the patient and his examination, it is possible to establish the presence of acute urinary retention, and sometimes suggest its probable nature of origin. Only after collecting complaints, anamnesis 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 perfectly visible.
- Magnetic resonance imaging (MRI) of the spinal cord - performed if a neurogenic nature of urinary retention is suspected.
- Cystoscopy - examination of the bladder with a small camera. Allows you to visualize obstruction, changes in 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.
During the diagnostic search, it is necessary to clearly differentiate urinary retention from anuria. The latter occurs when there is a violation of the excretion of urine by the kidneys.
Treatment methods
No way to 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, it is necessary to consult a specialist. Moreover, doctors of severalmajors:
- urologist;
- neurologist;
- nephrologist;
- oncologist.
Therefore, it is best to go to a general practitioner or family doctor first, who will be able to determine which specialist is best to see next.
But after all, it takes some time to eliminate the cause of the disease. If the complaint "I can't urinate" is heard, what should a man or woman do as soon as possible? Regardless of gender, a bladder catheterization procedure is performed. A tube is inserted into the urethra and reaches the bladder. In this way, you can quickly ensure a normal outflow of urine.
Forecast
The prognosis for recovery from urinary retention depends on many factors: the cause, the timeliness of seeking help, the correct diagnosis and prescribed treatment. But in most cases, the prognosis is favorable. The outflow of urine is quickly restored after the elimination of the etiological factor.
