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 further well-being of a sick person. So what are the causes and first manifestations of this urination disorder? What treatments can modern medicine offer? What are the complications of urinary obstruction?
What is urinary retention?
Acute urinary retention is a condition in which emptying 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 retention, on the contrary, the bladder fills, but under the influence of certain factors, its release is impossible.
It is worth noting that a similar problem develops much more often in men, which is associated with anatomical features. However, it is also possible for women. In addition, children often suffer from urinary retention.
The main reasons for the development of this condition
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 blockage or squeezing of the urinary tract);
- those that are caused by certain disorders of the nervous system (the brain, for one reason or another, stops controlling the processes of bladder emptying);
- reflex disorders that are associated with partial disruption of 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 the evacuation of its contents is simply impossible. This 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, and various injuries of the urethra. In men, urine outflow may bedisturbed by prostatitis or enlargement (hyperplasia) of the prostate, and in women by prolapse of the uterus.
Retention of urine can be associated with disorders 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, brain contusion.
If we are talking about reflex disorders, then the 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, fear, 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 a violation of the outflow of urine. These may include tricyclic antidepressants, benzodiazepines, adrenomimetics, anticholinergics, narcotic analgesics, some antihistamines.
What causes 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, accordingly, scarring of tissues, resulting inthe foreskin remains only a small pinhole - naturally, this interferes with the normal emptying of the bladder.
Inept attempts to expose the head of the foreskin often lead to paraphimosis - infringement of the head in a narrow ring. In this condition, the urethra is blocked almost completely, 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 a ureterocele, a cyst in the distal ureter, into the urethra.
In addition, do not forget that children are extremely active and careless in games, so various injuries of the perineum are by no means considered rare, and this can lead to urinary retention.
Urine retention in women and its features
Of course, acute urinary retention in women can occur for the reasons described above, which most often happens. However, there are some additional risk factors to consider.
In some girls, a violation of the outflow of urine develops against the background of hematocolpometry, which is associated with the anatomical features of the hymen. In most women, it has an annular or crescent shape. But in some girls, the hymen is a solid plate that almost completely closes the entrance to the vagina. When menstruation occurs, this anatomical feature creates problems. The secretions begin to accumulate, resulting in the development of a hematocolpometer, whichcompresses the bladder and urinary tract, leading to the development of urinary retention.
Pregnancy is also a risk factor. Violation of normal urination may be the result of the rapid growth and displacement of the uterus, which blocks the path for urine to be excreted. It should be noted 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 ectopic, namely cervical pregnancy. In this condition, implantation and further development of the fetal egg occur in the cervical region of the uterus. Naturally, the appearance of an 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 an overflow of the bladder and a significant increase in its volume. A painful protrusion forms over the pubic bone, quite hard to the touch - this is the bladder.
Patients complain of frequent urge to urinate, which does not lead to bladder emptying, but is often accompanied by severe pain in the lower abdomen. The pain may radiate to the genitals, perineum, etc.
For thispathology is also characterized by urethrorrhagia - the appearance of blood from the urethra. Sometimes it can be only small spotting, sometimes it can be quite massive bleeding. In any case, blood in the urethra is an extremely dangerous symptom that requires emergency care.
Other signs directly depend on the cause of such a condition and the presence of certain complications. For example, when the urethra and bladder are damaged or ruptured, patients develop a pronounced pain syndrome, which leads to traumatic shock.
If there is a rupture of the proximal urethra, then there is urinary infiltration of the pelvic tissue, which often causes severe intoxication. With vaginal or rectal (in men) examination, such patients experience tissue pastosity and severe pain on pressure. With an 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 often diagnosed in elderly patients. It is usually preceded by other urinary problems, including frequent nighttime urges and 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. Later, there are problems withurination. 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 the disease lead to?
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, there is often a reverse reflux of urine into the kidneys, which is also fraught with infections and serious disruption of the excretory system.
If the cause of the acute retention is not corrected, but only the bladder is emptied, similar 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, 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.
Diagnostic Methods
As a rule, a simple examination and history taking is sufficient to determine whether a patient has acute urinary retention. Treatment, however, largely depends on the cause of this pathology, therefore, aftermore research is underway to provide first aid.
In particular, a complete picture of the state of the body can be obtained after ultrasound, ultrasonography, percussion, radiography (if there is a suspicion of a spinal injury), magnetic resonance or computed tomography.
Acute urinary retention: emergency care
If there are suspicions and symptoms of such a condition, an ambulance should be urgently called - in no case should this problem be ignored. First aid for acute urinary retention is reduced to the urgent emptying of the bladder. The method in this case directly depends on the cause.
For example, if problems with emptying arose due to squeezing of the urinary tract (say, with prostatitis or adenoma), then the bladder is catheterized using a standard rubber catheter dipped 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, the patient may be advised to take a warm sitz bath or shower to help relax the urethral sphincters. If such manipulations are ineffective or there is no time to carry them out, emptying the bladder is caused by medication. For this purpose, Novocain is administered intraurethral to the patient, and Prozerin, Pilocarpine, or others intramuscularly. In addition, it will also be effectivecatheterization.
What treatments 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, as a metal device can damage the walls of the urethra). This method is great if the cause of the delay is reflex or related to trauma to the nervous system.
Unfortunately, not in every case, a catheter can be used to remove urine. For example, in acute prostatitis, the presence of stones in the urethra, catheterization can be quite dangerous.
If insertion of a catheter is not possible, the doctor may perform a cystostomy (a vesical fistula in the suprapubic region) or a suprapubic puncture of the bladder.
Further therapy already directly depends on the cause of the development of this condition and its severity. For example, with a bladder injury, detoxification, hemostatic, antibacterial and anti-shock treatment helps.
What other measures does acute urinary retention require in men? Treatment of a similar condition, which is caused by acute prostatitis, usually includes taking anti-inflammatory drugs and broad-spectrum antibiotics (for example, Cephalosporin, Ampicillin). In most cases, already a day after the start of therapy, urination returns to normal. The course of treatment also includes the use of rectal suppositories frombelladonna, hot enemas with antipyrine, sitz 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 research.
In the presence of neurogenic dysfunction, drug treatment is carried out. To eliminate the atony of the bladder detrusor, drugs such as Prozerin, Aceclidin, 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, so this drug is used very carefully).
If the violation of the outflow of urine occurred as a result of fright, emotional overstrain or any mental disorders, patients are also given medication, warm baths, bed rest, and a calming 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 needed?
There are many unpleasant and even dangerous complications that acute urinary retention can lead to. Emergency care and proper drug therapy, unfortunately, can not always eliminate the problem. In some cases, surgery is simply necessary. For example, the help of a surgeon is needed if there are ruptures of the urinary tract or bladder.
The operation is performed if the cause of the delay is stones that can only be removed surgically. In addition, atstrong prostate enlargement (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.
