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Urination disorders (dysuria)

Painful urination . Pain during urination may occur at the beginning, end, or during the entire urination act.

Pain in the beginning of urination occurs with acute inflammation of the urethra and depends on irritation with the urine stream of inflamed urethral walls. Pain at the end of urination is observed in acute cystitis , tumors of the bladder, inflammation of the prostate gland, posterior urethra, and in inflammatory processes in the bladder neck. Pain caused by compression of the inflamed nerve endings of the mucous membrane with a maximum contraction of the bladder muscles at the end of urination.

Rapid urination or pollakiuria (more often than 4-5 times in the daytime and 1 time at night) with copious drinking, with excitement is a physiological phenomenon.

Pollakiuria without pain is often observed during pathological processes in the reproductive system in women (when the anterior wall of the vagina is lowered, when the uterus is bending or swelling) and depends on the circulatory disorder in the area of ​​the bladder neck. In men with so-called hypertrophy (adenoma) of the prostate, urination is increased mainly at night, depending on the overflow of blood to the pelvic organs during sleep and an increase in the volume of the adenoma. In patients with bladder stones, urination, on the contrary, is accelerated mainly during the day, when the stone, moving as the patient moves, irritates the nerve endings of the bladder mucosa.

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Urinary incontinence is most often seen in inflammation of the bladder, especially its neck, posterior urethra, and prostate gland. In these cases, urination is increased, the urge to urinate is imperative, irresistible. Not holding the urine should not be confused with urinary incontinence. During the latter, urine is also expelled involuntarily, but there is no urge to urinate.

Difficult urination depends most often on mechanical obstructions to the free flow of urine from the bladder. These include narrowing, stones or tumors of the urethra, narrowing of the foreskin (phimosis), adenoma or prostate cancer, bladder tumors located in his neck. Urination occurs with the help of increased tension of the abdominal press. Compensatory hypertrophy of the muscle bundles of the detrusor, which protrude under the mucous membrane of the bladder in the form of rollers (log or trabecular bladder — see Fig. 35), develops. Gradually, however, the reserve power of the cystic muscle is exhausted, the stream of urine becomes sluggish, falls vertically downwards, the bladder is not completely emptied, residual urine appears.

Rarely there is difficulty urinating because of diseases or injuries of the brain or spinal cord: with tabes dorsalis, as well as with congenital disorders of the detrusor innervation (congenital atony of the bladder).

Urinary retention - the inability to empty the bladder, despite the overflow of urine. The causes of urinary retention are the same as difficulty urinating. There are also reflex forms of urinary retention, for example, after surgery (postoperative urinary retention), after a strong startle, with hysteria.

There are complete and incomplete urinary retention. When a patient is fully retained, despite a sharp urge to urinate and severe straining, not a single drop of urine can be expelled, with incomplete, partial, urinary retention is performed, but after it a part of urine remains in the bladder, i.e. residual urine appears, the amount which can reach thousands or more milliliters. Urinary retention may occur suddenly - acute delay, or develop gradually - chronic delay.

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Acute urinary retention is caused by injury of the urethra, blood flow to prostate adenoma (for example, with prolonged sitting, constipation or diarrhea), atony of the cystic muscle as a result of intoxication of urine in the presence of a urethral stricture or prostate adenoma.

Chronic urinary retention is the result of a long-term obstruction to the flow of urine or atony of the detrusor.

Acute retention of urine causes severe pain and requires emergency care.

Acute delay due to prostatic hypertrophy is often eliminated by a single bladder catheterization or urine release within a few days.

If catheterization cannot be performed, suprapubic puncture of the bladder or suprapubic section of it and urine diversion through the drainage tube (cystostomy) are used. This operation should be applied without delay during urinary retention due to injury of the urethra.

Postoperative urinary retention, depending on the weakening (paresis) of the muscular wall of the bladder, is in most cases eliminated by injecting 1 ml of a 1% solution of pilocarpine or 1 ml of a 0.05% solution of proserin, causing a reduction in smooth muscle. In the absence of effect, the urine is released by a catheter.

Urinary incontinence . By incontinence means involuntary discharge without urging to urinate. There are absolute and relative incontinence. With absolute incontinence, urination is absent, since all urine is released involuntarily, for example, for congenital cleft of the bladder, bladder (extrophy) or the entire urethra (total epispadia), and for large fistulas of the bladder.

With relative incontinence, only part of the urine is released involuntarily, while the rest is retained in the bladder, urination periodically appears, and it happens normally. Thus, with relative incontinence, the latter is combined with normal urination. This category includes urinary incontinence in congenital ectopia of one ureter, when its mouth opens somewhere outside the bladder - in the vagina, in the uterus, vulva, and the second ureter opens in the bladder. This includes urinary incontinence when the urahus (urinary duct) is not infected, in traumatic or postoperative small fistulas of the bladder or ureter.

Quite often, relative urinary incontinence occurs in women suffering from an omission of the anterior wall of the vagina, and hence the posterior wall of the urethra and bladder neck (cystocele). In most cases, the cystocele is accompanied by a weakening of the closure ability of the sphincter. As a result, with an increase in intra-abdominal pressure — laughter, coughing, physical stress — small portions of urine are released involuntarily.

A peculiar form of urinary incontinence is paradoxical ischuria (ischuria paradoxa). With prolonged urinary retention, not only the ultimate stretching of the muscular wall of the bladder occurs, but also the stretching of the sphincters. The urine entering the overflowing bladder, involuntarily drops out from the urethra, that is, the urine retention is combined with incontinence.

Bedwetting . Under bedwetting, or enuresis, refers to involuntary urination in sleep. When enuresis elements of urinary incontinence is not, because we are talking about the normal act of urination, but not perceived by consciousness.

Enuresis is very common in childhood, occurs in about 5-15% of children. In adults, it is rare, by the age of 15–18, bedwetting usually stops.

Urination in newborns occurs according to the type of unconditioned reflex, i.e., it is performed on the first urge; the ability to own a bubble and suppress the urge to urinate both in reality and in a dream is carried out through a conditioned reflex produced by upbringing. The essence of this reflex is that the urge to urinate, by means of an elaborated conditioned connection, relaxes and expands the wall of the bladder, and thereby lowering the intravesical pressure and stop the urge.

If this conditioned reflex is not sufficiently developed or not stable, then under the influence of external and internal stimuli (mental experiences, nasopharyngeal diseases, phimosis, worms, etc.), the conditioned connection ceases, leading to enuresis.