No urine flows into the bladder - what to do? Acute urinary retention: symptoms and first aid. Retention of urine in a child

21.04.2019

Acute urinary retention and lack of urination - this is a condition of the body in which a person does not pass urine on his own, but at the same time the bladder is full. With this phenomenon, the kidneys function and form urine, but it does not leave the bladder due to an obstruction at the level of the urethra or sphincter.

How does acute urinary retention manifest?

Almost always symptoms of acute urinary retention associated with the presence of a strong urge to urinate. In this case, urine is either not excreted at all, or only a small amount is excreted. Acute urinary retention is very often accompanied by excruciating pain in the lower abdomen. The pain becomes stronger when a person moves, tries to make certain physical efforts, makes attempts to urinate.

Acute urinary retention in men and women is often accompanied by nonspecific symptoms, the manifestation of which depends on the reasons for the development of such a condition. Acute urinary retention in women is a condition in which vaginal discharge may appear; in men - from the urethra. In addition, nausea and vomiting are possible, , a sharp increase in pressure. The patient may have a fever, sometimes there is a feeling of urge to defecate.

Visually, there can be a noticeable protrusion at the bottom of the anterior abdominal wall, or the doctor, while assisting with acute urinary retention, notes the overcrowding of the bladder. During palpation, a spherical formation in the lower abdomen that is painful during pressure is determined.

Very often, patients who suffer from acute urinary retention note that before such a phenomenon, urination is painful, the stream is very sluggish, and a small amount of fluid is released.

Determined complete and incomplete delay. The state of complete retention is characterized by an absolute absence of urine, despite straining and a pronounced urge to urinate. In some diseases, chronic urinary retention in men and women leads to the fact that urine is released to the patient only by a catheter for many years. It is important to distinguish between the full extent of retention and the state in which the formation of urine in the body stops.

Incomplete retention is a condition in which part of the fluid from the bladder comes out. Moreover, after each act of urination, a certain amount of fluid remains in the bladder. Sometimes it can be a significant amount - up to 1 liter. This condition often becomes chronic and remains invisible to the patient for a long time. As a result, stagnation of urine in the urinary tract can develop, as well as disruption of the normal functioning of the kidneys. If this condition continues for a very long time, then later the patient develops a pronounced stretching the muscle wall of the bladder , atony , sphincter sprain ... With such violations, urine is excreted involuntarily, coming out in drops. This condition is called in medicine paradoxical ishuria .

Why is acute urinary retention manifested?

This symptom is typical for some diseases of the central nervous system. Symptoms of urinary retention in women and men appear when injuries and brain tumors , spinal cord and also for myelitis , dorsal tabes ... In this case, there is a disorder in the regulation of the detrusor, as well as the sphincters of the bladder by the nervous system. Urinary problems can also be due to a previous spinal injury.

Also defined reflex functional causes urinary retention in women and men. We are talking about the condition after surgery on the genitals of a person, the rectum. Reflex urinary retention occurs in the first time after surgical procedures on the abdominal organs. This symptom sometimes manifests itself after, in a state of stress, hysteria, in a state of strong alcoholic intoxication. Acute urinary retention in some cases is also noted in people who have been in a supine position for a long time due to certain diseases and pathologies in the body.

Problems with the passage of urine can occur against the background of drug intoxication of the body, which arose as a result of taking large doses of sleeping pills or narcotic analgesics.

Experts note that most often the causes of urinary retention in older men are associated with the development of prostate adenoma ... In men with adenoma, acute urinary retention develops as a result of prolonged sitting, hypothermia, and alcohol intake.

With injuries of the urethra, difficulty urinating is observed mainly in men, since, unlike the female urethra, the male urethra is longer.

If the delay is manifested by a sudden interruption of urination, then this may be due to the appearance bladder stones ... When the process of urine flow begins, a movable stone blocks the opening inside the urethra, which leads to an interruption of the process. To resume urination, the person is forced to change their location. Often people who develop bladder stones are able to urinate only by assuming a certain position.

In women, in rare cases, urinary retention occurs during pregnancy. This occurs in the last months of gestation, since the uterus is significantly enlarged, which provokes additional squeezing of the bladder.

How to get rid of acute urinary retention?

If a person has such a symptom, he should definitely provide specialized medical assistance, and it is impossible to postpone the visit to a doctor with such complaints. Self-treatment of urinary retention in women and men often leads to unpleasant consequences. In particular, bladder rupture, infection leading to the development of chronic diseases, and urethral injuries that occur when trying to insert a catheter on their own can occur. Chronic urinary retention leads to manifestation chronic ... Therefore, in no case should you act on your own, practicing treatment with folk remedies. Emergency care for acute urinary retention should be performed only by qualified professionals. The patient needs to either urgently consult a urologist, or call an ambulance.

Before the doctor begins treatment of acute urinary retention in men and women, you can temporarily relieve a person's condition a little by putting heat on the lower abdomen or on the perineum. Before the arrival of the doctor, you can take a warm bath, use antispasmodic drugs.

The doctor necessarily conducts diagnostics, determines the causes and treatment. To establish the correct diagnosis, laboratory tests of urine, blood, ultrasound examination of the kidneys, bladder, and pelvic organs are required. Before treating urinary retention in men, the prostate gland is also examined. According to the indications, other studies can also be prescribed ( urethrography , cystography , urography and etc.).

Urgent management of urinary retention in women and men involves the use of a catheter, which is inserted into the urethra and allows the bladder to empty. The catheter should only be inserted by a specialist, as there is a risk of damage to the urethra if inserted incorrectly. If necessary, the catheter remains in the bladder for several days. In this case, it is important to take all measures to avoid infection. For this purpose, the patient is prescribed a course of antibiotics, antiseptics are used for washing. If a rubber catheter cannot be inserted into a patient, an urologist should be consulted urgently. In cases where bladder catheterization cannot be performed for certain reasons, a puncture of the bladder or surgery is practiced. Sometimes an epicystostomy is applied - this is a catheter that is passed through the anterior abdominal wall and through which urine exits.

If a person suffers from reflex urinary retention, several methods are used to help resume normal urination. For example, the external genitals can be watered with warm water. A person can try to listen to the sound of bubbling water, the perception of which reflexively promotes urination.

In the course of treatment, the doctor may prescribe the introduction of 1–2% solution into the urethra. Sometimes it is advisable to carry out an introduction subcutaneously, the doctor determines the dosage individually.

In case of an acute delay after rendering assistance, the doctor conducts a study and decides on the need for treatment or surgery in order to eliminate mechanical obstacles to normal emptying.

The entire further system of treatment directly depends on the disease that provoked the manifestation of this symptom. It should be clearly understood that after the catheter is inserted, the symptom may reappear later. To prevent serious complications, it is imperative to take the necessary measures for treatment.

Acute urinary retention is the name of a condition when a person feels strong, but self-expression is impossible. It is worth limiting this pathology from anuria, in which urine ceases to be produced and the organ remains empty, as a result of which urination is impossible.

With urinary retention, the bladder is filled to the limit, so a person urgently needs emergency help from qualified doctors to alleviate the condition. Consider what causes this pathology, by what symptoms it can be recognized and how acute urinary retention is treated.

Acute urinary retention can be triggered by various factors in children, adults and the elderly. Unfortunately, a person at any age is not protected from the risk of developing this pathology. The neurogenic causes of urinary retention include:

herniated intervertebral discs;
dorsal tabes;
spinal cord or brain injury / tumor;
myelitis;
multiple sclerosis.

Mechanical causes of acute urinary retention:

phimosis;
sclerosis of the bladder neck;
swelling of the urethra or bladder neck;
stricture, abnormal development of the urethra;
neoplasm localized in the lower urinary tract;
blood clots;
a foreign body in the bladder (stone) that blocks the flow of urine into the urethra.

There are also functional reasons, when reflex disorders of the functions of the bladder develop. Pathology develops as a result of:

Low ambient temperature.
Surgery on the rectum or perineum.
Strong alcoholic intoxication.
Long stay of a person in a supine position (recovery period after surgery, paralysis of the limbs, etc.).
Prolonged stress.
Fright.

Acute urinary retention can develop due to the intake of certain medications: anticholinergic, narcotic pain relievers, tricyclic antidepressants, and others. There are cases when in elderly people acute urinary retention was caused by injections of antispasmodics.

Common causes of the development of pathology in men

Retention of urination in men often develops as a result of acute prostatitis, adenoma and malignant tumor of the prostate. Usually, an acute condition is preceded by a number of symptoms accompanying the described pathologies: frequent nighttime urination, a sluggish stream of urine, feeling. In such cases, surgical treatment is often required.

If acute urinary retention was caused by acute prostatitis, the man will be worried about weakness, nausea and other signs of intoxication. In this case, painful sensations will be caused not only by overflow of the bladder, but also by inflammation of the prostate.

Causes of pathology in women

Acute urinary retention can be caused by the following factors:

prolapse of the uterus;
childbirth, especially prolonged or complicated;
surgery on the genitals in the postpartum period;
hysteria - a mental illness that mostly affects women;
swelling of the uterus or rectum.

In girls, urinary retention may also be associated with the characteristics of the hymen. If it looks like a solid plate, then during the onset of menstruation, the discharge accumulates and the hematocolpometer develops when the urinary tract and bladder are compressed. In this case, acute urinary retention occurs.

In medical practice, there are cases when pregnancy became the cause of urinary retention. This can happen when the uterus begins to grow and shift rapidly, thus blocking the urinary tract. If there is a cervical pregnancy (ectopic), then due to the expansion of the cervix, the urinary tract is compressed and urinary retention, bleeding and other dangerous symptoms occur, indicating the need for medical attention.

What causes it to develop in children?

In boys, phimosis is called a common cause of this pathology - narrowing of the foreskin, when only a small hole remains in it, which prevents the timely and complete emptying of the bladder. Acute urinary retention occurs if the narrowing develops into paraphimosis when the urethra closes completely. In this case, the only treatment is surgery.

In girls, this condition can be caused by prolapse of the cyst of the distal ureter into the urethra. In addition, children are especially susceptible to various injuries that they receive during active games, so urinary retention can be caused by injuries to the perineum.

Symptoms

Symptoms of acute urinary retention are pronounced:

very strong urge to empty the bladder;
when trying to make a miktion, drops of blood appear from the urethra;
strong painful sensations in the pubic area and slightly above;
bursting sensations in the lower abdomen;
a bulky bladder: a protrusion appears in the suprapubic region, it is densely elastic to the touch, severe pain is felt on palpation;
if there has been a rupture of the bladder or urethra, traumatic shock occurs.

Sometimes acute urinary retention is preceded by the following symptoms:

sleep disturbance;
general weakness;
frequent urge to empty the bladder, as for the night time;
nausea, vomiting;
lack of appetite;
increased body temperature;
constipation.

It is important to tell the doctor such manifestations when taking anamnesis so that he can correctly diagnose and prescribe adequate treatment.

Diagnostics

Acute urinary retention is easily diagnosed during the initial examination of the patient. In a place located in the middle of the distance between the pubic articulation and the navel, an arcuate bluntness is determined when tapped, facing up. Percussion of the suprapubic region is also performed when a dull sound is well heard.

After providing first aid, they often carry out:

Ultrasound of the pelvic organs.
Excretory cystourethrography.
Retrograde urethrography.
Intravenous pyelography.
Computed tomography.

Such diagnostic measures are necessary to clarify the diagnosis and the provoking cause, as well as to prescribe a suitable treatment.

First aid to the patient

Acute urinary retention requires urgent care, which consists in draining the bladder through catheterization, which leads to complete emptying of the organ. This technique can only be performed by a medic. The procedure is performed using a metal or flexible catheter:

for catheterization of women, a metal catheter with a soft tip is used;
for men, it is more advisable to use a flexible catheter, the diameter of which is identical to the lumen of the urethra.

In both cases, the catheter is abundantly lubricated with vaseline oil or glycerol, delicately inserted into the urethra until urine flows from the other end of the tube into a prepared tray. No more than two attempts of catheterization are carried out, if none of them was successful, the patient is urgently taken to the hospital.

There are a number of contraindications for this procedure:

trauma to the urethra;
the presence of stones in the urethra;
abscess of the prostate;
acute prostatitis;
orchitis;
acute urethritis.

If standard catheterization could not be carried out or there were contraindications for this, cystostomy is performed in stationary conditions. To do this, a puncture is made in the area of the bladder, through which an elastic rubber tube is inserted into the organ. As a result, urine flows out of the bladder constantly until the organ's function is fully restored.

When for a long time, a prerequisite is regular flushing of the organ with antiseptic solutions and the patient taking broad-spectrum antibiotics. Such measures will prevent infection from joining.

If the pathology was caused by reflex disorders, the first aid is taking a warm bath. This procedure will relax the urethral sphincter, after which the patient will be able to empty the bladder on their own. For the same purpose, a dose of pilocarpine or proserin can be urgently administered intramuscularly, and novocaine (1% solution) intraurethrally.

A big mistake of patients with urinary retention is self-medication, especially taking diuretics. Such therapy can only aggravate the patient's condition.

Treatment

The first and foremost treatment for acute urinary retention is to drain the bladder to empty it completely. Further therapeutic tactics depend on the cause that provoked this pathology.

In 98% of such cases, patients are prescribed α-blockers - tamsulosin or alfuzosin. To prevent the development of an infectious process, patients need to take antibiotics Furadonin, Ampicillin, Nitroxoline, Cephalosporin or other drugs prescribed by the attending physician.

Acute urinary retention caused by acute prostatitis requires antibacterial and anti-inflammatory treatment. Additionally, sit warm baths, enemas with antipyrine, belladonna suppositories and warm compresses on the perineum are prescribed. As a rule, one day after an exacerbation, urination returns to normal.

If there was a neurogenic cause of urinary retention, use drugs Aceclidine, Proserin, solutions of Atropine sulfate and Papaverine hydrochloride. Such therapy allows you to eliminate the atony of the bladder detrusor and quickly cope with the problem.

When the delay was triggered by severe stress, fear, nervous tension or similar factors, the patient is prescribed bed rest, warm baths and sedatives.

If it is difficult to urinate due to the formation of blood clots, flushing of the bladder with isotonic sodium chloride solution is required.

If there was a bladder injury, the patient is prescribed hemostatic, detoxification, antibacterial and anti-shock therapy.

In some cases, an operation is necessary:

with a ruptured bladder or urethra;
when phimosis occurs;
if a man has been diagnosed with prostatic hyperplasia, her tumor;
when a neoplasm of any nature is detected in the pelvic area in women;
in the presence of stones in the urethra or bladder.

If an acute urinary retention occurs, do not hope that the problem will "resolve" itself. Self-medication can lead to sad consequences in the form of urosepsis or rupture of the bladder. Therefore, do not hesitate and call an ambulance - and your problem will be solved competently and without consequences.

The syndrome of urinary retention (or ischuria) is a disease due to which the patient cannot empty his bladder on his own. In this case, the patient usually experiences severe pain in the lower abdomen. If the symptoms of the disease occur suddenly, then the patient's condition is characterized as a syndrome of acute urinary retention.

In addition, the disease can proceed in a chronic form, which is characterized by the presence of a certain obstacle in the path of urine output (for example, a benign tumor). Chronic urinary retention syndrome usually affects elderly men, who manifest themselves with frequent urge to urinate, while the patient cannot fully urinate: it seems that the bladder is still full. According to the international classification of diseases, the syndrome of acute urinary retention has the ICD-10 R33 code.

The reasons for the development of urinary retention syndrome can be different. Most often this disease is diagnosed in men over the age of 55. Often, the cause of urinary stagnation is prostate adenoma. With prostate adenoma, the tissue of the prostate gland grows, forming a benign tumor. Growing, the tumor begins to press on the urethra. As a result, urine can no longer pass through it as freely as it used to. That is why a patient with prostate adenoma may have a desire to urinate more than once a night.

In addition, in men, problems with urination may be due to the individual characteristics of the structure of the urethra, previous diseases of the urethra.

Among other things, constipation can be a cause of urinary retention syndrome. The rectum overflowing with feces can put pressure on the bladder, as a result of which it is compressed and even displaced. As a result, urine cannot flow normally through the urethra, and a delay occurs.

The reasons for urinary retention also include:

previous trauma of the central nervous system (central nervous system);
reflex urination disorder;
abuse of sleeping pills, narcotic drugs;
the presence of stones in the bladder;
prostate cancer;
recent surgery on the genitals;
severe stress;
childbirth;
phimosis;
tumors of the brain and spinal cord;
spinal cord injury.

Retention of urine syndrome can also occur as a result of severe alcohol intoxication.

Urinary retention syndrome has quite pronounced symptoms. So, the patient usually complains of acute pains in the lower abdomen, the urge to urinate (however, it is impossible to urinate on his own), bloating in the lower abdomen (as a result of excessive overflow of the bladder), poor appetite, nausea, insomnia, unexplained sharp increases in body temperature, weakness.

Diagnostics

The diagnosis and treatment of the disease is carried out by a urologist. He is authorized to refer the patient after taking an anamnesis for appropriate tests in order to determine the cause of urinary retention and provide qualified assistance.

First, the specialist feels the patient's lower abdomen. Thus, he can determine what exactly the patient is suffering from: ishuria or anuria. And if we are already familiar with the symptoms and causes of ischuria, then the absence of urine is called anuria, when urine does not flow into the bladder.

As soon as the doctor determines the nature of the disease, he can refer the patient to the following tests to clarify the causes of the disease:

KLA (complete blood count).
OAM (general urine analysis).
blood biochemistry.
Ultrasound of the kidneys and bladder.
Ultrasound of the prostate (for men).

A complete blood count is able to show the number of blood cells: erythrocytes, leukocytes, platelets, erythrocyte sedimentation rate. Why is a general blood test done? When a person is healthy, the quantitative composition of blood cells does not change, other indicators (neutrophils, basophils, lymphocytes, etc.) also do not go beyond the established norm. However, in the presence of an inflammatory process or other disorders in the body, the composition of the blood changes. So, by the quantitative composition of the blood, the doctor can determine the nature of the patient's disease.

If you suspect diseases of the kidneys, bladder, prostate gland, a general urine test is prescribed, which is designed to show the transparency, color, odor, and also the chemical composition of the patient's urine.

A biochemical blood test will allow the doctor to assess the quality of the work of internal organs such as the pancreas, kidneys and liver.

Ultrasound (ultrasound) will help a specialist assess the appearance and condition of internal organs. So, ultrasound of the bladder allows you to diagnose:

stones and sand in the bladder;
inflammation of the mucous membrane;
the presence of various foreign bodies in the bladder;
abnormal structure of the bladder.

Ultrasound of the prostate is prescribed for suspected prostatitis and other diseases of the genital organs in men, due to which the outflow of urine may be impaired. Ultrasound of the prostate is performed through the rectum using a special apparatus, the length of which is no more than the index finger: this allows you to avoid unpleasant sensations during the procedure.

How to provide first aid?

If the patient has symptoms of acute urinary retention syndrome (after alcohol, after surgery, after childbirth), he should be immediately taken to the hospital (to the urological department), where he will receive emergency care for acute urinary retention. If the pain in the lower abdomen is strong enough, then before the arrival of an ambulance, you need to put a warm heating pad on the patient's groin area.

Retention of urine in a child

Unfortunately, children are more likely to have urinary problems than adults. The reason for this is muscle cramps, which often happen in children. If your child simply cannot pee, but does not experience pain symptoms, this means that he cannot concentrate, he needs some kind of stimulus, for example, a sound one. To do this, you can open the water tap. The sounds of water will provoke the baby's body to urinate.

In newborns (boys), urinary retention syndrome can be triggered by remnants of the embryonic urethra, which blocks the outer urethral opening. In this case, the doctor must remove it with a special point instrument. Urinary retention in boys at an early age can also be caused by:

swelling of the bladder.
tumor of the prostate gland.
kidney inflammation.

In girls, problems with urination can be associated with infectious diseases of the genital organs, kidney stones, and in the bladder.

Treatment

Treatment for acute urinary retention may differ between men and women. So, urinary obstruction in women requires immediate medical attention, since the consequences can result in sepsis or infection of the genitals. During hospitalization, the first step will be to remove excess urine from the bladder. In acute retention, urine is released using a catheter. The procedure is performed while sitting in a gynecological chair. After emptying the bladder, the doctor prescribes treatment for the patient, which will be aimed at eliminating the cause of the disease.

Treatment of acute urinary retention in men also involves hospitalization and urine removal from the bladder. For this, an elastic or rubber catheter is used, which is gradually introduced into the urethra. The procedure takes place in the supine position.

Prophylaxis

To choose a set of preventive measures to prevent the disease of urinary retention syndrome, one should proceed from the reasons that caused this problem. So, in order to prevent prostatitis, men should move more, engage in exercise therapy (physical therapy). In addition, in order to avoid the occurrence of inflammatory diseases of the genitourinary system, hypothermia of the genitals should be avoided: wear thermal underwear in winter.

In addition, in order to prevent the occurrence of problems with urination, one should not abuse alcohol, one should not use narcotic substances, one should not resort to the help of sleeping pills too often, it is also advisable to avoid stressful situations.

Acute urinary retention is a condition in which it is impossible to urinate, accompanied by pain, weakening after catheterization of the bladder with a urethral catheter.

Reduced or absent urine output, combined with pain in the lower abdomen, is not sufficient to make a diagnosis of acute urinary retention. Many acute surgical conditions cause abdominal pain and hypovolemia. Hypovolemia can lead to a decrease in the amount of urine produced, which can give the erroneous impression of urinary retention, when in fact there is none.

Thus, the central place in the establishment of the diagnosis is the presence of a large volume of urine and relief of pain after catheterization. What is meant by the concept of "large volume" is not strictly defined, but the volume of 500-800 ml is typical. A volume of less than 500 ml should raise doubts about the correct diagnosis. A volume of more than 800 ml is defined as an acute retention associated with chronic urinary retention.

Causes of acute urinary retention

There are three main mechanisms:

increased urethral resistance, i.e. bladder outlet obstruction;
low bladder pressure, i.e. violation of the contractility of the bladder;
violation of the sensory or motor innervation of the bladder.

Causes in men

The most common cause is benign prostatic hyperplasia (BPH), leading to bladder outlet obstruction. Rarer causes include malignant tumors of the prostate gland, urethral strictures, and less commonly prostate abscesses.

Urinary retention can also occur spontaneously (usually preceded by symptoms of lower urinary tract disease) when exposed to a provoking factor in patients with or without symptoms of urinary tract disease. If the provoking factor has been eliminated, recurrence of urinary retention becomes less likely. Spontaneous urinary retention is likely to recur after removal of the urethral catheter and therefore requires more radical treatment, such as transurethral resection of the prostate (TURP). Factors that trigger urinary retention are anesthetics and other drugs (anticholinergics, sympathomimetics such as ephedrine in nasal sprays), abdominal or perineal surgery (without involving the prostate), and immobilization from surgery, such as after hip replacement.

Causes in women

Women have more possible causes, but they are less likely to have acute urinary retention. These causes include pelvic organ prolapse (nistocele, rectocele, prolapse of the uterus), in which the prolapse directly compresses the urethra; strictures, diverticula of the urethra; postoperative period after correction of stress urinary incontinence; Fowler's syndrome (impaired relaxation of the external sphincter in premenopausal women, often in combination with polycystic ovaries) and pelvic tumor (i.e. ovarian tumor). Postpartum urinary retention is discussed below.

Common Causes

A large number of diseases can cause urinary retention in both women and men: hematuria, leading to hemotamponade; drug exposure; pain (adrenergic stimulation of the bladder neck); postoperative urinary retention; compression or damage to the sacral nerve; compression of the cauda equina (due to prolapse of intervertebral discs, grams of vertebrae, benign or metastatic tumors); radical pelvic surgery with damage to the parasympathetic plexus (radical hysterectomy, abdominal perineal extirpation of the rectum); fractures of the pelvis, causing rupture of the urethra (more often in men); neurotropic viruses affecting the sensitive ganglia of the dorsal roots S II -S IV (simple and herpes zoster); multiple sclerosis; transverse myelitis; diabetic cystopathy; damage to the posterior columns of the spinal cord, leading to loss of sensitivity of the bladder (dorsal tabes, B12-deficiency anemia).

Neurological causes of urinary retention: warning!

It is always very easy to assume that urinary retention in men is caused by benign prostatic hyperplasia. Of course, this is the most common cause in older patients, but in the case of younger men (under 60, but sometimes over 60) it is worth taking some time to determine if there may be any other causes.

Likewise, in women, in whom urinary retention is much less common than in men, one should think about why they have a delay.

Be on the lookout for patients with a history of constipation and be especially careful if there is back pain. Many people sometimes suffer from back pain, but pain of neurological origin, for example, arising from a tumor of the spine or compression of the cauda equina in a herniated disc (compression of the nerve roots at the S II -S IV level, causing a deterioration in bladder contractility), can be very strong, unrelenting and progressive. The patient may report that the pain became severe several weeks before the urinary retention episode. Back pain and sciatica (pain through the back of the thigh and leg) that are relieved by sitting or walking at night are common with neurofibroma or ependymoma affecting the cauda equina. Interscapular pain usually occurs with tumors that have metastasized to the thoracic vertebrae.

Sensory changes resulting from cauda equina compression can manifest as a patient's inability to determine if the bladder is full, a lack of sensation of urine passing through the urethra during urination, and difficulty detecting the passage of feces or gases through the rectum.

Male patients with a neurological cause of urinary retention (such as a tumor in the spine) may complain of sexual dysfunction that may seem irrelevant (and therefore ignored). Patients may have erectile dysfunction and loss of orgasmic sensation. There may also be complaints of unusual burning or tingling sensations in the perineum or penis.

It takes no more than 1-2 minutes to ask the patient a few leading questions ("Do you have constipation?", "Do you have back pain?", "Do you feel sick or weak in your legs?"), Conduct an examination , which will help identify sensory disturbances (the main symptom of spinal cord compression), other neurological signs of spinal cord compression and check the integrity of the nerve roots in the sacral spine at the S II -S IV level that innervate the bladder.

In men, this can be checked by compression of the glans penis during a digital rectal examination. Contraction of the anal sphincter, felt by the doctor with a finger, indicates the intactness of the afferent and efferent sacral nerves and the sacral spine. This is called the bulbocavernosal reflex. In women who have been catheterized, a similar reflex can be tested by gently pulling the catheter up to the bladder neck while simultaneously performing a digital rectal examination. Contraction of the anal sphincter indicates intact afferent and efferent sacral nerves and sacral spine.

If you are unaware of these rare causes of urinary retention, you may not need to ask the patient leading questions. Misdiagnosis in such cases can have serious consequences for the patient (and for you). Magnetic resonance imaging of the thoracic, lumbar, sacral spinal cord and cauda equina should be urgently performed in patients with urinary retention in combination with additional symptoms and signs.

Risk factors for postoperative urinary retention

Postoperative urinary retention can be triggered by the effect of surgical instruments on the lower urinary tract, surgical interventions on the perineum and anorectal region, gynecological operations, bladder overstretching, reduced feeling of bladder filling, existing prostatic obstruction and epidural anesthesia. Postpartum urinary retention is not uncommon, especially if epidural anesthesia and birth control have been used.

First aid for urinary retention

Urethral catheterization is the main point in the primary management of urinary retention. It allows you to relieve pain caused by overstretching of the bladder. If urethral catheterization is not technically feasible, a suprapubic cystostomy should be performed. It is necessary to record the volume of drained urine; this allows you to confirm the diagnosis, determines further tactics and provides prognostic information regarding the outcome of the treatment.

Acute or Chronic Urinary Retention?

There is a group of older people with urinary retention, but they are not aware of this. We are talking about the so-called chronic high pressure urinary retention (partial chronic urinary retention).

Mitchell defined chronic high-pressure urinary retention as the ability to urinate when the volume of urine in the bladder is more than 800 ml and the intravesical pressure is more than 30 cm of water. Art., often combined with hydronephrosis. Over time, this leads to kidney failure.

The patient continues to urinate on his own, while often he does not have a feeling of incomplete emptying of the bladder. His bladder is not sensitive to severe distension. Often the first symptom is bedwetting. This extremely unpleasant symptom will cause most people to see their doctor. In such cases, examination of the abdomen will reveal a marked distension of the bladder, which can be confirmed by palpation and percussion of the strained bladder.

Sometimes in patients with chronic high-pressure urinary retention, the ability to urinate suddenly disappears, acute urinary retention develops against the background of chronic high-pressure urinary retention.

During catheterization, a large volume of urine is excreted from the bladder (often up to 1-2 liters, in some cases even more). The level of creatinine in the blood is increased, and ultrasound reveals hydronephrosis and an overstretched bladder.

Assessment of the volume of urine obtained during catheterization can help identify two groups of patients: with acute urinary retention (<800 мл) и с острой задержкой мочеиспускания, развившейся на фоне нелеченой хронической задержки мочи высокого давления. Еще до катетеризации, если пациент описывает картину парадоксальной ишурии, можно предположить острую задержку мочеиспускания на фоне хронической задержки мочи высокого давления. Объем остаточной мочи может подтвердить диагноз.

In cases where the patient has a large volume of residual urine (several liters), the level of creatinine in the blood is increased, and ultrasound of the kidneys revealed hydronephrosis, the development of post-obstructive diuresis should be expected. This condition is easy to detect. The reasons for the occurrence are the following factors.

Reducing the flow of urine along the Henle loop reduces the "driving force" that forms the cortico-medullary concentration gradient. In addition, the persistent renal perfusion effectively flushes out this gradient, which is very important for the kidney to concentrate urine. Once normal flow through the nephron has been resumed due to drainage of the bladder and elimination of back pressure on the kidneys, it should take several days for the cortico-medullary gradient to recover. During this period, the kidneys cannot concentrate urine, as a result of which post-obstructive diuresis occurs.
Elevated serum urea acts as an osmotic diuretic.
Excessive amounts of water and salt accumulated during urinary retention are excreted by the kidneys.

Usually, patients come out of the post-obstructive diuresis state without complications, even if several liters of urine are released during the day. However, sometimes the volume of circulating blood can decrease, which causes the development of postural hypotension. A good way to determine this condition is to measure the patient's blood pressure while standing and lying down. If there is a large difference between the values obtained, intravenous infusion of isotonic sodium chloride solution is necessary.

Treatment of acute urinary retention acute urinary retention

The provoked urinary retention often does not recur, in contrast to the spontaneous one.

If urinary retention is provoked, it is necessary to try to remove the urethral catheter. For spontaneous urinary retention, many urologists try to avoid transurethral resection of the prostate (TURP) after the first episode of retention. Instead, the urethral catheter is removed (with or without α-blockers) in the hope of restoring spontaneous urination and avoiding surgery. An attempt to remove the catheter is definitely not suitable in cases where there is reflux of urine into the kidneys, with high pressure urine retention. In about a quarter of men with acute urinary retention, spontaneous urination is restored after removal of the urethral catheter. In 50% of patients with restoration of urination after the first episode of retention, relapse developed within about a week, in 60% after a month, and in 70% after a year. This means that after a year, only one in 5-10 people who initially had urinary retention will not develop re-urinary retention. Recurrent urinary retention is more common in patients with an average urinary flow rate of less than 5 ml / s or an average urine volume of less than 15 ml. Therapy with alpha-blockers, started 24 hours before removal of the urethral catheter, increases the likelihood of restoring spontaneous urination (restored in 30% with placebo and in 50% with alpha-blocker therapy).

However, it is not known whether the risk of relapse decreases with continued therapy with α-blockers after an episode of acute urinary retention.

Thus, an attempt to use α-blockers is justified, but a significant number of men with spontaneous acute urinary retention will still relapse, and they will ultimately be referred to a urologist for TURP.

Urinary retention in patients with a catheterizable stoma

An increasing number of patients are undergoing reconstructive surgery, including the creation of a catheterizable stoma such as the Mitrofanov stoma.

Patients with a catheterizable Mitrofanov stoma sometimes cannot pass the catheter into the stoma. This often occurs after spinal or other surgery. Spinal surgery can change the angle of the stoma, or the patient's bladder can become overfilled in the postoperative period, which can deform the stoma to such an extent that it becomes difficult to pass the catheter through it.

In this situation:

try to pass the catheter yourself; at the same time, the use of a large amount of lubricant is justified. If the catheter normally used by the patient does not work, try a larger or smaller catheter;
if unsuccessful, try passing a flexible wire through the stoma (preferably under radiological guidance, if available). This can help you get into your bladder in cases where the catheter won't go there. A cut-off catheter can be passed into the bladder along a string;
if this does not help, try to pass the flexible ureterorenoscope along the guidewire as far as possible and try to overcome the obstacle and restore the passage to the bladder;
if all of the above attempts are ineffective, place a suprapubic cystostomy and empty the bladder; the patient will then usually be able to pass the catheter into the stoma without problems.

Postpartum urinary retention

Postpartum urinary retention is the inability to urinate independently after childbirth. In addition to this basic definition, there is no agreed definition of postpartum urinary retention in terms of the time of its development and the volume of the bladder at the time of retention.

Postpartum urinary retention, according to the currently used definition, is the absence of spontaneous urination 6 hours after birth through the vaginal route (with caesarean section - after 6 hours after removal of the urethral catheter). Despite the fact that this definition is somewhat arbitrary, in accordance with it in 2004, the Royal College of Obstetricians and Gynecologists recommended that patients naturally empty the bladder or catheterize no later than 6 hours after surgery or vaginal delivery. When it comes to compliance with these guidelines, less than a quarter of maternity hospitals in England and Wales have followed them. Regarding the recommendations themselves, Zaki noted that there are no clear guidelines for scheduling urine output, measuring urine volume, and checking residual volume prior to catheterization.

In a retrospective case-control study of urinary retention conducted at the Mayo Clinic between August 1992 and April 2000, postpartum urinary retention occurred in 51 of 11,332 vaginal deliveries (0.45%). Multiple logistic regression showed that for women with postpartum urinary retention, instrumental delivery and conduction anesthesia were significant independent risk factors.

Postpartum urinary retention in the early days is a well-known phenomenon. The reasons can be various factors.

At the second stage of labor, the emerging head of the fetus presses on the urethra and bladder, provoking edema, which can cause impaired outflow of urine through the urethra.
Tears and pain in the vulva can also make it difficult to urinate. As well as difficulty urinating due to groin pain, trauma (such as epishotomy) can cause swelling of the vulva and perineum, resulting in poor urine flow.
Changes in the anatomy of the lower abdomen after childbirth can reduce bladder sensitivity.
Conductive anesthesia (such as an epidural block) disrupts the function of the nerves (II-IV sacral nerves) that are responsible for emptying the bladder. Conductive anesthesia blocks the sensory afferent innervation of the bladder to stretch the walls (i.e., fill the bladder). This leads to the impossibility of relaxing the pelvic floor muscles and the work of the urethral sphincter, and then to the impossibility of contraction of the bladder. As a result, this leads to urinary retention.

According to the above, urinary retention can occur during the postpartum period.

If urinary retention is not resolved, it can cause bladder overextension. And in this situation, a woman will not be able to urinate on her own. When the bladder is stretched, the pressure inside it increases, which provokes an involuntary urination in an insignificant volume. If we talk about epidural anesthesia, the pain in the abdominal region that accompanies urinary retention under all other conditions may not appear in this case.

Bladder distension causes temporary damage to nerve endings in the bladder wall, possibly due to decreased local circulation. If distension of the bladder is observed for more than a few hours, reduced blood circulation can provoke so-called ischemic damage to the sensory and motor innervation of the bladder (ischemia leads to the release of reactive oxygen species, which can be an indirect cause of nerve damage).

A key factor in preventing postpartum urinary retention (and therefore bladder damage due to overstretching) is knowing about situations in which postpartum urinary retention occurs, the willingness to resort to catheterization and repeat the procedure if the first attempt fails. You also need to be prepared for periodic self-catheterization if the ability to urinate independently is not restored immediately.

Ketamine bladder

The incidence of ketamine use among patients aged 16-24 years increased from 0.8% of people in this age group in 2007-2008. up to 2.1% in 2010-2011 This question is included in the book because patients with ketamine uropathy can have emergencies with painful hematuria (pain in the suprapubic region), lower urinary tract symptoms, hydronephrosis (due to small bladder capacity, high bladder pressure, and / or obstructive uropathy). What exactly is the mechanism of the effect of ketamine is still unclear, but ketamine or its metabolites have a direct toxic effect on the urothelium, disrupt microcirculation in the bladder and, possibly, provoke an autoimmune reaction. A vicious circle is created in which the pain requiring ketamine for treatment results in more ketamine being supplied, resulting in further bladder damage. There are still no clear guidelines for the treatment of such cases. Critical from the urologist's point of view is the fact that a young Nazi with hematuria and bladder pain can use ketamine, and in addition to emergency pain relief, the involvement of a general practitioner, chronic pain specialists and information technology support services is necessary. on drugs in order to break this vicious cycle of drug abuse before irreversible damage to the bladder occurs.

In terms of pain relief during emergency procedures, a combination of buprenorphine, codeine-containing drugs, and amitriptyline may help to reduce the patient's need for ketamine as an analgesic.

Acute urinary retention takes a person by surprise. Confusion and pain do not give an opportunity to make the right decision. It is not recommended to endure in such cases; it is better to call an ambulance. To improve literacy, it will be useful to familiarize yourself with the reasons for this complication.

Sources of ailment

Acute urinary retention is characterized by a sharp manifestation of pain, bloating. More often, this condition is formed against the background of another developing complication. Infections, inflammation of the bladder, prostatitis, urethritis and many other diseases affect the release of excess urine. Damage to the nervous system also has a negative effect on the excretory system.

Acute urinary retention is similar in symptoms to anuria. However, in the latter case, soreness is manifested due to the lack of urine in the bladder. With this type of complication, she does not go there at all.

Acute urinary retention is predictable if you pay attention to the state of the body. Symptoms can be used to determine the onset of the disease and to be treated. A sudden worsening of the condition can be avoided.

In advanced cases, only surgery helps, which can also have side effects. Indeed, the formation of acute urinary retention can be affected by surgery on other internal organs. Likewise, women's health is affected by difficult labor, when muscle fibers are torn.

Signs of complication

Emergency care for acute urinary retention should follow immediately after detecting swelling in the lower abdomen. When there is a sharp and unnatural increase in the size of the peritoneum. The person discovers that he has not gone to the toilet to urinate for a long time, and the consumption of water occurs normally.

You will also need help with acute urinary retention, when there is sharp pain and the body needs relief. But I still can't go to the toilet. A doctor should be consulted if at least one of the listed signs is found. If all complications are observed at once, then the patient needs hospitalization.

The sharp color and smell of urine should be alerted if this is observed for more than two days. Often, the composition change depends on nutrition and bad habits. Many diseases of the genitourinary system are manifested by such properties, you should undergo a full examination when the normal state of urine changes.

Complication classification

A distinction should be made between chronic and acute urinary retention. Treatment is carried out in both cases, since this condition is a sign of a developing serious illness. A complete examination is carried out in order to identify the deviation of health and to prevent further blocking of the excretory passages.

If the deterioration occurs within a few hours, then this is an acute urinary retention. Treatment is unscheduled and is carried out in a hospital. With such a complication, unbearable pain in the lower abdomen is observed. The patient feels a constant urge to go to the toilet and cannot do it.

In the chronic form of complications, pain may be absent, the patient goes to the toilet, but the bladder is not completely emptied. This situation is eliminated by long-term treatment under the supervision of a doctor.

First aid can and should be carried out in case of acute urinary retention, aimed at alleviating the condition of the body. A different approach should be applied to each patient, based on the available information about chronic diseases.

The disease paradoxical ischuria is allocated in a separate area. Overflow incontinence is observed here. There is a complication of overstretching of the sphincters, otherwise the mechanism that closes the ducts is called so.

Complications in the stronger sex

Acute urinary retention in men is often caused by problems in the reproductive system. Adenoma of the prostate is a growing tumor that begins to compress adjacent tissues. If the neoplasm belongs to a benign species, then a malignant tumor - prostate cancer - has a similar effect.

A similar effect is observed in acute prostatitis, trauma to the urethra. The narrowing of the ducts is influenced by inflammation of the seminal tubercle, disruption of the normal movement of the foreskin. The latter situation occurs with phimosis.

The development of complications is influenced by infections of the genitourinary system. This is facilitated by promiscuous sexual intercourse and lack of basic hygiene. To prevent complications and when acute urinary retention may already form, the symptoms are diagnosed constantly at the first suspicion of inflammation.

Doctors recommend to undergo one more examination than to subsequently experience pain and bewilderment from acute pain in the lower abdomen. This condition can be prevented by simple preventive actions, and it will be possible to improve already spoiled health faster in the clinic.

Common complications

If there is an acute urinary retention, the causes of the ailment may be common in both sexes. More often these are inflammations in the urinary system and abnormalities in the nervous. These include: stone deposits in the bladder, tumors in the excretory system: disturbances in the structure of the rectum, swelling and narrowing of the urethral canal.

Diseases of the nervous system that affect the overlap of the excretory ducts include: damage to the spinal cord and brain, trauma in this area, failure of the parts of the body responsible for the production of myelin. Also, the blocking of the mechanism of the excretory pathways is affected by temporary disruptions in the work of the nervous system: stress, shock, in case of poisoning, after surgery. Dangerous for the excretory tract is a prolonged state of immobility, when the risk of muscle atrophy increases.

Mechanical effects on the lower parts of the body are also common: injuries, cuts, punctures. Alcoholic and toxic shock make no less contribution to the formation of complications. Smoking contributes to the slagging of the body, which causes stagnation of blood in the small pelvis. Hemoroidal veins are the result of negative factors of the body's immobility. They are able to partially block the lumen of the ureter.

If an acute urinary retention has formed, diagnostics often show that ordinary hypothermia becomes the cause of the complication. It leads to pathology in the work of the kidneys, bladder. Poor nutrition and mineral-rich food can lead to imbalances in the body. It provokes stagnation of urine by slowing down metabolic processes.

Complications in the weaker sex

First aid for acute urinary retention depends on the patient's gender. Diagnostics is based on statistics. In women, most of the ailments of the excretory system occurs due to the prolapse of the bladder. The risk of organ prolapse from the vagina increases.

Pregnancy and childbirth contribute to pathology. When the muscles are overstrained, and then there is no physical training for a long time, the process of sagging of the bladder begins. Risks increase if more than one birth has taken place.

Less often, the pathology manifests itself in women who have gone through a cesarean section. Another negative factor affecting muscle tone is the decrease in estrogen in the postmenstrual period. The risk zone includes people who experience overstrain due to lifting weights, excessive sports.

Also, the prolapse of the bladder occurs due to a genetic predisposition, when weak pelvic muscles were formed in childhood. Negative factors are: surgery to remove the uterus, postpartum trauma, depletion of the body.

Early diagnosis methods

Acute urinary retention (ICD-10 assigns complication number R33) is a relatively common complication. To assess the state of the body, information is collected using a survey method. Questions are asked about existing chronic diseases. Have you ever had such ailments. Doctors need all the information about whether a periodic examination of the genitourinary system has been performed.

Early operations can affect the formation of complications, therefore it is recommended to bring the most complete information to the doctors, even about the presence of a poor diet and bad habits. By palpation, the degree of bloating of the abdominal region is established. To establish the state of the body, you will need to collect tests: UAC, OAM. The level of leukocytes is determined, indicating the presence of inflammation.

When there is an acute urinary retention, emergency care is carried out before testing. After the patient feels better, doctors begin to look for the true cause of the complication. An increased level of white blood cells and red blood cells in the urine indicates an infection in the body.

Previous treatment for another medical condition can affect the condition and cause a worsening of urine output from the body. Therefore, it is important to report on the medications taken for the previous six months. Kidney health is an important criterion for assessing health. Alcohol and some beverages can disrupt all systems. It is not recommended to withhold this information either.

Laboratory methods

Methods for diagnosing the urinary system include:

Ultrasound helps to get a picture of the internal organs and determine the degree of compression of the excretory ducts. Ultrasound does not give a complete picture of the complication, therefore it is used as an additional method.
The state of the bladder, kidneys, intestines, and stomach is assessed. The prostate gland is also translucent. In women, attention is paid to the insides of the uterus.
Blood biochemistry can show overestimated protein values. They also detect urea and uric acid, creatinine.

Catheterization is a first aid method and can be used as a diagnostic method. During the procedure, the amount of fluid removed is assessed. A tube is introduced through the outlet channel, and the accumulated liquid is pumped out.

An emergency measure to save seriously ill people is a puncture or cystomy. A tube is inserted through the skin to drain excess urine.

Types of first aid

In case of acute urinary retention, they always resort to calling an ambulance. But before her arrival, you can help and alleviate the condition. The first step is to exclude the slightest movement so as not to experience pain. While waiting for the doctors, you can take a diuretic if you are sure that the cause of the complication is precisely the accumulation of fluid in the bladder.

If the cause of the illness is unclear, it is best to refrain from taking medications. It is not recommended to physically strain yourself to go to the toilet. Blocked canals must first be released, otherwise there is a risk of rupture of the urethra. Heating your abdomen makes sense. The heat can calm the muscles and help loosen the channels. To do this, use a heating pad as a safe method.

Pain relieves pain relievers and sedatives. The latter includes valerian. She is able to relax muscles and relieve spasms. Water consumption is also limited until medical attention is provided.

Inpatient care

First of all, doctors try to empty the bladder to relieve the condition. The method of assistance is chosen individually: a catheter or a puncture. In the process of choosing therapy, the need to treat the root cause is taken into account. If you do not extinguish the inflammation in the adjacent organ, then the complication will repeat.

Catheter assistance involves two types of procedure: soft and hard. Puncture of the skin can occur by the method of suprapubic puncture, called capillary: the procedure got this name due to the production of a very small hole after the puncture. Trocar cystostomy is also widely used: the technique is similar to the previous puncture. Before the procedure, two parameters are assessed: the degree of distension of the bladder and the result of the examination by palpation.

An epicystostomy also involves puncturing the suprapubic area to secure elastic drainage to drain fluid from the bladder. After the procedure, there is a risk of developing inflammation in the fistula area. To exclude complications, a course of antibiotic treatment and antiseptic treatment of the puncture site is carried out.

Each method has a number of significant disadvantages. One of these is mechanical damage to the walls of the bladder, as a result of which the space of the peritoneum can be filled with urine. The last action ends with the development of peritonitis. The risk of transmission of infection to healthy areas of the body increases.

How to prevent the development of complications?

To prevent the development of acute urinary retention, one has to switch to a healthy lifestyle, give up bad habits, normalize the diet, exercise physically and avoid overstrain, stress. It is mandatory to undergo a periodic examination of the genitourinary system at least once a year.

You will also have to be tested for infections. Treat chronic diseases to keep you healthy. They avoid hypothermia, overheating, observe the regime of the day for the night recovery of the body in a dream.

The state of blood counts is required to maintain. Remove slagging from the body, eat dietary meals. For men, the issue of acquiring prostate pathologies at the age of more than 50 arises, and for women - prolapse of the uterus.

The condition of the intestines also affects the bladder, it is required to monitor the formation of constipation and adjust the food intake. If an acute urinary retention in women manifested itself once, then the body is already under constant observation and at the first suspicion of a complication, they seek help from the clinic.

Athletes and workers in hazardous industries are susceptible to urinary retention when, in the process of performing duties, the groin experiences constant stress and mechanical stress. Such people have to see a doctor much more often for the occurrence of pathologies. If health deviations are found, it is recommended to change the profession or type of physical activity.