Acute urinary retention: first, emergency, causes, symptoms, treatment

Acute retention of urine is a relatively common complication, which is typical for various diseases. Therefore, many people are interested in questions about the features and the main reasons for the occurrence of such a state. 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 the sick person. So what are the causes and first manifestations of this disorder of urination? What methods of treatment can modern medicine offer? What are the complications of the outflow of urine?

What is the retention of urine?

Acute urinary retention is a condition in which emptying of a filled 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 urine flow into the bladder ceases. In acute delay, on the contrary, the bladder is filled, but under the influence of certain factors, its isolation is impossible.

It is worth noting that this problem is much more common in men, which is associated with anatomical features. Nevertheless, it is possible for women. In addition, children often suffer from urinary retention.

The main reasons for the development of this state

Immediately it is worth saying that the causes of acute urinary retention can be very diverse, therefore in modern medicine they are divided into four main groups:

• Mechanical (associated with mechanical obstruction or compression of the urinary tract);
• Those that are due to various violations of the nervous system (the brain, for one reason or another, ceases to control the processes of emptying the bladder);
• Reflex disorders, which are associated with partial disturbance of the innervation or emotional state of the patient;
• Medicamentous (due to the effect on the body of a drug).

Now it is worth considering each group of factors in more detail. Acute retention of urine often develops by mechanical compression of the bladder or urinary tract, as a result of which the evacuation of its contents is simply impossible. Similar is observed in the presence of a foreign body in the bladder or urethra. Also, risk factors include neoplasm in the lower parts of the urinary tract, sclerosis of the neck of the bladder, stones in the neck or in the urinary ducts, various injuries of the urethra. In men, the outflow of urine can be disturbed by prostatitis or proliferation (hyperplasia) of the prostate, and in women - with the loss of the uterus.

Urinary retention can be associated with disorders of the central nervous system, which is observed in the presence of tumors, as well as traumas of the spinal cord or spinal cord (including the intervertebral hernia), shock, stroke, and brain contusion.

If it is a question of reflex violations, then the risk factors include trauma to the perineum, pelvis and lower limbs. In some cases, the retention of urine develops against the background of partial denervation of the bladder as a result of operations on the female genitalia, rectum, etc. To the same group of causes can be attributed a strong emotional shock, fright, hysteria, alcoholic intoxication.

There are also groups of drugs that in some patients may lead to a violation of urinary outflow. These can be tricyclic antidepressants, benzodiazepines, adrenomimetics, anticholinergic drugs, narcotic analgesics, and some antihistamines.

What can cause a delay in urine in children?

Even the smallest patients are not insured against 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, the outflow of urine can develop with phimosis - a strong narrowing of the flesh. Such a pathology leads to constant inflammation and, consequently, tissue scarring, as a result of which only a small point hole remains in the foreskin - naturally, this prevents the normal emptying of the bladder.

Inept attempts to expose the head from the foreskin often lead to paraphimosis - infringement of the head in a narrow ring. With this condition, the urethra is blocked almost completely, which threatens with acute urinary retention - the surgeon's help is needed in this case.

In girls, urinary retention is much less common and may be related to the prolapse of the urethra: cysts of the distal ureter.

In addition, do not forget that children in games are extremely active and careless, so various perineal injuries are not considered a rarity, and this can lead to a delay in urine.

Urine retention in women and its features

Naturally, acute urinary retention in women can occur for the reasons described above, which often happens. Nevertheless, there are some additional risk factors that are worth considering.

In some girls, the outflow of urine develops against the background of hematocolpometers, which is associated with the anatomical features of the hymen. In most women, it has a ring-shaped or semilunar form. But for some girls, the hymen is a solid plate, which almost completely closes the entrance to the vagina. When menstruation appears, this anatomical feature creates problems. Allocations begin to accumulate, resulting in a hematocolpometer that compresses the bladder and urinary tract, leading to the development of a delay in urine.

Risk factors include pregnancy. Violation of normal urination can be the result of rapid growth and displacement of the uterus, which blocks the way for urinary excretion. It should be noted that this pathology is one of the most difficult in modern obstetrical and surgical practice, since it is not so easy to put the right diagnosis on time.

Also, in women, urinary retention can be associated with ectopic, namely cervical pregnancy. With a similar condition, implantation and further development of the fetal egg occur in the cervical uterine section. Naturally, the appearance of expansion is extremely dangerous, as it leads to a violation of outflow of urine, bleeding and other dangerous complications.

Acute retention of urine: symptoms

If you feel worse, you should immediately see a doctor. Detect the presence of a delay in urine specialist can still during a general examination, since this condition is accompanied by a number of very characteristic symptoms.

Pathology is accompanied by overflow of the bladder and a significant increase in its volume. Above the pubic bone painful protrusion is formed, quite hard to the touch - this is the bladder.

Patients complain of frequent urges to urinate, which do not lead to emptying the bladder, but are often accompanied by severe pain in the abdomen. Pain can spread to the genitals, perineum, etc.

For this pathology, urethrorrhagia is also characteristic - the appearance of blood from the urethra. Sometimes it can be only small spotting, sometimes - quite massive bleeding. In any case, the blood in the urethra is an extremely dangerous symptom that requires urgent care.

Other signs directly depend on the cause of this condition and the presence of certain complications. For example, if the urethra and bladder are damaged or ruptured, the patient develops a severe pain syndrome, which leads to traumatic shock.

If there is a rupture of the proximal urethra, urinary infiltration of the pelvic fat is observed, which often causes severe intoxication. With vaginal or rectal (in men) study in such patients, pastosity of the tissues and sharp pain when pressing. With intraperitoneal rupture of the urinary bladder, urine freely spreads through the abdominal cavity, which leads to the appearance of acute pain in the lower abdomen.

Peculiarities of pathology in men

Acute urinary retention in prostatic adenoma is most often diagnosed in elderly patients. As a rule, it is preceded by other problems with urination, including frequent nocturnal urges and the inability to completely empty the bladder.

With acute prostatitis, there are symptoms of intoxication, in particular, fever, weakness, chills, often severe nausea and vomiting. In the future, there are problems with urination. The pain in this case is more pronounced, since 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 cause?

Acute retention of urine - a condition extremely dangerous, therefore in no event it is necessary to ignore it. In fact, the lack of timely help 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, it is often observed that urine is returned to the kidneys, which is also fraught with infections and serious disruption of the excretory system.

If you do not eliminate the cause of acute delay, but only empty the bladder, such episodes can be repeated 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 infection of the urogenital tract, as well as chronic kidney failure. Acute urinary retention in men can lead to the development of acute forms of orchitis, prostatitis and epididymitis.

Methods of diagnosis

Typically, a simple examination and collection of anamnesis is sufficient to determine if the patient has an acute urinary retention. Treatment, however, largely depends on the cause of this pathology, so after the provision of first aid, additional studies are conducted.

In particular, a complete picture of the state of the body can be obtained after ultrasound, ultrasonography, percussion, radiography (if there are suspicions of spinal trauma), magnetic resonance imaging or computed tomography.

Acute urinary retention: emergency treatment

In the presence of suspicions and symptoms of this condition, you urgently need to call an ambulance team - in no case can not ignore this problem. First aid for acute urinary retention is reduced to an urgent emptying of the bladder. The method in this case directly depends on the cause of the occurrence.

For example, if problems with evacuation have arisen due to compression of the urinary tract (say, with prostatitis or adenoma), then a catheterization of the bladder is performed using a standard rubber catheter moistened in glycerin. Since it is impossible to conduct such a procedure alone, the help of medical personnel is simply necessary.

First aid for acute urinary retention, which is caused by reflex disorders, may look different. For example, a patient can recommend a warm sitting bath or shower, which will help relax the urethral sphincters. If such manipulations are ineffective or if there is no time for them, bladder emptying is medicated. To this end, the patient is given intraurepally Novocaine, and intramuscularly - "Proserin", "Pilocarpine" or others. In addition, the catheterization will also be effective.

What methods of treatment are used in modern medicine?

As already mentioned, acute care for acute urinary retention is reduced to evacuation of the contents of the bladder. Usually, this is done with a catheter (preferably rubber, as a metal device can damage the walls of the urethra). This method is perfectly suitable if the reason for the delay is reflex or is associated with traumas of the nervous system.

Unfortunately, not in every case for the excretion of urine can use a catheter. For example, with acute prostatitis, the presence of stones in the urethra, catheterization can be quite dangerous.

If the insertion of the catheter is not possible, the doctor may perform a cystostomy (imposition of the bladder fistula in the suprapubic region) or suprapubic puncture of the bladder.

Further therapy is directly dependent on the cause of the development of this condition and the degree of its severity. For example, with a bladder injury, detoxification, hemostatic, antibacterial and anti-shock treatments help.

What other activities require acute urinary retention in men? Treatment of this condition, which is caused by acute prostatitis, usually involves the use of anti-inflammatory drugs and antibiotics of a wide range of effects (eg, "Cephalosporin", "Ampicillin"). In most cases, a day after the beginning of the therapy, urination comes back to normal. The course of treatment also includes the use of rectal suppositories from belladonna, hot enemas with antipyrine, sessile warm baths, warming compresses on the perineum. If all these measures have not produced any results, catheterization using a thin flexible catheter and further studies are carried out.

In the presence of neurogenic dysfunction, drug treatment is performed. To eliminate atony of detrusor of the bladder, such drugs as "Proserin", "Acekledin", as well as a solution of papaverine hydrochloride or atropine sulfate (by the way, frequent repeated injections of atropine can lead to detrusor spasm and again an acute urinary retention, so this drug is used very careful).

If the outflow of urine is caused by fright, emotional overstrain or any mental disorders, patients are also given medications, warm baths, bed rest, soothing. Sometimes it is possible to take sedatives. In the most severe cases, an examination and consultation of a psychiatrist is required.

When is surgery necessary?

There are many unpleasant and even dangerous complications, which can lead to acute retention of urine. Emergency care and proper medication, unfortunately, can not always solve the problem. In some cases, surgical intervention is simply necessary. For example, the surgeon's help is needed in the presence of ruptures of the urinary tract or bladder.

The operation is carried out in the event that the cause of the delay are stones that can only be removed surgically. In addition, with a strong proliferation of the prostate (hyperplasia), the only way to normalize the outflow of urine is to remove excess tissues. The same applies to the presence of tumors or other tumors in the small pelvis in women.

Of course, the decision on surgical intervention is made by the attending physician.