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RETENTION OF URINE & ANURIA
This term, used in a medical sense, means the persistent keeping within the body of matters normally excreted. It is most commonly applied to urine, and here the fundamental difference between retention of urine and suppression of urine (anuria) must be borne in mind. In the former there is a normal secretion of urine from the kidneys and the bladder is full, but for some cause the patient is unable to void it; in the latter the bladder is empty, since the kidneys are not functioning properly.
Retention of urine may arise either from mechanical obstruction to the outflow or from some disturbance of the nervous system, as in paralysis or hysteria, or after surgical operations. Most cases belong to the first group, the commonest causes being stricture of the urethra (which may be acute or chronic), congestion of the urethra with spasm, enlargement of the prostate gland in elderly men, or stone impacted in the urethra, pressure outside the neck of the bladder, such as occurs from fibroid tumours or from a pregnant uterus displaced backwards may also cause retention. A third group of causes comprises cases of weakness, or atony, of the bladder.
The symptoms of the condition are inability to pass urine, a tense swelling over the lower part of the abdomen, and if the nervous connexions are organically unimpaired pain of a constant character over the abdomen and perineum. If the condition remains untreated there will sooner or later be rupture of bladder or of urethra, or the bladder will be distended and overflow of urine occur. It is considered a medical emergency.
 
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The treatmeut varics with the cause. Simple devices such as the sound of running water, a hot bath, or, if the patient is confined to bed and circumstances permit, a change of position will sometimes suffice in cases of functional disturbances without organic obstruction or nerve disease. For congestive spasm hot baths with morphia and belladonna suppositories are usually tried after which a soft catheter is passed up the urethra to allow void. For definite obstruction a catheter is passed where possible at any rate as a temporary measure; but if no catheter can be inserted, an operation must be performed for the relief of the obstruction.
A very important instance of retention is that of the after-birth (q.v.) or membranes in the womb for longer after delivery of the child than can be considered normal.
Rctention of menstrual fluid sometimes occurs in young girls at puberty, and needs an operation for its relief.
ANURIA
The literal meaning of anuria is failure to pass water. This failure may be due to the fact that although the bladder contains urine, even to the point of over-filling, none can be passed because of obstruction of the urethra, the passage through which urine is voided, by a stone or an enlarged prostate gland. It may also be due to nervous cases, and is common after operations or childbirth. This state of things is described as retention of urine and is dealt with under the heading Retention: in medicine. It may be, however, that no urine is entering the bladder; it is suppressed, and this is what is meant by anuria.
Suppression of urine is usually due to cessation on the part of the kidneys to perform their function, also called renal failure. In exceptional cases where one kidney has been removed surgically or has been destroyed by disease the ureter (the tube passing from the kidney to the bladder) of the remaining kidney may become blocked by a stone or by pressure upon it. No urine will then enter the bladder.
Failure of the kidneys to function may be due to acute Bright's disease or to the effect on these organs of irritant poisons such as mercury, phosphorus, turpentine, etc. It may also occur in profound collapse or shock, as after severe injury, in the exhaustion following acute disease such as cholera, peritonitis, etc., or may follow operations on the genital organs. Even the passing of a catheter may have this effect, particularly when it is used for retention of urine in elderly men and the bladder is completely emptied. In these cases it should always be the rule to draw off only a certain quantity at a time. Suppression of urine may also occur in hysteria.
Urine is the vehicle by which much of the waste material poduced in the body is got rid of, and anuria results in the accumulation of these substances in the blood, with consequent poisoning. It is a very serious condition, and unless relieved the patient will inevitably die within usually 48 hours.
If obstruction be the cause, surgical interference will be required to relieve the condition. Usually a catheter can be passed and will suffice, but if not, the bladder must be opened through the abdominal wall. In suppression, dependence must be placed on cupping the loins or applying hot poultices over the kidneys, on free sweating induced by hot baths, hot air baths, or drugs, and on the production of profuse watery motions fron the bowels. In this latter case, Epsom salts (q.v.) is of service.
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