RETENTION OF 'URINE is the term employed in medicine to signify a want of power to discharge the urine from the bladder, and it must be carefully distinguishedfrom a tar more serious affection kuown as suppression of urine, in which also no urine is passed, because in this ease there is none in the bladder.
Retention may arise either from change of structure of the parts concerned in the expulsion of the urine, or from mere disordered function unaccompanied by change. The former are termed organic, and the latter functional causes of retention.
Among the chief organic causes are: 1. Permanent stricture of the urethra (q.v.). 2. Contraction of the urethra, in consequence of a blow on the perinmum, or other external injury. 3. Tumors within the urethra. 4. Foreign bodies in the urethra, as calculi, clots of blood, or mucus, etc., which have entered it from the bladder, or frag ments of bougies, etc., introduced from without. 5. Enlargement of the prostate gland, especially in aged men. The treatment in retention from these causes must be entirely left in the hands of the surgeon.
The principal functional causes are: 1. Spasm of the urethra, often termed spasmodic stricture: and 2. Want of power in the muscular coat of the bladder and urethra.
Spasm of the urethra is most likely to occur in those who have a slight permanent stricture, or a urethra irritable front other causes. The spasm usually follows exposure to cold and wet, but it may likewise be excited by piles or other sources of irritation in the lower bowel, or by the use of cautharides either taken internally as a medicine, or absorbed from blisters applied to the skin. The patient finds himself unable to pass his water, although lie has a great desire and makes strong efforts to do so. The bladder soon becomes so that it can be felt as a tense round tumor above the pubes. If relief be not speedily afforded, the bladder may burst, and discharge its contents into the peritoneal cavity, in which case death rapidly ensues; or the urethra behind the stricture gives way, and the urine is extravasated into the cellular tissue of the adjacent parts—a condition which, if not promptly relieved by surgical interference, is likely to be followed by gangrene, typhoid symptoms, and death.
If the symptoms are not very severe, and there is no evidence of old permanent stricture, a hot bath, combiued with the administration of the tincture of muriate of iron, in doses of ten minims, taken every ten minutes in thin gruel or in barley-water, will often give relief. Sometimes a full opiate administered by the mouth, or prefer
ably as an enema, or the inhalation of a few whiffs of chloroform, will, by allaying the spasmodic action, give immediate relief. If these means fail, surgical assistance must be at once procured, and the bladder evacuated by a catheter—an operation often requiring very delicate manipulation. If these means fail, which only happens when the spasm is associated with old-standing disease of the urethra, the surgeon must either puncture the bladder through the rectum, or above the pubes, or make an incision into the urethra either at or behind the seat of the stricture.
Paralysis of the muscular coat of the bladder may arise from the debility of old age, from the depressed state of the nervous system in fevers of the typhoid type, from injury or disease of the head or spine, and from various other causes. Iu a temporary form; it is often a result of over-distention of the bladder from stricture or prostatio disease, and it sometimes occurs in the ease of nervous sedentary persons, if they have allowed rather more than the usual time to elapse without evacuating the bladder. It should be generally known that retention of urine from paralysis is sometimes accompanied with dribbling away of the water, so that the retention might •itt first sight be mistaken for incontinence of urine. Ou examination, however, it will be found that the bladder is abnormally distended, and cannot be evacuated by the act and will of the patient.
In these cases, toe urine must for a time be regularly drawn away by the catheter. General tonics, such as the cold-bath (or sometimes preferably the sitz-bath) and chalyb eates, must be given to improve the general health; while medicines which are supposed to act locally on the mucous coat of the bladder or on the spinal cord, must be simul taneously administered.
A peculiar form of retention sometimes occurs in women of hysterical temperament, in which the will rather than the power at fault. The treatment should here bo directed toward the general hysterical tendency, rather than to this special manifesta tion of it.