Paralysis of the bladder may be the result of injury or disease of the spine, or of parts in the neighbourhood of the bladder. Over-dis tention of the bladder often leads to inability to empty it properly. As a result either the urine is retained iu the bladder or it constantly dribbles away. In such cases the catheter must be passed (see APPLIANCES FOR THE SICK ROOM, Plate XXXVIII., Vol. II.).
Retention and Incontinence of urine.— In retention the bladder is constantly full and the patient cannot empty it. It is, however, commonly accompanied by constant dribbling of urine, so that the person thinks his bladder cannot hold the urine. He imagines his bladder is empty, whereas it is simply the overflow, the quantity that cannot find accommodation in the already over-distended bladder, that escapes. True incontinence is present when the bladder can retain no urine, and such cases are rare, occurring only in paralysis. As a rule in so-called incontinence, affecting usually men advanced in years, the bladder is over-full, being unable to empty itself, and only the overflow dribbles away. In the lower part of the belly the distended bladder may be felt as a tumour, and uneasiness is experienced there.
The treatment consists in passing the catheter and withdrawing the urine ; and this requires to be done regularly till the bladder recovers its tone. Retention sometimes occurs suddenly— for example, to men on a journey who cannot get an opportunity to empty the bladder, and who, when the opportunity occurs, find they cannot then make water in spite of effort. Sometimes in such cases a hot hip bath relieves.
Incontinence of urine in children is spoken of in the section devoted to DISEASES OF Cum DREN.
Stone in the bladder.—The causes of the for mation of stone have been considered at p. 402.
Its symptoms are irritability of the bladder, frequent desire to pass water, and symptoms of chronic inflammation. There is pain occasion ally at the neck of the bladder or point of the penis, aggravated by jolting exercise. The stream of urine is sometimes suddenly arrested by the stone falling over the opening from the bladder, and on the person changing his posi tion it flows again. Blood frequently occurs in the urine. Stone cannot, however, be abso lutely said to be present till a surgeon has detected it with a sounding instrument.
Treatment consists in crushing the stone by means of an instrument passed up the passage into the bladder, and allowing the fragments to be washed away in the urine. Such an opera
tion is called lithotrity. The stone may be removed entire by means of an opening made into the bladder, through which the stone is drawn by forceps. This operation is called "cutting for stone" or lithotorny. Relief from some of the symptoms may be had by such measures as are recommended for inflammation of the bladder (p. 410).
Tumours of various kinds, cancerous and others, may occur in the bladder, and lead to symptoms of chronic inflammation, sometimes to serious loss of blood.
Disease of the Prostate Gland is com mon after middle life. As stated (p. 398) this is a structure which surrounds the urinary canal where it connects with the bladder, and is present only in the male sex. After middle life the gland tends to enlarge, and if the en largement be not uniform but irregular, the shape of the urinary canal may be seriously altered, made exceedingly tortuous, or reduced to a slit. A consequence of such a condition is a gradually increasing difficulty in emptying the bladder, the stream is slow and without force though full. As the bladder loses tone it fails to empty itself, and if it is never properly emptied the desire to pass water becomes more frequent. This is specially noticeable at night, and in bed, until the patient may have to rise every hour.
Another consequence of the urine being re tained is that the bladder becomes irritated, large deposits of mucus occur in the urine, which may also undergo decomposition in the bladder and become foul-smelling. Blood may be passed. If so it is usually at the beginning of urination, and it may be in clots, the more or less clear urine following.
If the early symptoms of this condition be attended to, a patient may take such precau tions as will probably save him from the ne cessity of serious surgical treatment. These precautions are: avoidance of chills, great tem perance in eating and drinking, light, easily digested food in moderate quantity only being taken, alcohol and malt liquors being avoided, regulation of the bowels, and the establishment of a habit of emptying the bladder at regular intervals. As soon as the patient begins to be disturbed several times at night, the question should be considered whether he should not be taught to completely empty the bladder by means of an instrument each night. But this is a question for a doctor to settle.