Retention of Urine.
This condition must be distinguished from suppression of urine. In the former the urine is retained in the bladder, because of inability to evacuate. Suppression consists of an entire failure upon the part of the kidneys to secrete urine, hence there is no urine to be evacuated.
Retention is due to traumatism, to cold, to severe compression as in childbirth—a very common condition—and to nervous and mental causes, and also to urethral stricture, and from foreign growths. Congenital retention may be due to malformation or to a urethral plug, or to a fault of the urethral sphincter.
Symptomatology:—The symptoms are the desire to urinate without an ability to do so, restlessness, increasing discomfort and soreness, and a distressing sensation of fulness, which finally amounts to pain. The symptoms finally become aggravated until the distress is almost unendurable. Hysterical patients can bring on the condition almost at will. It occurs with them with any violent hysterical manifestation.
Treatment:—In newborn infants where no urine is passed for several hours, hot applications to the lower portion of the abdomen or across the loins and over the organs between the thighs, will usually be sufficient, unless there is a malformation, which is very rare. Occasionally a small catheter will have to be introduced in male infants. In other cases, a retraction of the prepuce, fully uncovering the meatus urinarius, will be sufficient. In adult cases the treatment consists of the immediate introduction of the catheter, and evacuation of the bladder.
In cases of spasmodic stricture, anesthesia will sometimes permit an escape of the urine, but I have succeeded in nearly all cases by the repeated use of large doses of gelsemium, from five to ten minims of the specific, until its physiological effect was plainly marked. This has succeeded in cases where it was impossible to introduce a catheter, and it will be found beneficial in other cases. Relief must be given as soon as possible, because distention of the bladder walls, and the influence of the decomposing urine, produce cystitis, paralysis, or other serious disorder. Neurotic patients can succeed in relieving the bladder occasionally by listening to the sound of running water. Other cases, besides those of newly born infants, can be relieved by hot applications, or by the taking of a hot sitz bath.
In puerperal cases, the condition is usually spontaneously relieved after the catheter has been introduced two or three tinies. If the condition is prolonged the difficulty may be overcome by the use of hot applications, and by the use of hydrangea and cimicifuga. Occasionally gelsemium may be added after the second or third day, but given early it causes paralysis of the uterine muscular fibers and permits post partem hemorrhage. Cases which result from paralysis may be overcome by repeated small doses of strychnin or nux vomica.
