Incontinence of Urine.

Other tomes: ElTh1908

Synonym.—Enuresis.

Definition.—A partial or complete inability to control the sphincter of the bladder, thus permitting the urine to escape.

Etiology.—Incontinence of urine, whether occurring in children who habitually wet the bed, or in patients of more mature years whose control of the sphincter is only partial, permitting accidents to occur, or whether it be the constant dribble occasionally seen in elderly people, constitutes one of the most disagreeable, distressing, and stubborn lesions that the physician meets.

Among the many causes may be mentioned the following: Spinal lesions, whereby the sphincteric center is involved, is known as paralytic incontinence. This form is attended by a constant dribbling of urine, and when any sudden muscular contraction occurs, as in sneezing, coughing, laughing, etc., there is a spurt of urine. The lax and weakened condition of the sphincter muscles may be due to general bodily weakness following-prolonged febrile diseases.

In children it is usually due to atony of the muscular fibers closing the neck of the bladder, or to irritation of the nervous fibrillae distributed to the mucous membrane of the bladder, preventing a normal distention of the organ.

A temporary paralysis of the walls of the bladder may result from overdistention and also from prolonged pressure of the urethra in tedious cases of labor, when the fetal head has pressed upon it for hours.

The presence of a vesical calculus may so irritate the bladder as to give rise to incontinence. Irritation from an elongated prepuce, a contracted meatus, an adherent clitoris, or from the presence of ascarides, is not to be overlooked as an exciting cause. When due to this kind of irritation, it generally gives rise to nocturnal enuresis; or bed-wetting. A persistent and incurable form, save by surgical measures, is due to congenital misplacement of the ureter, the opening being into the urethra or vagina.

Symptoms.—"The symptoms of this affection vary in different cases; some being able to partially retain the urine, while others have no control over it at all. In the worst cases it continually dribbles away as it is passed into the bladder, the patient being unable to retain it. As the result of this state of affairs, we find that the person is rendered filthy, and is debarred society on account of the disgusting urinary odor that he can not get rid of. There is also more or less irritation of the genital organs, and of the adjacent integument, sometimes very severe, resulting in deep, foul-looking ulcers. In other cases, it is retained to the amount of a few drams, and then commences to dribble away, unless the patient has an opportunity to void it. Again, the bladder being irritable, it is forcibly expelled after having accumulated to a certain extent, the patient having no power to resist its expulsion. Incontinence of urine at night is a troublesome affection among children, and the physician is frequently consulted about it; but, unlike the other, it usually arises from an irritability of the bladder, which, assuming control when the will is in abeyance during sleep, causes the discharge."

Diagnosis.—"There is little difficulty in determining the existence of enuresis, but care should be taken to ascertain definitely the cause. In females, a careful examination should be made to determine that the constant dribbling of urine is not consequent upon vesico-vaginal fistula."

Treatment.—Before prescribing any internal medication, a thorough examination should be made of the penis, vagina, and rectum; for it is a humiliating experience to find, after several weeks of unsuccessful medication, the incontinence to be due to an elongated prepuce, contracted urethra, or adherent clitoris, or a diseased rectum, the correction of which effects a cure.

The selection of the proper remedy will depend, as in all diseases, upon the condition present, as no one remedy will fit all cases. Where there is atony of the sphincter and abdominal walls, there is usually general debility, and the patient will need tonics, good food, outdoor exercise, and have regular habits.

Belladonna has been regarded by many as a specific, and where there is a feeble capillary circulation, it will give good results. Combined with nux vomica, it is especially effective. The small dose should be used:

Sig. Teaspoonful every three or four hours.

Thuja.—Professor Howe used to regard thuja as a specific for bed-wetters, and where there is atony, it is a splendid remedy either in nocturnal incontinence or the dribbling found in elderly patients.

Sig. Teaspoonful every three or four hours.

Nux vomica, ergot, strychnia, and like remedies, would also be suggested in cases needing tonic and stimulating treatment. Electricity is also of special benefit in these cases—the Faradic current being used—the negative pole being attached to a urethral electrode, while the positive pole will be applied over the pubes. A three-minute application should be made two, three, or four times a week.

Brisk friction along the spine with salt water is also beneficial. Where the incontinence is due to irritation, the treatment will be sedative in character.

Rhus Aromatica.—This remedy has earned a reputation for curing incontinence, and should be used in fifteen or twenty drop doses. Agrimony, hydrangia, gelsemium, bromide of potassium, and santonin will be found useful in cases due to irritability.

Whatever remedy is used, however, must be fortified by an intelligent assistance on the part of the patient. But little fluids should be taken during the after part of the day, the bladder evacuated before it is greatly distended, and at the last moment before retiring.

The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.