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Sep 20, 2011

Retention of urine (ischuria)



Copy rights of the content in this article are with the respectable Author.
-SMALL A. E.,
When an interruption of the flow of urine occurs, and the secretion of the kidneys goes on, the bladder becomes so filled and distended with the fluid, that it rises up above the pubis, and forms a perceptible swelling in the hypogastric region. The bowels also become somewhat swollen, and tender to the touch. There is always considerable fever present. The inclination to pass water, frequent and urging, but painful and ineffectual; inflammation, and consequent mortification will ensue, when this difficulty continues for any great length of time; under such circumstances, the bladder will become ruptured, and the urine will find an outlet into the abdomen, and death will be the result.



Causes
Inflammation of the urethra, or stricture; suddenly suppressed piles, or enlargement of the hemorrhoidal veins. Over-distension of the bladder may in some instances close the internal orifice of the urethra, as also may spasm of the neck of the bladder; paralysis of the bladder as well as inflammation and hernia of the organ.
Sometimes fatal retention of the urine has been the result of intoxication, or habitual use of wine, sometimes by the abundant use of fly blisters, which yield their poison to the system, and sometimes from the lodgement of indurated faeces, or difficulties of the uterus, tumors on the neck of the bladder, swelling of the prostate gland, urinary calculi lodged in the neck of the bladder, or in the urethra.
Treatment
The remedies ordinarily the best adapted to afford relief, are Aconite, Belladonna, Arnica, Camphora, Arsenicum, Sulphur, Pulsatilla, Cantharides, Dulcamara, Nux vomica, Opium, Staphysagria, Phosphorus, and c.
Aconite is decidedly indicated when there is considerable pain with burning heat in the region of the bladder, externally manifest to the touch. When the difficulty occurs in children, and there is also distension of the bowels, with complete interruption of the urine, and feculant discharges, this remedy is also indicated.

DOSE. - Dissolve one drop, or six globules, in half a tumbler of water, and in urgent cases give a teaspoonful every half hour, until the symptoms yield.
Belladonna is indicated when retention of urine results from distension of the uterus, in consequence of congestion of that organ, or of an accumulation of the menstrual fluid, or from retroversion of the uterus, or from any cause that produces the difficulty but the enlargement of this organ, causing it to press against the urethra or the neck of the bladder. This remedy may be used in connection with Sepia, Pulsatilla or Nux vomica.
DOSE. - Dissolve one drop, or six globules, in a tumbler one-third part filled with water, and give a teaspoonful every three hours, until amelioration or change. If it should fail of relief, proceed with the other remedies as indicated.
Arnica is indicated when the retention has been caused by some mechanical injury done to the bladder by the use of the catheter, or when the bladder has been distended from want of opportunity of emptying it while travelling, thereby causing the difficulty.
DOSE. - Dissolve one drop, or six globules, in six teaspoonfuls of water, and give a teaspoonful every hour until relieved, or if it becomes necessary to empty the bladder by means of a catheter. The remaining effects may be alleviated by the use of this remedy.
Camphora is indicated when the retention arises from spasmodic action, and is also a valuable remedy when it is difficult to assign any particular cause of the disorder. This remedy may be used even when there is a burning heat in the abdomen and urethra, with shivering coldness of the surface, and shivering succeeded by a hot fit; but as soon as fever sets in, Aconite is decidedly preferable. The spirits of camphor smelled simply will often relieve the difficulty in children and persons very susceptible to impressions. In other cases, one or two drops on a small lump of sugar, repeated, if necessary, once or twice, or, until relieved, every half hour.

When the retention of urine has been caused by the excision of piles, either by the knife or ligature, which is sometimes the case, the urine should be drawn off by the catheter, and the pain relieved by the alternate use of Aconite and Sulphur, or Nux vomica; if the patient has been addicted to the habitual use of intoxicating liquors, or in case of severe burning, Arsenicum.
The repeated application of cold water to the stomach may also prove of service in relieving the sufferings that remain after emptying the bladder by the catheter. But when no assistance of the kind is at hand, Camphora or Aconite ought to be tried first, and it will be found that these remedies will often supercede the necessity of mechanical means at all.
The application of hot fomentations over the region of the bladder, or injections of tepid water, or a hip bath of moderately warm water, may sometimes prove serviceable in procuring a relief.
Arsenicum may be used with advantage when in conjunction with the difficulty there is a burning pain in the bladder, and even after the urine is drawn off. This remedy may be employed to remove the painful burning that remains, especially when the difficulty has been caused by an operation for piles.
DOSE. - Dissolve one drop, or six globules, in half a tumbler of water, and give a teaspoonful every hour, until relieved or change.

Sulphur, Pulsatilla and Cantharides, Phosphorus, Lycopodium and Staphysagria are severally indicated when retention of the urine is caused by distension of the uterus in consequence of an accumulation of the menstrual fluid, or from tumors pressing against the neck of the bladder. Phosphorus is also another remedy to be consulted.
DOSE. - Of the selected remedy, dissolve one drop, or six globules, in half a tumbler of water, and give a teaspoonful every hour, but if no relief is manifest after twelve hours, proceed with the next remedy, and so on.
Nux vomica, and Opium or Plumbum are remedies that may be used when the difficulty is caused by severe constipation and an accumulation of hardened faeces in the rectum.
Aconite and Pulsatilla are indicated if the difficulty be occasioned by the swelling of the prostate gland.
Hyoscyamus and Dulcamara if caused by paralysis of the bladder.
DOSE. - Of the selected remedy, dissolve one drop, or six globules, in half a tumbler of water, and give a teaspoonful every hour, and if relief is not obtained in twelve hours, proceed to select from the other remedies. But if the remedies seem to prove inefficient, it is necessary to resort to mechanical measures for relief. The catheter should be resorted to with great caution, to prevent injuring the urethra, or doing violence to the neck of the bladder.

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