Urine does not flow in men: what to do and how to treat? Urinary retention in men - causes and treatment of the disease

Men often have problems with urination, especially later in life. One of the main problems is that a man does not pass urine well. In medical terms, this condition is called ischuria.

Urinary retention is usually caused primarily by psychological difficulties and physical discomfort. Moreover, in a man with such congestion, the general condition of the body worsens. If timely measures are not taken to eliminate the problem, complications may occur. That is why the treatment of pathologies that cause urinary retention should be timely.

Urinary retention in men: types of pathology

Ischuria is a disease that can develop at different rates. As a rule, depending on this symptom, pathology is divided into two main types

acute form

As a rule, acute urinary retention in men is quite unexpected for a man. At the same time, he experiences a number of symptoms that accompany the disease. These signs include pain in the lower abdomen and the urge to go to the toilet more often than usual.

In addition, a man may feel an unpleasant feeling that the bladder is not completely empty. At the beginning of the development of the disease, the patient's urine is excreted in small portions, however, over time, even with stress, urine ceases to be excreted at all. At the same time, urine accumulates in the bladder, causing an increase in the abdomen in a man, which becomes very noticeable externally. This condition is dangerous for the body, and therefore it is necessary to urgently consult a doctor..

Chronic form

The chronic form, in which urine is poorly discharged in a man, usually proceeds for a long time. In this case, a man may not notice the signs of the disease and not pay attention to the difficulties that have arisen when urinating. However, sooner or later the urinary canals will narrow so much that it will begin to cause a certain discomfort to the man. Chronic urinary retention in men can, under the influence of external factors, turn into acute.

Incomplete urinary retention allows a man for a long time not to notice the appearance of a problem at all. With the full form of pathology, a man feels a sharp deterioration in well-being, and therefore, as a rule, urgently seeks medical help. In such cases, when a man cannot urinate outside on his own, the doctor uses a catheter.

It is possible to determine the development of ischuria by a characteristic feature - the need to strain to go to the toilet. In this case, urination often occurs intermittently. Sometimes in men there is a so-called paradoxical ischuria, in which the patient is not able to empty the bladder voluntarily, but drops of urine are involuntarily released from the urethra. In any case, the pathology requires medical intervention, and therefore it is highly not recommended to delay the problem.

Causes of urinary retention in men

Ischuria can develop in a man under the influence of many factors. The most common reasons are the following:

Urinary obstruction in men can occur due to various reasons and at different ages. Even some disorders in the central nervous system, trauma or damage to the brain or spinal cord can have an impact. Frequent violations in urination after operations on the spine or abdominal organs.

Sometimes the abuse of alcohol or drugs leads to ischuria in men.
In some cases, urinary retention appears as a result of prolonged use of drugs, for example, sleeping pills or sedatives, antidepressants have a strong effect.
Sometimes urine can stop being excreted after severe hypothermia of the body, after serious stress or heavy physical exertion.

The chronic form of the disease, as a rule, appears in elderly men.. If for a long time a man has experienced various or problems with the organs of the genitourinary system, pathology may appear over time.

One of the most dangerous causes of ischuria is neoplasms in the prostate, including benign hyperplasia. As a rule, in most cases, urination becomes difficult due to the enlargement of the prostate gland. In this case, the gland on both sides squeezes the urethra, making the urethra narrower, which is why the urine does not pass completely, or does not come out at all.

In addition, diseases that occur in other organs near the genitourinary system can cause urinary retention. For example, fibrosis and sclerosis, as well as inflammatory processes in the intestines, can affect. In older men, neurogenic dysfunction in the bladder is sometimes observed.

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Signs of ischuria in a man

The main symptom of ischuria is, of course, a violation of the normal process of urination. In the acute form, such symptoms are more noticeable, because due to the accumulation of urine in the bladder, its walls are greatly stretched, which causes quite severe pain and a lot of discomfort.

Sometimes, if the cause of urinary retention is a blockage of the urinary canal, then a man may also feel pain in the urethra due to stones that linger there. If the cause of urinary retention is an injury to the penis, then discharge in the form of blood clots from the urethra is possible.

The acute form of ischuria can be seen even with the naked eye, since the man's belly increases significantly in size. In addition, the man experiences, but no urine is excreted. If the cause of urinary retention lies in inflammatory processes, the man will feel sharp pains in the lower abdomen and lower back.

If the chronic form of ischuria is caused by prostate adenoma, then the man will experience the following signs of the disease:

Frequent urge to go to the toilet.
Constant feeling that the bladder is not completely emptied. As a rule, only a small portion of urine is excreted during urination.
The stream of urine is sluggish.
Frequent urination at night.

In the absence of proper medical care, intoxication can occur in the body due to harmful substances that are in the urine. In addition, due to the strong overflow of the bladder with urine, rupture of its walls may occur. At the same time, the man has symptoms of an "acute abdomen", in which irritation occurs in the abdominal cavity.

In order to make a correct diagnosis, the doctor may additionally prescribe a urinalysis, ultrasound, cystoscopy or computed tomography. These studies help to determine the presence of neoplasms in the organs of the genitourinary system, as well as other disorders and pathologies.

Poor urine output - how to treat

With an acute form of urinary retention in order to alleviate the patient's condition and prevent intoxication or rupture of the bladder. However, the use of a catheter to remove urine is a one-time procedure that cannot be used on an ongoing basis. Therefore, to improve the patency of urine, complex therapy is needed to eliminate the cause of the disease:

There are also folk recipes that help improve the process of urination and get rid of diseases. However, if symptoms of ischuria are detected, the first thing to do is to consult a doctor and conduct an examination.

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- This is a pathological condition characterized by a violation or impossibility of normal emptying of the bladder. Symptoms are pain in the pubic region and lower abdomen, very strong persistent urge to urinate and the resulting psychomotor agitation of the patient, a noticeable decrease in urine output or its absence. Diagnosis is based on a patient interview, the results of a physical examination, and ultrasound methods are used to determine the causes of the condition. Treatment - catheterization or cystostomy to ensure the outflow of urine, elimination of etiological factors of ischuria.

Urinary retention or ischuria is a fairly common condition that accompanies a significant number of various urological pathologies. Young men and women suffer from it in about the same way, as the age increases, male patients begin to prevail. This is due to the influence of pathologies of the prostate gland, which are usually determined in the elderly and are often manifested by urination disorders. Approximately 85% of all cases of ischuria in men over 55 are due to problems with the prostate. Urinary retention rarely occurs in isolation, more often it is part of a symptom complex caused by urological, neurological or endocrine pathologies.

The reasons

Urinary retention is not an independent disease, it always acts as a consequence of various pathologies of the excretory system. It should be distinguished from another condition, also characterized by the absence of urine output - anuria. The latter occurs due to damage to the kidneys, leading to the complete absence of urine formation. With urinary retention, fluid forms and accumulates inside the bladder cavity. This difference causes a different clinical picture, similar only in the volume of diuresis. The main reasons preventing the normal discharge of urine are:

Mechanical blockade of the urethra. The most common and diverse group of causes that cause ischuria. These include strictures of the urethra, its obturation with a stone, tumor, blood clots, severe cases of phimosis. Blockade of the urethra can also be caused by neoplastic and edematous processes in nearby structures - mainly the prostate gland (adenoma, cancer, acute prostatitis).
dysfunctional disorders. Urination is an active process, for the normal provision of which an optimal contractility of the bladder is necessary. Under certain conditions (dystrophic changes in the muscle layer of the organ, impaired innervation in neurological pathologies), the contraction process is disrupted, which leads to fluid retention.
Stress and psychosomatic factors. Some forms of emotional stress can lead to ischuria due to inhibition of the reflexes that provide the process of urination. Especially often this phenomenon is observed in people with mental disorders or after severe shocks.
Medicinal ischuria. A special type of pathological condition caused by the action of certain drugs (narcotic, sleeping pills, cholinergic blockers). The mechanism for the development of urinary retention is complex, due to the complex effect on the central and peripheral nervous system and bladder contractility.

Pathogenesis

Pathogenetic processes in different types of urinary retention are different. The most common and studied is mechanical ischuria, due to the presence of an obstruction in the lower urinary tract. These can be cicatricial narrowing (strictures) of the urethra, severe phimosis, urolithiasis with the release of calculus, prostate pathology. After some manipulations on the bladder (surgery, taking a biopsy of the mucosa) or bleeding in the urine, blood clots form, which can also obstruct the lumen of the urethra and prevent the outflow of urine. Strictures, phimosis, pathologies of the prostate usually lead to slowly progressive ischuria, while when a calculus or blood clot is released, the delay occurs abruptly, sometimes at the time of urination.

Dysfunctional disorders of the urinary tract are characterized by a more complex pathogenesis of urinary excretion disorders. Obstacles to the outflow of fluid are not observed, however, due to a violation of contractility, the emptying of the bladder occurs weakly and incompletely. Violations of innervation can also affect the sphincters of the urethra, as a result of which the process of their disclosure, which is necessary for urination, is disrupted. Stress, pharmacological variants of this pathology are similar in their pathogenesis - they arise reflexively due to disorders in the central nervous system. There is a suppression of natural reflexes, one of the manifestations of which is ischuria.

Classification

There are several clinical variants of urinary retention, differing in the suddenness of development and duration of the course. Each of these varieties, in turn, depending on the nature of the delay, is divided into complete and incomplete. With complete ischuria, emptying the bladder in a natural way is impossible, urgent medical intervention is required. With incomplete variants, urine output occurs, but very weakly, some volume of liquid remains inside the bladder. Each type of pathology also differs in etiological factors; in total, three variants of this condition are distinguished in clinical urology:

Acute delay. It is characterized by a sudden abrupt onset, most often due to mechanical causes - obstruction of the urethra by a stone or a blood clot, sometimes a neurogenic variant of the condition is possible. With incomplete forms, there is a weak excretion of urine with pressure on the lower abdomen or a strong tension in the abdominal press.
chronic delay. It usually develops gradually against the background of strictures of the urethra, diseases of the prostate, dysfunctions, tumors of the bladder, urethra. The rare complete form requires long-term (sometimes for several years) catheterization. In incomplete chronic forms, the amount of residual urine can reach large volumes - up to several hundred milliliters or more.
Paradoxical ischuria. A rare variant of the disorder, in which, against the background of filling the bladder and the impossibility of voluntary urination, there is a constant uncontrolled release of a small amount of fluid. It can be mechanical, neurogenic or medicinal etiology.

There is a less common and more complex classification of urinary retention, based on their relationship with other diseases of the excretory, nervous, endocrine or reproductive systems. But, given the fact that ischuria is almost always a symptom of some disorder in the body, the relevance and validity of such a system remains in question. In some cases, different forms of the condition can turn into one another, for example, acute delay - chronic, complete - incomplete.

Symptoms of urinary retention

Any type of ischuria is usually preceded by manifestations of the underlying disease - for example, renal colic, due to the release of a stone, pain in the perineum associated with prostatitis, urination disorders due to strictures, etc. interrupted, further outflow of urine becomes impossible. This is how ischuria can manifest itself with urolithiasis or obstruction of the urethra with a blood clot - a foreign body is displaced along with the fluid flow and blocks the lumen of the canal. In the future, there is a feeling of heaviness in the lower abdomen, a strong urge to urinate, pain in the groin.

In acute incomplete ischuria, a weak thin stream may appear with strong abdominal tension or pressure on the suprapubic area. Urination brings almost no relief, since a significant amount of fluid remains in the bladder. After catheterization and treatment of the causes of ischuria, the symptoms completely disappear. Chronic urinary retention is rarely complete and usually develops gradually. Initially, patients may experience a decrease in urine volume, a feeling of incomplete emptying of the bladder, and frequent urination associated with this circumstance.

In the absence of progression of the causes of chronic incomplete ischuria, the symptoms may subside, however, studies reveal the retention of residual urine after each emptying, against this background, inflammation of the bladder mucosa (cystitis) often occurs, which can be complicated by pyelonephritis. The full variety of chronic urinary retention differs from acute only in the period of catheterization of the patient. In almost any form of delay, its first difference from anuria is the excited psycho-emotional state of the patient, due to the impossibility of urination.

Complications

Urination retention with a long absence of qualified assistance leads to an increase in fluid pressure in the overlying sections of the urinary system. In acute forms, this can cause the phenomena of hydronephrosis and acute renal failure, in chronic forms - chronic renal failure. Stagnation of residual urine facilitates tissue infection, therefore, the risk of cystitis and pyelonephritis increases.

In addition, with significant volumes of retained urine, conditions are created in it for the crystallization of salts and the formation of bladder stones. As a result of this process, a chronic incomplete delay is transformed into an acute and complete one. A relatively rare complication is the formation of a bladder diverticulum - a protrusion of its mucosa through defects in other layers, due to high pressure in the organ cavity.

Diagnostics

Usually, the diagnosis of "ischuria" does not cause any particular difficulties for a urologist, a simple questioning of the patient, examination of the suprapubic and inguinal regions is sufficient. Additional research methods (ultrasound diagnostics, cystoscopy, contrast radiography) are required to determine the severity and causes of the pathological condition, the choice of effective etiotropic therapy. In patients with chronic variants of ischuria, auxiliary diagnostics is used as a monitoring of the progression of the pathology and timely detection of urinary retention complications. The vast majority of patients use the following diagnostic methods:

Questioning and inspection. Almost always they allow to determine the presence of acute urinary retention - patients are restless, complain of a strong desire to urinate and pain in the lower abdomen. On palpation of the suprapubic region, a dense filled bladder is determined; in lean patients, bulging can be noticeable from the side. Chronic incomplete varieties of the disorder are often asymptomatic, there are no complaints.
Ultrasound diagnostics. In acute conditions, ultrasound of the bladder, prostate, urethra allows you to establish the cause of the pathology. A stone is defined as a hyperechoic mass in the lumen of the urethra or in the region of the neck of the bladder, but blood clots are not detected by most ultrasound machines. Ultrasound examination of the urethra, prostate can diagnose strictures, adenomas, tumors and inflammatory edema.
neurological research. A consultation with a nephrologist may be required if neurogenic or psychosomatic causes of ischuria are suspected.
Endoscopic and radiopaque techniques. Cystoscopy helps to determine the cause of the delay - to identify the stone, blood clots and their source, strictures. Retrograde cystourethrography is the gold standard in determining the amount of residual fluid, therefore it is used to diagnose incomplete forms of pathology.

Differential diagnosis is made with anuria - a condition in which the excretion of urine by the kidneys is impaired. With anuria, patients have no or sharply weakened urge to urinate, manifestations of acute or chronic renal failure are observed. Instrumental diagnostics confirms the absence or an extremely small amount of urine in the bladder cavity.

Treatment of urinary retention

There are two main stages of therapeutic measures for ischuria: emergency provision of normal urine outflow and elimination of the causes that caused the pathological condition. The most common method of restoring urodynamics is bladder catheterization - the installation of a urethral catheter, through which fluid is drained.

Under some conditions, catheterization is not possible - for example, with severe phimosis and strictures, tumor lesions of the urethra and prostate gland, "impacted" calculus. In such cases, they resort to cystostomy - the formation of a surgical access to the bladder and the installation of a tube through its wall, which is brought out to the front surface of the abdomen. If a neurogenic and stressful nature of ischuria is suspected, conservative methods of restoring the outflow of urinary fluid can be used - turning on the sound of flowing water, washing the genitals, injections of M-cholinomimetics.

The treatment of the causes of urinary retention depends on their nature: for urolithiasis, crushing and extraction of the calculus are used, for strictures, tumors and lesions of the prostate - surgical correction. Dysfunctional disorders (for example, hyporeflex type of neurogenic bladder) require complex complex therapy involving urologists, neuropathologists and other specialists. If the cause of ischuria is taking medications, it is recommended to cancel them or correct the drug therapy regimen. Urinary retention due to stress can be eliminated by taking sedatives.

Forecast and prevention

In most cases, the prognosis of urinary retention is favorable. In the absence of medical care, acute variants of the pathology can provoke bilateral hydronephrosis and acute renal failure. With the timely elimination of the causes that caused this condition, relapses of ischuria are extremely rare.

In chronic variants, the risk of infectious and inflammatory diseases of the urinary tract and the appearance of stones in the bladder increases, so patients should be regularly observed by a urologist. Prevention of urinary retention is the timely detection and proper treatment of pathologies that cause this condition - urolithiasis, strictures, prostate diseases and a number of others.

An extremely unpleasant condition occurs in a man when he naturally unable to empty the bladder.

The reservoir is full of urine.

But it is partially or completely not brought out.

When the fluid produced by the kidneys is not completely removed, part of the urine remains in the bladder (it is called residual).

The phenomenon becomes chronic.

If the urine cannot be withdrawn in full at all, the person is in great danger.

What it is

Problems with emptying the bladder, especially in older men, occur when ischuria – delays in the natural outflow of urine. Violation of the act of urination often indicates that pathological processes are developing in the urinary system of the body. They cause pain.

The normal outflow of urine is prevented by squeezing, damage, blockage of the urethra, hypertrophy of the muscle that expels urine.

Disease classification

Depending on the symptoms accompanying the dysuric disorder, various stages of urinary retention: acute, chronic, paradoxical and reflex.

Features of the course of the disease

Acute stage pathological condition of the urinary system occurs suddenly. A person experiences a sharp pain in the groin, an unbearable urge to urinate. The outflow of urine is accompanied by pains.

Obstruction of the ureter in the acute stage, in the absence of the necessary therapeutic measures, can develop into chronic form. If the acute stage is manifested by severe pain, then the chronic one proceeds for a long time without much concern for the patient. This is where the danger lies: chronic ischuria is found already in advanced form.

Since with a chronic delay, complete independent disposal of urine does not occur, the outflow of urine is carried out artificially.

A special form of difficulty urinating is paradoxical ischuria. An excess of a product produced in the kidneys puts pressure on the walls of the groin and expands it. The patient urinates in small portions or the liquid is secreted spontaneously drop by drop.

A patient with this type of retention also needs to be forced to pass urine.

Prevalence and risk factors

Violation of the function of the excretory urinary system occurs more frequently in men than in women. The ability to urinate normally becomes a problem in males over the age of fifty.

Foreign statistics claims that one case of acute urinary retention was observed within 5 years in 10% of men aged 60-70 years, within 10 years - in every third.

The most common risk factors for the disease state are adenoma and prostate cancer.

The condition of an inflamed prostate, and how it affects urination.

Other causes of ischuria

Urination disorders in men can be caused by other reasons.

Incomplete excretion of urine gives rise to such diseases:

inflammation in the urinary organs;
urolithiasis disease;
infectious diseases;
multiple sclerosis, etc.

Urinary retention can be caused injuries of the urethra, bladder, pelvic organs, brain and spinal cord.

One of the causes of improper urination is a congenital pathology of the urinary system.

Urinary retention in men can be observed in such cases:

with strong, often recurring stressful conditions;
with hypothermia of the body;
with severe alcohol and drug poisoning;
in case of intoxication from medicines;
after surgical operations on the pelvic organs;
as a result of a long stay in a prone position, etc.

Lack of time to visit the toilet is also a potential cause of ischuria.

Video: "Causes of urinary disorders in men"

Effects

As you can see, urinary retention is a consequence of certain conditions, bad habits, life circumstances and complications of diseases.

But incomplete or complete violation of the natural physiological process is also potential danger of developing such pathological conditions as:

inflammation of the peritoneum (peritonitis);
the formation of a septic focus in the kidneys and bladder;
renal colic, insufficiency.

A large volume of residual urine or its complete stagnation in the bladder causes development of cystitis. Most often, the inflammatory process occurs in patients with pathologies of the brain of the head and back.

Too dangerous is the rupture of the bladder and leakage of urine into the abdominal cavity. Such damage is possible in men with falls, blows to the groin.

Symptoms

The delay in emptying the bladder is different. According to the signs that are observed in this condition, one can judge the underlying disease that caused problems with urination.

With prostate adenoma the bladder is not completely released, the process is accompanied by the release of blood, pain and fever.

Intermittent urination can cause stones that block the excretory ducts.

Urinary retention should not be allowed to be permanent. A large volume of fluid in the bladder stretches its walls and sphincter muscles. Then urine begins to depart involuntarily in drops or small portions. Urologists in this case ascertain the onset of paradoxical ischuria.

Diagnostic methods

If you find it difficult to pass urine, complete retention, you need to see a doctor. The urologist will conduct a thorough examination, make the correct diagnosis.

In the complex of diagnostic studies of urinary retention, the following methods are provided:

scrupulous study of the anamnesis;
careful examination of the patient;
mandatory X-ray of the spine - lumbosacral;
urinalysis - general and others;
urine culture for sterility;
carrying out cystoscopy;
a blood test to confirm or rule out an infection in the urethra;
Ultrasound of the bladder and ureter - to analyze the condition of the muscles;
CT scan, MRI - exclude nervous diseases of the brain and spine;
the use of urodynamic methods for examining the bladder, etc.

Which of the above examinations to appoint, the specialist decides, coordinating his appointments with the patient.

Treatment

Therapy of a pathological condition is carried out depending on the characteristics of the disease. Treatment is carried out surgically, with the help of medicines and folk remedies.

Surgical intervention is necessary, first of all, if the inhibition of the movement of urine is caused by a mechanical obstacle. Inflammatory processes, infectious diseases are treated with antibiotics, sulfanilamide and other medications.

In case of acute violation of the functional process, it is necessary:

Hospitalize the patient.
Invite a specialist to the patient, under whose supervision the therapy will be carried out.
To provide the patient with emergency assistance in the form of surgical manipulations with a rubber or metal catheter to artificially release the bladder from stagnant urine.
If this procedure fails, a suprapubic section of the bladder should be performed.

To stimulate normal muscle contraction in the urethra performing implant surgery. It will normalize the outflow of urine.

Cleanup surgical intervention, associated with a violation of the act of urination, is carried out, if possible, without a catheter.

The natural outflow of the product of the activity of the kidneys can be removed by the following methods:

open a faucet so that the patient hears the sound of flowing water;
irrigate the external genitalia with warm water.

Postoperative urinary retention can be eliminated drug administration in certain doses of one of these drugs:

novocaine - into the urethra;
urotropin - intravenously;
pilocarpine - subcutaneously.

If the above methods and medications do not help, catheterization should be performed. It is carried out very carefully, with a sterile soft rubber catheter that can be left for a long time.

To prevent the occurrence of inflammatory processes and urinary tract infections, it is necessary to attribute antibiotics to the patient, as well as furadonin, urosulfan and other chemicals.

Video: "How to install a urinary catheter"

Folk recipes

Traditional medicine has its own secrets of getting rid of the symptoms of urinary retention. Using them, we must remember: folk remedies do not cure the disease, do not eliminate the cause of a functional disorder. These are additional sources of relief for the patient's condition. Let's give an example of a folk recipe.

Tea rose

Pour the fruits of the plant with alcohol or water. Insist until the liquid acquires a pale yellow hue. Dilute 10 drops of the product with a small amount of water. Drink 2 times a day.

Prevention of dysuric disorder

To prevent difficulty urinating, men are advised to:

Forecast

Mastering new methods of treating acute urinary retention, experts came to the conclusion that the combined use of bladder drainage with a catheter and the use of uroselective a-blockers - tamsulosin and alfuzosin in patients with BPH gives a good effect. Natural urination after using this method was restored in 67% of patients, half of whom were transferred to outpatient treatment. This method of conservative treatment is a good alternative to surgical therapy.

Conclusion

Urinary retention in men- This is a painful condition in which the function of urination is impaired or completely absent.
Problems with the outflow of urine occur as a result of complications of diseases such as adenoma and prostate cancer, the result of damage to the brain and spinal cord, injuries of the urinary organs, etc.
There are acute, chronic, paradoxical and reflex forms of pathology. Each of them runs differently.
The most dangerous is acute urinary retention. In this condition, urgent medical attention is needed.
The most insidious is the chronic form of the disease. In order to detect it in time and start treatment, men after 45 years of age need to undergo a medical examination by a specialist once a year.
It is not difficult to prevent pathology. Compliance with the recommendations of the urologist, preventive measures - a guarantee of maintaining health for many years.
Modern medicine, using various methods for diagnosing and treating urinary retention in men, effectively fights a painful condition.

Andrologist, Urologist

Conducts examination and treatment of men with infertility. He is engaged in the treatment, prevention and diagnosis of diseases such as urolithiasis, cystitis, pyelonephritis, chronic renal failure, etc.

Urinary retention in men is a dangerous pathological condition when it is impossible to empty the bladder on its own, despite its overcrowding. In medicine, such a violation of physiological function is called ischuria.

Many confuse pathology with anuria, in which urination also does not occur, but due to the lack of urine. With ischuria, the patient experiences unbearable urge to empty, which do not lead to a result. If urination is not restored, the condition can cause serious complications in the form of acute inflammation of the pelvic organs or rupture of the walls of the bladder.

Types and forms

Ischuria often occurs in an acute form and develops suddenly, sometimes against the background of complete health. In a chronic course, the delay is formed gradually from several months to several years.

If part of the biological fluid is released, but not completely, an incomplete delay is diagnosed. In this case, the urine that has not come out is called residual. With the absolute absence of the process of urination, they speak of its complete delay.

Separately, it is necessary to consider paradoxical ischuria. So called one of the forms of acute delay. With this pathology, urine leaves the bladder slowly drop by drop. The patient cannot urinate completely and feels excruciating pain and fullness in the area of the suprapubic part of the abdomen. Pathology must be differentiated from incontinence, which does not cause pain.

Etiology

Acute urinary retention in men occurs both against the background of concomitant diseases and due to injuries. Often, pathology is a consequence of disorders of the central nervous system, poisoning and taking medications.

In the postoperative period, when urinating, a reflex delay may be observed. It resolves with several catheterization procedures and resolves completely after the patient recovers.

Among the main causes of urinary retention in men:

prostate lesions (cancer, prostatitis, adenoma);
mechanical obstructions (obstruction) that have developed due to diseases of the kidneys or urethra (stones, tumors, injuries);
neurogenic and psychogenic disorders of a general nature;
localized disorders of innervation in any of the areas of the urinary tract;
traumatic injuries of the pelvic organs;
organic and functional lesions of the brain and spinal cord;
malignant and benign neoplasms of the intestine and urinary tract.

Urinary retention is also promoted by sexual activity and physical overwork. A passive lifestyle is no less harmful. Urine is not completely excreted with prolonged sitting, lying down or overeating, which leads to constipation and blood stasis, followed by inflammation in the pelvic organs.

Important! An acute disorder in men is often one of the leading symptoms of the development of malignant neoplasms of the rectum and prostate.

Symptoms

The clinical picture of urinary retention in men is acute and has characteristic features. Patients experience excruciating urge to urinate, which become more frequent over time and take a continuous course.

Pain in the lower abdomen (above the pubis) becomes unbearable. This forces them to take a forced position (kneeling, squatting). Often, when men are not passing urine, they try to relieve the situation by pressing on the abdomen and squeezing the penis. This does not help urinate and further aggravates the condition.

The behavior of patients with ischuria is restless, the appearance is suffering, they are ready for any manipulation to quickly get rid of pain.
Attention! With ischuria caused by diseases of the urinary tract with impaired innervation, clinical manifestations in the form of pain may be absent, even if urine does not come out for about a day. If the delay is not detected in time, the bladder may rupture with subsequent complications.

External manifestations of delay

If the patient complains about the lack of urination for a long time, you must first examine the abdomen above the pubis. The configuration in this department changes, swelling in the form of a ball becomes noticeable. These changes are especially visible when urine does not pass in a man with a low weight. The skin over the bladder becomes taut and smooth.

When trying to palpate (palpate), there is a high elasticity and tension above the pubis. With percussion (tapping), a dull sound is determined.

On a note! With a delay in urination against the background of a strong pain syndrome, a reflex disruption of the intestines can occur. In this case, there is general bloating.

Diagnosis

Regardless of the causes of urinary retention in men, help and treatment must be provided immediately. The main indicators during the examination are clinical symptoms, complaints and external examination data. It is also necessary to collect a detailed history, find out the presence of concomitant diseases of the kidneys and urinary system. When diagnosing, pay attention to the following points:

time of onset of the current attack (last normal bladder emptying);
features of urination before the development of obstruction (rare or frequent, free or difficult);
the appearance and amount of the last portion of urine (cloudy, bloody or unchanged);
the presence of factors contributing to chronic urinary retention (trauma, inflammation of the excretory and reproductive systems);
possible use on the eve of a large amount of liquid or alcohol, taking medications.

If a man’s urine does not pass well for the first time, you need to clarify how the problem was resolved earlier, and how long the result of the treatment lasted.

After providing first aid, in order to find out why a delay or blockage has developed, a full examination of the man is prescribed. It includes urine tests according to Nechiporenko and Zimnitsky, as well as ultrasound or CT of the kidneys and bladder.

According to indications, retrograde cystourethrography is done using a contrast agent. Additionally, the patient is referred to a nephrologist and urologist. If a prostate adenoma is suspected, especially in older men, an examination is performed through the rectum. It helps to more accurately determine the consistency of the gland, its size and pathological changes in shape.

If there are no inflammatory diseases, mechanical obstacles in the form of stones (tumors), and there is still no outflow of urine, then the patient is referred to a neurologist to exclude psychogenic and neurogenic disorders.

Urgent care

What should a man do if his urine goes badly or does not go at all. Depending on the general condition, you need to call an ambulance or go to the hospital. Before the doctor arrives, a warm half-bath or a heating pad on the lower abdomen area helps to relieve pain, and sometimes restore urination.

In the presence of previously diagnosed malignant or benign tumors in the pelvis, warm procedures are prohibited.

If ischuria has developed against the background of injuries to the organs and bones of the pelvis, the man is transported to a medical facility on a hard shield in the “frog” position, lying on his back with half-bent knees spread apart. There should be a pillow under the head, a roller under the knees.

Treatment Methods

In medicine, there are several basic methods for helping with urinary retention. They are used depending on the causes and condition of the patient. Only the doctor decides how to remove urine from a man, and what to do if she does not go on her own.

Most often, acute retention is resolved by catheterization with the simultaneous administration of drugs. Subsequently, a complete examination and treatment of the underlying disease is carried out.

Medicines

Drug therapy includes injections of Urotropin, Prozerin and Atropine to relieve atony. With the threat of infection, antibiotics are prescribed (Cefazolin, Azithromycin, Ceftriaxone). To relieve spasm, No-shpu or Spazgan is administered intramuscularly at a dose of 2 ml. In case of injuries, hemostatic and anti-shock drugs are indicated (Vikasol, Prednisolone, Adrenaline).

catheterization

The safest way to empty your bladder. Catheterization is carried out by a paramedic or a nurse. The specialist inserts a soft rubber catheter through the urethra until the first drops of biological fluid come out. All equipment must be sterile. Urine is withdrawn into a special tray, its quantity is measured and sent for analysis. An indication for the procedure is considered an acute urinary retention for more than 12 hours.

It is enough to make 4 or 5 catheterizations per day. If severe pathologies are detected, the patient is admitted to the hospital and a permanent catheter is placed for several days. In this case, a prophylactic course of antibiotics is prescribed to prevent urethral fever.

With ischuria caused by operations or stress, one procedure is enough to restore independent urination. They try to preliminarily establish a physiological process by giving the patient a sitting position, turning on the water from the tap and creating a calm environment without the presence of outsiders.

In this way, patients can be helped after the removal of appendicitis or operations on the liver and stomach. If the intervention was carried out on the organs of the urinary system, it is possible to do without catheterization in rare cases.

Catheterization is not carried out in the presence of:

purulent inflammation in the urethra;
orchitis;
abscesses of the prostate;
urethral injuries;
blockage of the urinary tract with stones.

Also, the procedure is contraindicated in case of tumor germination from the intestine to the urinary tract and in case of pathological spasm of the sphincter of the bladder.

During the manipulation, attention should be paid to the patient's condition. Normally, the catheter should move freely along the paths without resistance. In case of acute painful sensations, the introduction should be stopped and the cause of the obstruction should be identified.

Important! It is strictly forbidden to independently carry out catheterization, this can cause damage to the walls of the urinary canal and cause bleeding or infection.

Epicystostomy

If the delay is due to trauma to the urethra or pathologies requiring serious treatment, patients undergo an epicystostomy. It is used to artificially excrete urine for a long time.

During the operation, a small incision is made in the suprapubic region. The trocar is inserted into the hole. Next, a drainage tube is installed, which is sutured to the upper layers of the skin for fixation in one position. From above, the seams are closed with sterile material. The tube is lowered into the container and the outflow is constantly monitored. After eliminating the causes of urinary retention in men, the drainage is removed.

If it is not possible to restore independent urination, a permanent cystostomy is installed. The drainage tube is led into a soft urinal, which the patient places under the clothes in a convenient place.

To prevent the sudden development of acute retention in men, one should carefully consider the process of urination. If urine does not come out for a long time, you should contact a urologist. It is necessary to diagnose and treat diseases that cause ischuria in a timely manner. This will help to avoid complications that require the installation of a cystostomy and prevent a decrease in the quality of life of a man.

Puncture

It is carried out when catheterization is impossible or contraindications to it. The procedure is performed only with a full bubble having a spherical shape. With the help of a needle, a puncture is made, and they wait until urine comes out. If necessary, rinse the cavity with antiseptics. You need to repeat the puncture every 10 or 12 hours, provided that the bladder is filled.

Acute urinary retention is called ischuria. It can occur in people of any gender and age, even a child.

In men, this condition can appear for many reasons. Urinary retention leads to stretching of the bladder, which leads not only to pain, but also to dysfunction of other organs.

The reasons

When urine is released irregularly, with pain and incomplete emptying of the organ in men, some reasons contribute to this:

The presence of stones, from which there is a blockage of the urethra.
Narrowing of the foreskin.
Hematomas and aneurysms in the pelvis.
Presence of infections.
Inflammatory process in the prostate or foreskin of the glans penis.
Injury to the urethra or bladder.

In addition, urinary retention may occur for other reasons:

Multiple sclerosis.
Spinal or brain injury.
In case of poisoning with alcohol or drugs, with an overdose of sleeping pills.
After hypothermia.
In the presence of constant stress.
Forced retention of urine due to the inability to go to the toilet, which eventually becomes a habit.
Prostatitis or prostate adenoma.
Phimosis, or narrowing of the foreskin, often develops in boys.
Benign or malignant tumors, including in the prostate gland.

Symptoms

Acute urinary retention is manifested by a feeling of an overflowing bladder, but attempts to empty it of fluid are unsuccessful. There are several types of ischuria, this is, first of all, a chronic condition and complete and incomplete devastation of the organ:

Acute retention begins suddenly with unbearable pain in the lower abdomen. Urges to go to the toilet are frequent, but unsuccessful. The acute period of ischuria is dangerous for the health of a man.
Chronic urinary retention occurs without visible symptoms. For a long time, a person may be unaware of his illness until additional symptoms appear.
Complete urinary retention is characterized by the absence of fluid from the bladder. You have to use a catheter to get the urine out.
Incomplete urinary retention can accompany a man for a long time. However, he does not feel much discomfort. The following symptoms may appear: difficulty urinating, forced attempts, urine droplets, lack of urge to urinate.

Sometimes there is another type of this pathology - this. The paradox of this condition is that the urethra is overflowing with urine, its walls are stretched, but it is not possible to release it. Urine leaves in small portions.

Diagnostics

Urinary retention in men cannot develop just like that, so you should first of all identify the causes. Urinary retention can be determined already at the first examination of the patient. When tapping the suprapubic part of the abdomen, a dull sound is heard.

Diagnosis is carried out after first aid.

Diagnostic procedures for ischuria in men:

Ultrasound examination of the pelvic organs.
Excretory cystourethrography.
Retrograde urethrography.
Pyelography performed intravenously.

These methods allow you to make the correct diagnosis and conduct treatment.

Treatment

Postponing treatment with symptoms of urinary retention is not recommended, moreover, sometimes emergency medical care is needed. With self-treatment of this disease, various complications can develop:

Rupture of the urinary tract.
Infection.
Injury to the urethra when trying to insert a catheter on your own.

In the chronic course of the disease, the development of chronic renal failure is possible.

If you have pain during urination, consult a urologist or call an ambulance. If acute pain occurs before the arrival of an ambulance or a doctor, you can apply heat to the abdomen, take a bath with warm water, or use an antispasmodic. Before prescribing treatment, the doctor will send the patient for testing.

The first emergency aid for acute ischuria involves insertion to remove excess fluid. Only a specialist should do this, otherwise the urethra may be damaged. If necessary, the catheter is left for several days.

In this case, care must be taken to ensure that the infection does not penetrate the organ. The doctor may prescribe a course of antibiotic therapy and topical antiseptics.

If it is impossible to enter the catheter, an appropriate operation is performed or performed. In extreme cases, an epicystostomy is performed, when a special catheter is inserted through the abdominal wall and urine is excreted outside.

It happens that urinary retention causes a reflex lack of urination. In this case, some actions are applied, for example, in the form of irrigation of the penis with warm water, listening to the sound of murmuring water. All this reflexively contributes to painless urination. After first aid is provided, an additional study is carried out, after which the question is raised about further conservative treatment or surgical elimination of the problem.