Disorders urination (dysuria)

Painful urination. Pain during urination may be observed in the beginning, the end or during the whole of urination.
Pain at the beginning of urination occurs in acute inflammation of the urethra and depends on the irritation urine stream inflamed walls of the urethra. The pain in the end of urination occurs in acute cystitis, urinary bladder tumors, inflammation of the prostate gland, posterior urethra, inflammatory processes in the bladder neck. Pain caused by compression of the inflamed nerve endings of the mucous membrane at the maximum reduction of muscles of the bladder at the end of urination.
Frequent urination or pollakiuriya (more than 4-5 times a day and 1 night time) when drinking plenty of fluids, with the unrest is a physiological phenomenon.
Pollakiuriya without pain occurs often in pathological processes in the reproductive system in women (with the omission of the front wall of the vagina, when you bend or tumors of the uterus) and depends on disorders of blood circulation in the area of the bladder neck. In men, a condition called hypertrophy (BPH) prostate, urination is ecasino mainly at night, depending on overflow blood pelvic organs during sleep and increase in connection with this volume adenomas. In patients with bladder stones urination, on the contrary, casino mainly in the daytime, when the stone, moving with the motion of the patient, irritates nerve endings of the mucous membrane of the bubble.
The enuresis most often observed in inflammation of the bladder, especially his neck, the back of the urethra and prostate gland. In these cases urination casino, the urge to urinate imperative (mandatory), unstoppable. The enuresis should not be confused with urinary incontinence. At last the urine excreted also involuntarily, but the urge to urinate is absent.
Difficulty urinating depends mostly from mechanical obstacles to the free flow of urine from the bladder. These include narrowing, stones or tumors of the urinary canal, the narrowing of the foreskin (phimosis), adenoma of prostate cancer, bladder tumors located in the cervix. Urination with increased voltage abdominals. Developing compensatory hypertrophy of the detrusor muscle bundles, which are under the mucous membrane of the bubble in the form of rollers (log or trabecular bubble - see Fig. 35). Gradually, however, the reserve force of the cystic muscles exhausted, urine flow becomes sluggish, falling straight down, the bladder is emptied completely, you receive the residual urine.
Less likely to have difficulty urinating because of diseases or damage to the brain or spinal cord: when tabes dorsalis, as well as in congenital disorders of innervation of the detrusor (congenital atony bladder).
Urinary retention is the inability to empty the bladder, despite the overflow of his urine. The reasons for the delay of urine are the same as difficult urination. Meet and reflexive forms of urinary retention, such as after surgery (postoperative urinary retention), after a strong fear, hysteria.
May be complete or incomplete urinary retention. When fully patient delay, despite the sudden urge to urinate and a strong natureline, cannot allocate a single drop of urine, incomplete, partial, the delay urination takes place, but after some of the urine remains in the bladder, i.e. you receive residual urine, which amount can reach thousands or more ounces. Urinary retention may occur suddenly acute delay, or develop gradually chronic delay.
Acute urinary retention is caused by injury to the urethra, a rush of blood to the adenoma of the prostate (e.g., long seat, constipation or diarrhea), atony gallbladder muscles in result of intoxication or peretiranie urine when there is a stricture of the urethra or prostate.
Chronic urinary retention is the result of long-standing obstacles to the flow of urine or atony detrusor.
Acute urinary retention causes severe pain and require emergency care.
Acute delay on the grounds of Hyper prostate often eliminates single catheterization of the bladder or releasing urine over several days.
If you cannot produce a catheterization is used supra-pubic aspiration suprapubic bladder or its section and discharge of urine through the drain tube (cystostomy). This operation must be applied without delay at a delay of urine on the ground injured urethra.
Postoperative urinary retention-dependent attenuation (paresis) muscular wall of the bladder, in most cases, liquidated by the injection of 1 ml of 1% solution pilokarpina or 1 ml of 0.05% solution prozerina, causing the contraction of smooth muscles. In the absence of the effect of urine produced by the catheter.
Urinary incontinence. Under incontinence refers to the involuntary release of her without the urge to urinate. There are absolute and relative incontinence. At the absolute incontinence act of urination is missing, because all of urine excreted involuntarily, for example with congenital cleft urinary, bladder (extrophy) or the urethra (the total epispadias), at the big fistula bladder.
Relative incontinence only part of urine excreted involuntarily, and the rest is retained in the bladder, sometimes have the urge to urinate and it occurs normally. Thus, in the case of relative incontinence last combined with normal urination. This category refers to incontinence in congenital ectopia one of the ureter, when his mouth opened outside bladder into the vagina, into the uterus, vulva, and the second urethra opens into the bladder. This may include incontinence cleft of Arousa (urinary flow), traumatic and post-operative small fistula bladder or ureter.
Quite often the relative incontinence occurs in women with sagging anterior wall of the vagina, and hence the back wall of the urethra and bladder neck (cystocele). In most cases, cystocele accompanied by the weakening of the switching capacity of the sphincter. Consequently, when increased intra-abdominal pressure - laughing, coughing, physical stress is a small portion of urine excreted involuntarily.
A peculiar form of incontinence is paradoxical isoria (ischuria paradoxa). The long delay of urine occurs not only the ultimate tensile muscular wall of the bladder, but stretching sphincter. Urine is entering a crowded bladder, involuntarily drops out from the urethra, i.e., urine retention combined with incontinence.
Bedwetting. Under the night enuresis, or enuresis means involuntary urination during sleep. Minor items incontinence no, because we are talking about normal urination, but is not perceived by consciousness.
Enuresis is very common in children, occurs in approximately 5-15% of children. In adults it is rare to 15-18 years bedwetting usually stops.
Urination occurs in newborns by type of unconditional reflex, i.e. takes place on the first impulse; the ability to control the bladder and suppress the urge to urination as reality, and in the dream is realized by means of a conditioned reflex, produced by education. The essence of this reflex is that the urge to urinate calls produced by conventional communication relaxation and expansion of the bladder wall, and thereby lowering intravesical pressure and termination urge.
If this conditional reflex insufficiently developed or not racks, under the influence of external and internal stimuli (psychic experiences, diseases of a nasopharynx, phimosis, worms and so on) conditional relationship is terminated, leading to incontinence.