If you have trouble completely emptying your bladder when you go to the bathroom, then you may be suffering from a condition called urinary retention or iscuria. This can be caused by weakened muscles, nerve damage, kidney stones, bladder infection, prostatic hypertrophy, and other diseases. Urinary retention can be acute (short-term) or chronic (lasting for a long time) and consists of the complete or partial inability to empty the bladder. In many cases, the problem can be addressed with certain techniques to be performed at home, but in other situations, emergency medical intervention is required.
Steps
Part 1 of 2: Improving Bladder Emptying at Home
Step 1. Strengthen the pelvic muscles
One of the most effective and best known methods of strengthening the pelvic floor muscles is to perform Kegel exercises. These are very simple exercises you can do at home to strengthen the muscles that control the bladder, uterus, small intestine, and rectum. To identify them, try to stop the flow of urine; the muscle groups that you contract to succeed in this action are precisely those that you can strengthen with Kegel exercises. You can "train" them in any position, even if it is easier lying down.
- Once the pelvic floor musculature is located, contract and hold it for five seconds, then relax it for another five. Repeat this sequence 5-10 times on multiple occasions throughout the day.
- Over the course of a few weeks, increase the intensity of the exercise by holding the contractions for 10 seconds at a time, then releasing them for another 10 of rest. Also do the exercises standing or sitting. Repeat this sequence 5-10 times a day until you are able to better control your bladder.
- Be careful not to "cheat" by contracting the abdominal muscles, thighs or buttocks. Remember to breathe normally during the exercises.
- There are many factors that weaken the pelvic muscles, such as pregnancy, childbirth, surgery, age, obesity, chronic cough and overexertion due to constipation.
Step 2. "Reprogram" the bladder
Regaining bladder control is an important behavioral therapy that is useful in cases of incontinence and iscuria. The goal of this technique is to increase the time between urinations; If you can increase the volume of fluid that your bladder is able to hold, you can reduce the feeling of urgency and / or the loss of urine. Bladder training involves following a fixed bladder emptying program regardless of the presence of the stimulus. If the urge to urinate before the appointed time occurs, this sensation must be suppressed by contracting the pelvic muscles.
- Empty your bladder as much as possible as soon as you wake up. Then set a series of "appointments" every 1-2 hours that you will have to respect, regardless of whether or not you need to urinate.
- As you manage to control your bladder and pee on command, increase the intervals between urinations by 15-30 minutes until you can last 3-4 hours without problems.
- Typically, it takes 6-12 weeks of training to regain control of your bladder and empty it completely when you need to urinate.
Step 3. Make sure you feel comfortable in the bathroom
This way you can empty your bladder normally. If the air or floor temperature is too low, it may inadvertently distract you from what you need to do. Sitting on the toilet may be the most comfortable for both genders, as some men experience pain in their back, neck, or prostate when peeing standing up. Privacy is another key factor, so avoid urinating in public restrooms if you can, and lock the door when you are in your home.
- Set your home's heat to a higher temperature during the winter, and consider wearing a robe and slippers to keep warm.
- Distribute aromatherapy candles in the bathroom to give it a "spa" look, so you can relax and soothe yourself while peeing.
- If you are a "clean freak", keep the bathroom tidy so you don't get distracted and don't feel bothered by something out of place.
- Take your time. It typically takes 30-60 seconds to urinate, so don't rush and stress.
- Run water from the sink faucet in an attempt to trigger a strong urge to urinate and thus empty your bladder.
Step 4. Apply external pressure or stimulation
Try to gently press on the bladder from the outside of the lower abdomen to induce urination and improve emptying; think of this operation as if it were a massage or physiotherapy exercise. Observe anatomical tables online, so you will better understand where the bladder is; then apply gentle pressure inwards (towards the spine) and downwards (towards the feet) and try to "squeeze" the bladder as you urinate. It is easier to practice this technique while standing than sitting and leaning forward on a toilet.
- Alternatively, try gently tapping the skin / muscle / fat directly above the bladder to trigger contractions and decontractions.
- Women should insert a clean finger into the vagina and apply some forward pressure to the front wall to stimulate the bladder to release urine.
- In men, excessive stimulation of the lower abdomen could cause an erection which would greatly complicate the urination process. For this reason, try to avoid sexual arousal when you want to empty your bladder completely.
- Run hot water over your lower abdomen to trigger the urge to pee. For example, you can try to empty your bladder when you are in the shower.
Step 5. Learn self-catheterization techniques
If you are in desperate need to urinate and experience bladder and kidney pain, you can try this method when the above remedies don't work. Self-catheterization involves inserting a catheter (a long, thin tube) into the urinary tract until the bladder opens to allow urine to drain. This procedure must be taught to you by your family doctor or urologist and is not suitable for fussy or fearful people.
- It is generally best to let the doctor insert the urinary catheter after numbing the area with a topical product. however, if you want to give it a try, you can give it a try using a lube.
- Lubrication reduces the need for a topical anesthetic, but some compounds (such as petroleum jelly) can irritate the delicate mucous membranes of the urethra and cause pain.
- It is vitally important to thoroughly sterilize the catheter before inserting it, as any bacteria can trigger an infection.
Part 2 of 2: Get Medical Treatment
Step 1. Contact your doctor
If you have trouble emptying your bladder for more than a couple of consecutive days, make an appointment with your family doctor. He is able to perform a physical check and pinpoint the root of the problem. In addition to weakened pelvic muscles, other causes of urinary retention are: obstruction of the urethra, bladder and kidney stones, genitourinary tract infections, severe constipation, cystocele formation (in women), prostatic hypertrophy (in men), injuries spinal cord, over-the-counter antihistamine abuse, and side effects of anesthesia after surgery.
- Your doctor will take a urine sample, ask you for an x-ray, computed tomography, MRI, and / or ultrasound to determine the cause of the problem.
- Ask your doctor to refer you to a urologist to undergo further tests, such as cystoscopy (inserting an endoscope to view the inside of the urethra and bladder) and / or electromyography (to measure muscle activity in the bladder) and pelvic floor).
- Common symptoms of urinary retention are: pain in the lower abdomen, swelling, frequent urge to urinate, difficulty stopping or starting urine flow, leaking and weak urine flow.
- If you experience intense pain from a full bladder that you can't empty, your doctor might insert a urinary catheter - a relatively quick outpatient procedure that is done with local anesthesia. Your doctor may also teach you self-catheterization on this occasion, so you can repeat the procedure at home.
Step 2. Find out about available medications
Ask your doctor if your bladder problem and inability to empty it can be treated with medication. Some active ingredients trigger the dilation (relaxation and enlargement) of the smooth muscle of the urethra and the opening of the bladder, although long-term use of these drugs can lead to the opposite disorder: incontinence and loss of bladder control.. For men with prostatic hypertrophy, a common cause of urinary tract problems, there are medicines available, such as dutasteride and finasteride, which stop benign hypertrophic development of the prostate or even reduce the size of the gland.
- Other medicines that relax the muscles of the bladder, urethra and also act on the enlarged prostate are: alfuzosin, doxazosin, silodosin, tadalafil, tamsulosin, terazosin.
- Medicines should only be considered as a short-term solution and not as a permanent cure for urinary retention.
Step 3. Evaluate urethral dilation and stent insertion
Dilation serves to heal obstructions in the urethra by inserting tubes of increasing diameter to widen the passage. Conversely, the stent is used to widen the narrowed urethra, but this acts as a spring that constantly pushes the surrounding tissues and does not need to be replaced with a larger one. Stents can be permanent or temporary. Both procedures are performed on an outpatient basis with local anesthesia and sometimes sedation.
- Alternatively, the caliber of the urethra can be widened by inflating a balloon attached to the end of a catheter.
- All these procedures are performed by the urinary tract specialist i.e. the urologist.
- Unlike normal catheterization that can be taught to the patient, dilation and stent insertion should never be attempted at home for any reason.
Step 4. Evaluate sacral neuromodulation
This technique uses mild electrical impulses to stimulate the nerves that control the bladder and pelvic floor muscles involved in urination. This treatment helps the brain, nerves and muscles to communicate better with each other so that the bladder can empty properly at regular intervals. During surgery, an electrical device is inserted and operated; however, this is a reversible procedure which can be stopped at any time by turning off the device or removing it from the body.
- This treatment is sometimes referred to as sacral nerve stimulation, although the nerves in and around the tailbone can be stimulated externally with a vibration device. Try it at home to see if it helps you empty your bladder.
- Sacral nerve stimulation is not indicated for bladder problems or urinary retention caused by an obstruction.
- Know that not all forms of non-obstructive iscuria can be treated with this technique, for this reason always ask your urologist for advice.
Step 5. Consider surgery as a last resort
If all the techniques and treatments described above have not led to the desired results, then surgery may be considered, as long as the urologist believes it will be useful. There are many procedures available, but one needs to identify the one that can solve the underlying problem. Some examples of surgeries to relieve urinary retention are: internal urethrotomy, cystocele correction or rectocele for women, prostate surgery for men.
- During an internal urethrotomy, the urethral stricture (block) is repaired by inserting a special catheter equipped with a laser on one end.
- Surgical correction of the cystocele and rectocele involves removing the cyst, suturing the hole, and strengthening the vaginal and surrounding tissues to bring the bladder into its natural position.
- To treat urinary retention caused by benign prostatic hypertrophy, all or part of the gland is surgically removed, usually following the transurethral method (thanks to a catheter inserted into the urethra).
- The other surgeries are done to remove cancerous or cancerous tissues in the bladder or urethra when possible.
Advice
- The sound of running water is a neurological and not a physical stimulus for urination. It works with just about anyone, but is generally more effective with guys.
- Avoid caffeine and alcohol because these substances increase the need to urinate and often increase bladder irritation.
- Whistle while you urinate. This simple action helps you empty your bladder completely by applying gentle pressure to your lower abdomen.
- Urinary retention is much more common among men and its incidence increases with age. Among male subjects in the age group between 40 and 83 years, the overall incidence of this phenomenon is equal to 0.6%.
- If urine returns from the bladder to the kidneys due to urinary retention, it can lead to permanent damage and a reduction in their function.
