Incontinence and Problems of Urination

 Incontinence and Problems of Urination
Urination. anatomically, involves the renal arteries blood supply to the kidneys, the kidneys themselves and their drainage down the ureter tubes into the bladder, the prostatic and penile urethra and, finally the penis or (in women) the vulvar openings to the  outside.

The main purpose of urination is to regulate body water; electrolyte concentrations, like Na+ and K+; the acid/base balance (through NH4 1+Ammonium); and to rid the body of toxic substances. There is an obligate production of urine from the kidneys so that even without drinking any fluids for a day or more, a person still produces c.200 ml urine. And there is a capacity to produce thousands of cc of urine a day if one drinks excessive fluids. 
When urine accumulates in the bladder, its capacity is c. 500 ml before agony. The urination mechanism is an autonomic reflex. The bladder is a thick-walled pouch that, unfilled, is collapsed on itself like an un-inflated balloon. As it fills with urine, its muscular wall experiences increasing tension and this stimulates parasympathetic nerves (acetylcholine neurotransmission) which cause the bladder wall to more strongly contract and cause the lower urethral sphincter muscle to relax, opening the urine pathway, and then streams of urine squirt from the urethra’s external opening.

Incontinence is the involuntary loss of urine. When it is due to fistula—-a hole in the bladder from botched surgery—- or trauma, there is constant leakage from the abdominal wall.  In women it comes out from vagina or vulva; in men, from shaft of penis. The hole needs to be surgically trimmed and sewed up.  When it comes from childbirth’s vaginal  stretching, urinary sphincters are damaged and the woman cannot hold her urine against even partial pressure. Then it is called stress urinary incontinence and needs a few choice stitches to tighten up the sphincter. In old age many men suffer a partial incontinence of very slow drip-drop loss of urine leaving pants constantly moist and urine-smelling.

Urine stream stoppage due to prostate lesions occurs in men and has been dealt with in a previous chapter.  This very brief summary is meant to introduce the reader to my personal/professional experience with urination problems.

Recently, as an 88 y/o man, I experienced urinary stoppage due to tumor pressing on the prostate gland and narrowing the passage. Because it was from tumor pressure and not from the much more frequent benign prostatic hypertrophy (BPH), my urologist preferred not to do surgery but instead started off by inserting a Foley catheter up my penis into the bladder. This was the culmination of an emergency room (ER) visit because I stopped being able to pee and was in agony with an enlarged, thick-walled bladder. The catheter was a brown rubber, 5.3 mm (Size 16) diameter, double-lumen tube with a rounded, semi-pointer front tip. He inserted it with the use of vaseline under sterile technique, pushing the tube up my penis through prostatic urethra and into bladder. Instantly he was rewarded by a strong stream ot deep amber urine which flowed out (to my great relief) until about 500 ml had drained. Catheterization may be a single relieving one (as for women with edema in the vagina/vulva from too rough sex. Or, more frequently, as in my case, the catheter may be left in place for days, weeks, months, to keep a constant drainage for a chronic condition, and prevents kidneys damage and dialysis from the high back pressure of obstruction.

I had the catheter in place for 10 days and my experience should prove invaluable for others needing catheterization. First, keeping the catheter securely in place is accomplished upfront by an outer layer balloon in the tip which is expanded by injecting 5 ml water into it. That way, the catheter cannot be inadvertently pulled out but it can be advertently removed by hypodermically sucking the water out of the bulb and collapsing it.  The catheter may be attached to drainage tube at its open end and the urine is collected in a plastic bag that may be tied to a user’s leg or wheelchair; or, it may just be plugged in  to close and the user unplugs and drains it at intervals. I had mine plugged and was sent home with it.W

The main risk of catheter insertions and especially longterm placement is introducing  bacterial infection into the bladder urine from where it can spread to and destroy the kidneys.  So sterile technique by medical and wash-hands cleanliness and use of anti biotic by user-patients is a must. When these are observed, one may get around independently outside of hospital as I did for more than a week.

Removal of long term catheters presents the problem of being assured that urination will not block up right after the removal and necessitate a repetitious insertion. In my case I had had signs of obstruction for weeks and ended in ER 1 Oct in agony that was relieved by insertion of a size 16 catheter that was left in place and I was sent home and returned to urology clinic and my urologist decided to admit me to hospital. He explained that routine in my kind of catheter reliance was to pull out catheter after 10 days. The time is needed to train my bladder to moteSo I was admitted and on 11 Oct. a nurse pull it out after deflating the 5 ml retention balloon,

After such a 10-day retention it is necessary to record the Rome and amount of each urination, and do an ultrasound through abdomen of bladder size which gives residual urine amount. A residual urine < 200 ml reassures that the patient will be OK to send home sans catheter. (To continue, 13 Octr 2021)

　

 

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