URINARY RETENTION

Inability to void may develop abruptly, but is usually preceded by a history of diminished size and force of the urinary system, hesitancy, nocturnal urination, and dribbling. Many of these individuals are older men, having developed gradual prostate enlargement, but scarring and stricture from infection in the urinary tract can also produce these symptoms.
One of the most important ways of relieving these conditions, short of actual surgical cure, is the use of the urinary catheter. Unless the obstruction is severe this soft, flexible tube with a rounded end can be passed successfully into the bladder in most people. The catheter should be sterilized, the opening of the urethra (meatus) cleansed carefully with antiseptic solution, and with appropriate lubrication the catheter passed gently into the bladder. Usually relief is obtained and this technique is easily learned at home thus allowing either for the necessary time to seek medical care or a chronic relief in older patients deemed unsuitable for surgery.
The Foley catheter, which contains an inflatable balloon, can be used for indwelling drainage of the bladder. This, connected to a closed, sterile system of collection can provide comfort for a longer time. However, infection mayresult from the presence of this foreign substance after only two to three days.
In association with gentle catheter placement techniques, bladder irrigation may be learned. Different patients require varying intervals between catheter change and this can often be prolonged by the use of irrigating solutions. Some of these inhibit bacterial formation and others improve patency of the catheter by reducing bladder sludge. All instrumentation of the bladder may produce hematuria or the presence of blood. Persistence of this and other urinary symptoms should cause a patient to seek counsel from a competent physician.
Although the urinary tract is complex and mysterious it is usually amenable to simple home remedies. The early use of these preventive measures can frequently restore health before chronic illness or disability becomes a problem.

TRAUMA TO THE KIDNEY

Injury to the urinary tract may at times produce blood in the urine. This is
particularly a problem in contact sports, since the kidneys are easily traumatized.
Long distance runners also frequently show signs of kidney damage
with elevated enzymes and blood in the urine. This may be related not only to
the metabolic breakdown of muscle during severe exercise, but also to the
dehydration that results from profound sweating. In most cases of urinary
trauma where the urethra, bladder, or ureters have not been ruptured bed rest
combined with hot packs and adequate fluid intake will produce a rapid cure.

KIDNEY FAILURE

Failure of the kidneys to form urine properly can be either of an acute or chronic nature. The acute types are called nephritis, referring to the inflammation of the functional kidney complex. This may occur in conjunction with a Strep. throat or other bacterial infection. At times it develops suddenly, associated with protein loss, edema, and high blood pressure. These cases need to be evaluated with laboratory tests and medical expertise. But several simple approaches are helpful.
First of all it is important to recognize the influence of diet on kidney function. Many years ago it was discovered that a high protein diet predisposes to kidney complications. For this reason it is wise to avoid an excess of animal products, particularly flesh foods. Adequate fluid intake is
also important. In treating these symptoms hot packs as well as hydration will be beneficial.
Chronic failure of the kidneys frequently produces metabolic disturbances in water, sodium, potassium, calcium, and acid-base balance. The onset of renal failure is usually insidious. Excessive formation of urine and passage of urine at night may be only signs at first. Later a patient complains of feeling weak, fatiguing easily, sleeping poorly, and becoming slightly breathless. The appetite is lost and there is a bad taste in the mouth. Nausea, especially in the morning or anemia may be present. With increasing kidney failure, a person becomes lethargic, may develop twitching of the limbs, hemorrhages, and eventually develops a breath with an odor of urine, dry skin, and if not treated may progress into a coma and die. Therapy of kidney failure demands an early determination of the cause.
The role of dietary protein is very important. To reduce the blood urea accumulation a good quality protein is used with restriction in quantity to around 20 gm. daily. Sweating treatments may help eliminate toxins through the pores. The most efficacious are usually the hot blanket pack or steam bath. However, the latter is not advised (contraindicated) in severe hypertension.
Scientific research has offered a number of artificial approaches to kidney disease, such as dialysis of the blood (hemodialysis) or abdominal (peritoneal) fluid, and even transplants from a healthy donor. All of these have hazards, however, and if approached early and controlled, many cases of chronic kidney failure can be arrested.

Involuntary loss of urine is a very troublesome symptom

This may occur in children and when associated with bed-wetting is usually termed enuresis. Up to 4-5 years of age this may be quite common, and when persistent usually indicates some psychological distress. Congenital defects in the formation of the urinary organs may contribute to this disorder, and they can be evaluated with a specific x-ray study, the intravenous pyelogram.
Most cases of childhood incontinence subside with the passage of years. Women of childbearing age may have incontinence after the delivery of a large baby. Or with successive pregnancies, the support of the bladder and urethra may be weakened, producing a hernia or prolapse called a cystocele. Often this is associated with stress incontinence on sneezing, coughing, or straining. The Kegel exercises described in the chapter on gynecology are often helpful in alleviating these symptoms. If persistent anatomic defect is demonstrated, surgical repair may be indicated to restore continence and alleviate the anxiety that inhibits social interaction.
Men seldom have incontinence until advanced age. This may occur at times after operations such as a prostatectomy. If the incontinence does not improve during convalescence it should be evaluated by a urologist since research centers have developed a number of surgical approaches to this troublesome problem. Mechanical devices to preserve social acceptance and self-confidence are also available.

URINARY INFECTION

Bacterial infections of the urinary tract are extremely common. Some are also notoriously resistant to treatment and thus likely to reoccur. Yet the majority of persons with urinary tract infections are unaware of it. On other occasions, infections take the form of an acute disease usually with characteristic symptoms. The commonest symptoms are pain on urination, urinary frequency, and a strong urge to void. More serious infections may produce fever, pain in the bladder region, or over the kidneys.
Many different causes can produce infection. The commonest of these come from the group of gram negative bacteria (such as E. coli) inhabiting the digestive tract. Cultures of the urine can usually pinpoint the exact offender. Most of the time these coliform bacteria gain access to the bladder through the urethra. Under normal circumstances the urine in the bladder is sterile and large numbers of bacteria can be cleared rapidly in both humans and animals. Slight physiologic alterations, however, may permit survival of as few as ten microorganisms, which multiply rapidly, then persist for prolonged periods. Some associated conditions that may contribute to the formation of urinary infections are as follows: One to four percent of females from childhood to the childbearing age may harbor bacteria in the bladder or urethra, sometimes without the presence of symptoms. In men urinary infections are quite rare below the age 50. Four to eight percent of pregnant women may have infections, some of them without symptoms. Diabetes is another contributing factor, particularly when sugar is present in the urine.
Any impediment to the free flow of urine—tumor, stricture, or stones— results in distention of the kidney and greatly increased frequency of urinary infection.
In fact, the reflux of urine in the bladder cavity up to the ureter occurring during voiding will contribute to more infections, particularly children. Infection of the lower urinary passages is sometimes initiated by bacteria carried on catheters or other instruments passed into the urethra and bladder. Sterile technique in catheter insertion can help to reduce this risk. Kidney diseases with resulting high blood pressure may also contribute at times to the lowered defense against infection. Once the diagnosis has been established, treatment can be begun at home.
The fluid intake should be increased, usually with water as well as Vitamin C or cranberry juice to render the urine more acid. A special protein found in cranberries and blueberries can combat most urinary tract infection by causing the causative germs to lose their grip on the bladder wall. Thus, the infective organisms become more amenable to bladder rinse-out with normal urination.
One glass of liquid per hour up to 12-16 cups per day is recommended. In at least half such cases, the urinary infection will clear itself, with symptoms subsiding over 24-48 hours. Increasing blood flow to the urinary organs, these hydrotherapy treatments aid the body in natural resistance to infection and the clearing of disease. Persistence of symptoms or the underlying presence of diabetes, high blood pressure, or chronic kidney disease should be evaluated with appropriate urine tests, cultures, and medical counsel.

URINARY STONES

Stones in the kidney or ureters may occur at any age, but are more common in the third and fourth decades. These calculi may be single or multiple, firmly lodged or free. Kidney stones often cause pain, produce blood in the urine, and symptoms of vague abdominal distress. Occasionally, even when large, stones may occur without symptoms, while causing serious and
insidious kidney damage.
Characteristically, as mentioned above, renal calculi cause severe, sharp flank pain, which is often acute in onset and present intermittently. A small stone being passed in the ureter creates painful colic and the patient usually moves about restlessly, vainly seeking relief. Blood is frequently present in the urine, but at times requires the microscope for its detection. Physical findings may be entirely normal, although tenderness, muscle spasm, or even a lump may be felt in the location.
It is important to search for the original cause of the stone, then attempt to correct it. Most stones after bladder passage can be analyzed to determine their composition. Some are composed of calcium salts; others of oxalate crystals, and less commonly uric acid or cystine may precipitate to form stones. Each of these causes needs to be ascertained in order to correct the
diet, avoiding future recurrence.
One of the commonest situations that sets the environment for an attack of colic is inadequate fluid intake. Normally our kidneys require at least one and a half to two quarts of fluid a day! That will maintain urine volume at diluted concentrations, to avoid the precipitation of these salts. A high consumption of milk may result in calcium precipitation and the formation of a stone. Ice cream, cheese, and soft drinks such as cola beverages, and foods high in oxalic acid may provide the situation where stones begin to crystallize.
Uric acid stones usually result from a high intake of purines, found in meats, particularly sweetbreads, and other flesh foods obtained from animal organs. Uric acid calculi are usually seen in combination with other symptoms of gout, a metabolic disease traditionally associated with indulgence in rich foods and alcohol. A discriminating, well-balanced diet associated with adequate fluid will usually bring relief to patients who form uric acid stones frequently.
The treatment of colic in the urinary tract usually begins at home. Drink a high intake of water, at least one glass of liquid hourly, and begin immediately. Urinary acidifying agents are helpful to deter stones of calcium or oxalate composition, while for uric acid stones the urine should be alkalinized. Vitamin C and cranberry juice are both good acidifying agents for the urine, and are also helpful in treating urinary infections. Diuretic herbs, such as Buchu tea may also be helpful, when combined with a high volume of fluids.
Relief of acute urinary pain can be obtained in a hot tub bath, or with intensely hot fomentations applied to the flank and hip region. At times when flank pain is severe, the treatments will not only modify the pain, but through reflex pathways may help to relax the ureter and alleviate the spasm. Most often the smaller stones (calculi) will pass down into the bladder, where they are then excreted. Since obstruction in the urinary tract can progressively damage the kidney, as well as be painfully disabling, any urinary stones that do not resolve promptly should be evaluated be a competent physician.
Newer diagnostic techniques using x-ray contrast, and cystoscopic basket stone retrieval, water immersion shock (sound) wave lithotripsy, and other types of surgery may be necessary to save the kidneys from permanent harm.