Urinary retention

　　The main reasons for urinary retention after childbirth are mainly as follows:

　　1. Dynamic obstruction: Caused by urinary dysfunction, there is no intrinsic obstructive lesion in the bladder and urethra, such as spinal primary voiding center dysfunction or inhibition due to trauma, disease, or the use of anesthetics, resulting in the inability to form a micturition reflex. It is mainly aimed at postpartum women.

　　2. During the process of childbirth, the bladder is compressed, the mucosa swells and becomes congested, muscle tone decreases, the sensitivity to intravesical pressure decreases, and perineal wound pain, as well as the unaccustomed to bed urination, are reasons that can easily lead to increased residual urine and urinary retention.

　　3. Other reasons that cause difficulty in forceful urination or not being accustomed to bed urination, including certain psychological factors such as anxiety and embarrassment, which prevent timely urination. Due to excessive urine retention, the bladder becomes overly full, causing the bladder to contract weakly, leading to urinary retention.

　　Clinical diagnosis of urinary retention:

　　During diagnosis, based on medical history, symptoms and signs of bladder distension, urinary retention can be confirmed when urine cannot be expelled or cannot be completely evacuated. After identifying urinary retention through supra-pubic inspection and percussion, further confirmation is obtained through B-ultrasound examination and catheterization.

　　The diagnosis of etiology relies on asking about a history of urinary tract infection, urination of stones, urethral injury, prostatic lesions, central nervous system infection, and diabetes, etc., combined with symptoms, signs, and bladder X-ray films, B-ultrasound, and urethral and cystoscopic examinations to identify the cause of urinary retention.

　　① Secondary urinary tract infection: Because urinary retention is conducive to bacterial proliferation, it is easy to develop urinary tract infections, which are difficult to cure and prone to recurrence, accelerating the deterioration of renal function. For example, male patients with benign prostatic hyperplasia and female patients with urethral stricture often have partial urinary retention, but they have no自觉 urination disorders. For such patients, early diagnosis and treatment are needed to clear residual urine, effectively control urinary tract infections, and protect renal function.

　　② Secondary reflux nephropathy: Due to the increased intravesical pressure caused by urinary retention, urine flows back along the ureter, causing hydronephrosis and subsequently compressing and ischemic renal parenchyma, even necrosis, leading to chronic renal failure in the end.

　　Acute urinary retention

　　It manifests as acute bladder distension that cannot be urinated, often accompanied by pain and anxiety caused by a strong urge to urinate.

　　Chronic urinary retention

　　It manifests as frequent urination, a feeling of incomplete urination, abdominal distension and discomfort, and can lead to overflow incontinence. Ultrasound examination indicates an increase in residual urine in the bladder.

　　Many people are not familiar with urinary retention. Urinary retention refers to the accumulation of a large amount of urine in the bladder that cannot be expelled, known as urinary retention. The harm of urinary retention is great, seriously endangering human health. The following are several methods to prevent urinary retention:

　　1. Within 4-6 hours after childbirth, pregnant women should actively urinate regardless of whether they have the urge to urinate. In addition, they can eat more soup-based foods and drink more brown sugar water in a short period after childbirth to quickly fill the bladder, thereby enhancing the feeling of urgency to urinate.

　　2. For mothers who are not accustomed to lying down to urinate, they can sit up or get out of bed to urinate.

　　3. Wash the external genitalia with warm water or steam the external genitalia to relieve urethral sphincter spasm and induce urination reflex. It can also be induced to urinate with the sound of slow flowing water.

　　4. Apply a hot water bottle externally over the bladder area above the pubic symphysis to improve the blood circulation of the bladder and eliminate edema.

　　5. Intramuscular injection of neostigmine 0.5 mg to promote bladder contraction and urination. If urination is still not achieved after taking the above measures, a catheter can be inserted after strict disinfection and retained for 24-48 hours, opening once every 4 hours.

　　1. Abdominal color Doppler ultrasound shows bladder distension, and women may show compression of the uterus, posterior displacement.

　　2. Urine examination: A small number of leukocytes can be seen, and more than 5 per high-power field of centrifuged urine. The specific gravity of urine is often greater than 1.025.

　　1. For urethral obstruction, eat kelp, wakame, seaweed, green crab.

　　2. For infections, eat yellowfish bladder, shark fin, water snake, pigeon, jellyfish, lotus root starch, buckwheat, Malan head, earth ear, turnip, olive, eggplant, fig, mung bean sprouts, soy milk, amaranth, seaweed, loach.

　　3. Avoid smoking, alcohol, coffee, and cocoa.

　　4. Avoid spicy, hot, and blood-activating foods.

　　5. Avoid moldy, fried, and fatty foods.

　　Acute urinary retention requires emergency treatment and immediate resolution of urine drainage. Therefore, in addition to the causes that can be resolved by emergency, such as urethral stones or blood clots blocking the urethral orifice, phimosis causing narrowing of the urethral orifice, prepuce entrapment, etc., acute urinary retention caused by other causes can be treated after urine drainage, and then treated for different causes.

　　Medication is only used as an auxiliary treatment for urine drainage or in cases where the patient refuses catheterization or is not suitable for catheterization. According to the pathogenesis of acute urinary retention, the drugs currently used for the treatment of urinary retention mainly include cholinergic drugs that enhance the contraction of the detrusor muscle of the bladder and α-adrenergic receptor blockers that relax the urethral sphincter.