The symptoms of permanent stricture are often as slow in their progress, and as insidious in their nature, as they are appalling in their results, and are seldom distinctly observed by the patient, until firmly established.
He is suffering from a long-continued gleet, and is first alarmed by a partial retention of urine—it passes by drops, or by great straining, or not at all. This usually occurs after intemperance, and is relieved by the warm bath, fomentations, and laxative medicines. This is the first stage, and is attributed to the debauch solely; whereas, at this time an alteration of structure is going on in the urethra. Its calibre is becoming diminished, which necessarily causes the urine to flow in a smaller stream. This is not observed at first; and it is only after a long period that the patient becomes aware of the fact.
The disease proceeds. In the morning, from the gluing together of the sides of the urethra, by the discharge from its diseased surface, the urine flows in a forked or double stream; and then, as this agglutinution is dissolved, it become natural.
There is a greater and more frequent desire to make water, disturbing sleep many times during the night, but unattended with pain, unless the neck of the bladder be affected.
There are also uneasy sensations in the perinœum, a sense of weight in the pelvis, with flying pains in the hips; and in the permanent stricture there is a remarkable symptom frequently prevailing—that is, a pain extending down the left thigh from the perinœum.
As the disease advances, the urine flows in only a very small stream, or forked, twisted, double, or broken, or in drops; and the patient solicits the flow by pressing with his finger on the perinœum, and elongating the canal, somewhat after the manner in which a dairy-maid milks a cow.
The dilatation of the urethra between the stricture and the bladder already alluded to, now takes place; and some urine remains in the dilated part, which oozes through the stricture, making the patient wet and uncomfortable.
There is great difficulty felt, and more time is occupied in getting rid of the last drop of water, than formerly. This sensation continues all along; and the cure is never accomplished until this is finally removed.
If the stricture is still neglected, more severe symptoms come on, and the neighboring parts become affected also.