DIAGNOSIS.—This is readily made by measuring the thickness of the bladder-wall between the finger in the vagina and the sound in the bladder. The capacity of the bladder is easily noted by measuring the urine passed at each micturition or by injecting a bland solution of salt and lukewarm water.
TREATMENT.—The treatment should be directed to the removal of the cause. When this is not possible, palliatives may be sought for in the use of the catheter, at regular intervals, to prevent over-distension. Cold baths, astringent injections, and electricity are often of use. By these means the evil results of the disease may be overcome, but the hypertrophy is usually permanent.
Atrophy.
Atrophy of the bladder is a rare disease in early life. In women, in addition to the ordinary decay of age, there is a special predisposition to degenerative changes in the pelvic viscera, the bladder-walls included, after the menopause. Extreme distension of the bladder is usually the exciting cause, giving rise to temporary or even permanent paralysis, and eventually causing either inflammation or atrophy and fatty degeneration. Interrupted nutrition, due to impaired circulation, is the immediate cause, but such altered nutrition may be purely nervous and due to atrophy of certain ganglion-cells in the spinal cord.
SYMPTOMS AND DIAGNOSIS.—Patients complain of difficulty in emptying their bladders, the urine coming away in interrupted jets. They are apt to be irregular in their times of urinating, and are liable in consequence at times to have retention and over-distension. Pain and sometimes a slight cystitis are present. Finally, they completely lose the power of urinating and a catheter has to be used. The diagnosis is to be made as in hypertrophy, by a finger in the vagina and a sound in the bladder.
TREATMENT.—Regular catheterization, strychnia in full doses, electricity, and tonics, combined with washing out the viscus. Where the atrophy is due to nerve-degeneration these measures are purely palliative, in other cases they are of more avail.
FUNCTIONAL DISEASES OF THE BLADDER.
Under the name of functional diseases of the bladder are included a large number of varied affections of which the pathology is as yet very obscure. Where there are marked symptoms of vesical disorder, while no organic lesions are found in the tissues of the bladder, the affections must be classed under the name of functional derangements. As our knowledge increases the number of these is constantly diminished, and a still further and more rapid diminution will occur as the physiology and pathology of the nervous system innervating this viscus become better known. These diseases are much more common in children and women than in men—in children, because the controlling power of habit is only in process of formation; and in women, mainly because of the more complex organization of the genito-urinary organs, which are the more easily exhausted and deranged, especially by the functions of maternity. True, neuralgia of the bladder has been described under a variety of names, irritable bladder, cysto-spasm, etc., but it is rather a rare affection. The most prominent symptom is the painful micturition, and attendant on this a desire to pass water too frequently.
There is no particular change in the character of the urine, and no appreciable visible alteration in the appearance of the parts, though they are more sensitive than normal to the touch. This condition is best met by warm fomentations locally and sedatives either locally or generally, while nutrition is improved by appropriate tonics, nervines, and by the use of the galvanic current.