A system of practical medicine. By American authors. Vol. 4

by Unknown

A much more common class of affections of the bladder accompany hysteria, sometimes grouped under the name of hysterical bladder. A great number of pathological conditions are grouped under this vague term, but they are held together by all having, as a more or less prominent symptom, varying degrees of incoördination. The disturbing effect of strong sudden emotion, as fear, upon the bladder is familiar to all, and in various organic diseases of the spinal cord and brain, such as myelitis and locomotor ataxia, a disturbance in the functional action of the bladder is among the first symptoms. It then becomes a matter of great difficulty, and yet of great importance, to make a differential diagnosis.

In hysteria the urine usually diminishes in specific gravity; it is apt to be increased in quantity, and, though clear in appearance, is irritating to the mucous membrane. In such cases frequent urination, sometimes almost continuous, sets in; but it is an important point that during sleep the patient retains her urine the normal time. In others we get, on the contrary, retention, and this may be due to various causes. In some it is doubtless involuntary, as they say they cannot urinate, but in others it is assuredly will not. Many of these latter derive a morbid pleasure from catheterization. These are the patients who are given to the introduction of hair-pins, slate pencils, etc. etc. into the urethra.

Some authors claim that in the intense sexual excitement of hysteria the chronic erection of the clitoris makes pressure on the urethra, and so prevents the escape of urine, but this seems somewhat apocryphal.

Another class of cases resembling the hysterical in the frequency of urination are those addicted to masturbation; these are, fortunately, not very common.

In all of these cases the frequency and irregularity of urination is a much more prominent symptom than the pain. This latter is usually a slight scalding from the urine passing over the chafed and irritable urethra, especially at the meatus. (These symptoms sometimes occur in the miasmatic affections.) A number of neuroses of the bladder are reflex and dependent on peripheral irritation elsewhere. A typical example of this class of affections is what has been described under the title of ovarian irritation. In this condition there is very much heightened reflex irritability accompanying the increased tenderness and vascular engorgement of the affected ovary. It is difficult to explain the bladder symptoms which sometimes accompany the recurring crises of this disease, except as due to a nervous excitation spreading from the ovarian centres in the spinal cord to the adjacent bladder centres.

The diagnosis of this group of affections must be made by exclusion. We have some of the same symptoms—increased frequency of micturition, pain during and after the evacuation, tenesmus and shooting pains in the pelvis—as in organic disease. The most important guide is a careful examination of the urine, which shows the absence of abnormal constituents, thereby excluding organic disease. This diagnosis will be much strengthened by a digital examination, by the vagina, of the neck of the bladder, and the passage of a urethral sound, neither causing pain, as they would do in cystitis.

The PROGNOSIS is usually good, but it depends upon the length of time the affection has lasted.

The TREATMENT is mainly tonic and nutritive. The diet should be nutritious and simple, and the bowels regulated by mild purgatives. Constitutionally, small doses of strychnine are most valuable in improving the nerve tone; so also the constant electric current is of service. Locally, sedative suppositories in the vagina or enemata are advantageous, conium combined with belladonna or hyoscyamus seeming to act best. The liberal use of the bromides gives good results in some hysterical cases.

Paralysis of the Bladder.

This is the most grave of the functional affections, and, like paralysis elsewhere, it may be either peripheral or central. When the latter, as in certain injuries of the brain or in certain well-marked lesions of the spinal cord, it hardly calls for more than mention here. Often, however, the cause is not recognizable in any organic lesion either of the bladder-walls or the central nervous system, and is to be sought for in more temporary and transient influences; thus as a result of over-distension most frequently, of impaired or lost nerve-conduction in fevers involving serious derangements of nutrition, all of which may be described as functional or temporary paralysis.