Straining to Urinate

Treatment: If the prostate is enlarged and the person is losing urine due to overflow, it is important to notify a specialist. Although there are medical treatments for prostate shrinkage, this problem usually requires surgery. It would not be responsible on my side to recommend a medication since each case must be evaluated individually as these are drugs that have other effects. You have to be very careful with their use. However, there are natural remedies that you can use both to reduce the size of the gland and to prevent its growth: 1. Beta-sitosterol supplements This component is extracted from plants and seeds to be mixed in a single supplement. Both scientific evidence and patient testimonials agree that it works to improve urinary symptoms. The dose is one capsule twice a day. 2. Saw palmetto, zinc, pygeum africanum, multivitamin blend supplements All these natural extracts, as well as zinc and vitamins, have shown beneficial results in patients with urinary symptoms due to prostate enlargement. The recommended dose is one tablet twice a day. 3. Changes in lifestyle Reducing caffeine and alcohol intake and setting aside time for stress reduction practices such as meditation help control urinary symptoms and improve prostate inflammation.

Urination difficulties can have causes ranging from neurological, involving the brain’s communication pathways, to local, such as bladder lithiasis. Systemic causes are usually due to diseases of other organs. Thus, there may be difficulty in urinating in the patient with a stroke. At this point, I want to focus mainly on local causes that can cause acute urinary retention, which is an emergency that requires procedures that can be performed at home without major complications.

Acute Urinary Retention

This is a fairly common condition that, as a surgeon in my residency program, I used to see very often since one of the effects that general anesthesia has on some people is the retention of urine. Procedures such as internal hemorrhoid surgery, hysterectomy, or pelvic and rectal surgery can cause this symptom for the patient due to the manipulation of the nerves in that area. In the case of men, specifically those over 50 years of age and those who have previously had urinary symptoms such as post-void dribbling and incomplete urination, we should think that the problem is likely that the size of the prostate is blocking the passage of urine. In patients with acute urinary retention, a mass can be seen below the navel, which is the completely full and distended bladder. The bladder must be emptied promptly as the urine can become contaminated and infect the patient. In addition, it can cause damage to the bladder wall and to the ureters and kidneys.

Frivadossi, Own work, CC BY-SA 3.0

Bladder Catheterization

The placement of a bladder catheter is a procedure that everyone should be aware of since it can easily solve a complex situation such as this one. Urinary catheterization can be done to another person, and it can also be done to oneself. The important thing is to follow the directions and learn to identify the anatomical points. Materials needed: • Disposable gloves • Intermittent urinary catheter #12 or #14 Fr OR 2-way Foley catheter for indwelling catheterization #12 or #14 Fr • Lubricating jelly • Urine bottle/bedpan/container for urine OR Urinary bag • Povidone-iodine • Gauze • Mirror (for female self-catheterization) • 10cc syringe (for indwelling catheter)

INTERMITTENT CATHETERIZATION PROCEDURE: Step 1 Prepare all the materials so they are close at hand. If you are self-catheterizing, open three gauze pads, place a stream of iodopovidone in a container, and leave the tube half open, leaving the tip inside the package. Don’t forget to put some lubricant on a gauze pad as well. Step 2 Clean the area near the urethra (glans in men; inside the labia minora in women) with the povidoneiodine gauze, and locate the opening of the urethra. Obviously, locating the urethral opening in the penis is much easier than in the vulva. When I didn’t have much experience with this procedure, one of the things I did was to insert one gauze pad in the vagina. You do not have to put it in completely; just covering that opening is enough to find the urethral opening and not confuse it with the vaginal opening. I know this may sound silly, but it is a fairly common confusion, and you end up catheterizing the vagina instead of the bladder.

1. PREPUCE 2. CLITORIS 3. URETHRA OPENING 4. VAGINAL OPENING 5. LABIA MAJORA 6. LABIA MINORA 7. ANUS

Step 3

Take some lubricant and apply it to the tip of the catheter, up to about an inch. For catheterization just to empty the bladder, a catheter called a Nelaton catheter is used. It is made of a semi-rigid material that slides easily through the urethra.

Have the container you are using to collect the urine handy, and slowly insert the catheter into the urethra. You may feel some resistance when you are about to reach the bladder, in the internal sphincter. This is normal. Just push firmly without excessive force until it gives way. In women, it is not necessary to insert the whole length of the catheter because the urethra is shorter than in men. To avoid spilling urine from the container, bend the catheter or clamp it with your fingers until you see urine coming out and can properly position the container.

Bengt Oberger, Own work, CC BY-SA 3.0

BruceBlaus, Own work, CC BY-SA 4.0

INDWELLING CATHETERIZATION: Another type of catheter is used for prolonged catheterization. The Foley catheter is the one I prefer because it is easy to use. This type of catheter has two openings at the end that is external. One is the drainage opening, and the other one is to fill the balloon. In the end that goes inside the bladder, there is an inflatable balloon for anchoring the catheter.

First of all, you must check that the balloon works well. Through the lumen, you introduce 5cc of sterile water or air (I prefer sterile water) to check the permeability of the catheter and the proper functioning of the balloon. Once you’ve checked that everything is working, you must deflate the balloon to start the catheterization. Connect the catheter to the collection bag so that any urine that comes out falls directly into the bag. Once this is done, the catheter is inserted. As in the previous technique, in women, it is not necessary to insert the entire length. When urine starts to come out, it means that you have reached the bladder. You can then inflate the balloon.

Olek Remesz, Own work, CC BY-SA 3.0

Bruce Blaus, Own work, CC BY-SA 4.0

Step 4 In the case of acute retention, try to quantify the amount of urine you emptied. This information may be important for your visit to the specialist later on. Dispose of all used materials and remember that in the case of using a Foley catheter, the collection bag should not be tightened or the drainage line bent. WHEN SHOULD YOU PERFORM THIS PROCEDURE? In the case of a person who feels like they need to urinate yet is unable to do so within four hours, you should drain the urine. However, always check the abdomen for a pelvic mass due to a very full bladder. If it has not been four hours but you find this sign, urinary catheterization is indicated. Try to maintain your hygiene measures to avoid urinary infections. Pelvic surgeries can often cause acute urinary retention. I have a lot of experience with this because for a long time I worked with a team of proctologists, and this symptom was very common among our patients. Once the bladder has been emptied, the person can relax and rest. This sphincter contraction effect then disappears, and the person can urinate normally.