Incontinence

“ In adults it is not so much a condition of incontinence in the sense of water being passed against the will, but is rather due to a difficulty in retaining the urine in consequence generally of an over-full bladder, the water which passes being the overflow from a too full reservoir. It is usually caused by an obstruction external to the bladder, e.g., enlarged prostate or stricture of the urethra. Occasionally the presence of a calculus may produce the condition. ”

“ Plainly, then, the incontinence concerned with appetite is more disgraceful than that concerned with anger, and continence and incontinence are concerned with bodily appetites and pleasures; but we must grasp the differences among the latter themselves. For, as has been said at the beginning, some are human and natural both in kind and in magnitude, others are brutish, and others are due to organic injuries and diseases. ”

“ Bladder Symptoms.— If there is any irritability of the bladder, any scalding on urination, or a very great frequency of emptying the bladder in the early months of pregnancy, a physician should be consulted at once; in the last months of pregnancy there is a desire to evacuate the bladder frequently, and sometimes at the last there is an incontinence of urine, which is due to the descent of the uterus and the great pressure on the bladder ”

“ For the serosities, which are secreted by the kidneys (whose cavity is even at this day named pelvis by Anatomists) runs into the bladder; which, by reason of the relaxation of its sphincter, as if the pitcher were broken at the fountain head, is not able to retain its contents a sufficient time. Hence an incontinence or dribbling of urine is continually troublesome.
Now, the evils hitherto enumerated lodge in particular parts; but the last calamity, both in this discourse, as well as in old people, is that the whole body is afflicted. The very course of the blood is interrupted ”

“ The predisposing and occasional causes of incontinence of urine are, palsy of the sphincter of the bladder, from either too great dilatation and accumulation of urine, or from violent efforts in parturition; debility, old age, excess of venery; fistula, abscess, ulcers, lithotomy, stone, spasm, gout, apoplexy, palsy, external injuries. Also, copious, watery, acrid urine: the bladder irritable from inflammation,{307} ulcers, excoriation, defect of mucus; spasm, relaxation of the sphincter; weakness of the sphincter ani, and accelerator muscles; pregnancy, laborious parturition ”

“ But as they increase in quantity, and become more acrid by remaining and consequently more irritating, then the sensible organic contractility strongly brought into action, empties the intestine involuntarily. If the sphincter, which is voluntary, is paralyzed, there will be incontinence, because no resistance is opposed to the tendency of the rectum to contract, a tendency which though feeble as long as it is but partly filled, is however always real. ”

“ If the bed clothes are not found wet after a full dose of opium, during the operation of which the patient has been suddenly awoke, we may also be satisfied that there is no incontinence. Foderé says that if the penis is secured by a ligature, it will swell considerably in the real incontinence, in consequence of the urine running into the urethra; but that no such effect will happen if the disease be feigned. ”

“ To sum up the results of my experience in the management of seminal incontinence, I may add that the steel bougie, bromide of potassium, and atropia are especially adapted to cases of nocturnal and diurnal pollutions, and that after the hyperæsthesia has been relieved electricity, ergot, and strychnia are the most reliable agents in spermorrhagia. The end having been accomplished, moderation in sexual intercourse should be enjoined if the patient is married; continence in thought and action should be observed if he remains single ”

“ But the injury to man by incontinence (and intercourse outside the disengaged period is incontinence) may perhaps not be so great when moderation is observed (how disgusting even to pronounce this word in such a connection!) , if a man knows but one woman; but what is moderation for the husband is terrible incontinence for the wife when with child or nursing her infant. ”

“ But if, in spite of such treatment, the incontinence persists, it is better, from an economic standpoint, to treat the urinary eczema with astringents, etc., and quickly to fatten the animal.
EVERSION OF THE BLADDER. Eversion of the bladder only occurs in female animals after difficult parturition. The viscus is turned completely inside out, as occurs in eversion of the uterus, the base of the bladder becoming invaginated in 520the cavity of the bladder itself, and afterwards passing into the urethra and vagina. ”

“ The intestines next to the stomach are the most often sympathetically affected in diseases. The bladder is the organic muscle that is the last to feel the influences that go from the diseased organ; this sometimes however happens. In fevers, we know that retentions of urine from sympathetic and temporary paralysis, are not very rare; incontinence of urine is less often seen. ”

“ The conventional view that incontinence in men is a necessary condition of health must be corrected. Instead of the popular fallacy that a young man is physically the worse for a clean moral life, the entire weight of evidence of the world’s foremost medical scholars is unreservedly of the opinion that he is physically402 better for it.EK It is recognized by the highest authorities that continence is perfectly compatible with the most perfect health. ”

“ Follow this on the fourth day by a copious enema, one pint of water, to which one tea-spoon [Pg 233] of salt has been added. After three days, if the symptoms still continue, repeat treatment.
Incontinence of Urine.—This annoying ailment is common among children. Mothers and nurses often deal impatiently with the unfortunate child, believing it to be a habit, which may be easily overcome. It is more often a malady than a habit. In neither case is it ever cured by scolding. If a habit, a promised reward is more effective than harsh treatment. Give the child a light supper devoid of liquids. ”

“ Wherefore the more they follow the inclination of nature, the more strongly do the passions urge to the pursuance of an object. Now nature inclines chiefly to those things that are necessary to it, whether for the maintenance of the individual, such as food, or for the maintenance of the species, such as venereal acts, the pleasures of which pertain to the touch. Therefore continence and incontinence refer properly to desires for pleasures of touch. ”

“ Still the muscles are not shrunk, nor unable to perform powerful movements; but the patient cannot put his hand or foot to the place he wishes, and cannot support the weight of the body without assistance. Sensation in the limbs is lost to a greater or less degree, their heat is diminished, and it is found difficult to preserve their temperature equable. The symptoms increase till the limbs become totally useless. Along with the lower limbs the bladder is affected, though not always. The urine is not voided with force, and incontinence occurs from distention. ”

“ Fever Blisters, Cold Sores on the Lips; Ulcerated Lips; Sore Mouth or Canker in adults, children or infants; Nursing Sore Mouth; Morning Sickness of expectant Women; Indigestion; Ulceration or Canker of the Mouth.
No. 30—For Diseases of the Urinary Organs; Urinary Incontinence; Frequent, Painful or Scalding Urination; Inability to retain the Urine; Catarrh of the Bladder; in alternation with No. 27; Frequent Scalding Urination, with Mucus Discharge; Urine loaded 284with Mucus; Nightly Wetting the Bed in children; Nocturnal Urinary incontinence. No. 30 is to the bladder and passages what No. ”

“ Many females can urinate with tolerable comfort while lying on the back or abdomen, and others are much [402] relieved by constantly wearing a bandage. Constipation always makes this difficulty worse, and sometimes even causes it, by keeping the rectum full and thus increasing the pressure. In all such cases it will be readily seen, that forcing medicines are not only useless, but liable to cause injury. The change of position, rest, and supporting the abdomen are the means to be relied upon. If these fail, and the urine accumulates, the catheter must be used. ”

“ Horseback riding, climbing, and all exercises which rub, chafe, or excite the genital organs, should be avoided. Even the clothing should be loose, so that walking will not produce friction or cause any excitement of these organs. The calls of nature should receive prompt attention, and the urine be voided at any time (especially during the night) when there is an inclination. If there be irritation of the bladder and lower bowels, the patient will receive decided benefit from the daily use of an injection of cold water into the bowels. ”

“ In consequence of prostatic enlargement, pain is felt in the perineum, with occasional throbbing, and a sense of weight; there is frequent desire to make water, the bladder is irritable, and discharges ropy mucus. There is more or less irritation of the lower bowels; there is an almost constant desire to empty the rectum, from a feeling of fulness there, and pain, often severe, is felt on going to stool; when the enlargement is great, the bowel is considerably compressed, and the feces, when solid, are passed flattened like portions of tape. ”

“ The patient may have shivering fits, pain round the loins, down the thighs, and over the lower part of the [211] abdomen. He will betray a readiness to submit to anything, although conscious that his bladder is empty, notwithstanding the violent and urgent efforts at straining, which he is continually being called upon to make, as though his bladder were distended, and ready to burst. On passing the catheter (I am supposing a severe case, where retention of urine has at last occurred) , not a drop will flow, and the danger of the disease is thereby made apparent. ”

“ Tenderness on pressure, indicating involvement of the perimetrium, is marked. The pain is increased in intensity by standing, walking, coughing, straining at stool, or any act which causes an elevation of intra-abdominal pressure. Distressing symptoms arise in connection with the bladder and rectum. Urination is frequent and painful, while the secretion may contain blood. Griping pains are felt along the colon and rectum; the sensation of fulness or the presence of a foreign body excites a frequent or constant desire to defecate, and the act is accompanied with straining. ”

“ If she find an obstruction or stoppage of the urine, by reason the womb bears too much on the bladder, let her lift up her abdomen a little with her hand, and try if she receives any benefit; if she finds she does not, it will be necessary to introduce a catheter into her bladder, and thereby draw forth her urine. If the difficulty be from the ill posture of the woman, let her be placed otherwise, in a posture more suitable and convenient for her ”

“ Possibly hardened feces maybe in the rectum; if they are you may be assured of the fact when you make a digital examination, as they seem like tumors posterior to the vagina. The remedies are physic, enemas, rest—possibly opium.
2. Inefficient pains may be due to a bladder distended with urine. When this is suspected we should observe whether there is abdominal swelling (not tympanitic) low down; pain on pressure which gives rise to a desire to urinate; a constant desire to pass water though the patient has just performed the act, or a dribbling of water from the parts. ”

“ We now see, therefore, that against the injurious physical contacts of environment, against heat and cold, against damaging sunlight, against local anemia when resting or sleeping, the body is protected by virtue of the muscular action which results from pain. Then, too, for the emptying of the pregnant uterus, for the evacuation of the intestine and of the urinary bladder as normal acts, and for the overcoming of obstructions in these tracts, pain compels the required muscular actions, For passing gall-stones and urinary calculi, urgent motor stimuli are awakened by pain. ”

“ Again, all the symptoms of retention may exist, and all its bad consequences result, without any apparent swelling of the abdomen. But then the distended bladder can always be felt by the finger introduced into the vagina or rectum; indeed its posterior fundus bulges in towards the cavity of the gut, in every case, before it ascends upwards in the abdomen. Sickening and agonizing pain, with great anxiety and ineffectual straining, generally attend distention of the bladder to any great degree. ”

“ It is important, moreover, to remember that thoroughly free movements of the bowels, by preventing to a great extent the reabsorption of material from the intestines which may prove irritant when excreted through the kidneys and when present in the bladder, is of itself an excellent therapeutic measure in cases of irritability of the genital organs. The setting of the patient's mind to thinking about his rectum, his bowels, and his bladder instead of his genital tract is an excellent psychotherapeutic measure that will soon bear fruit. ”

“ Accordingly if we suspect some accretion of tissue, the result of ulceration, to be blocking the neck of the bladder, our diagnosis will depend both on the foregoing signs of the existence of an ulcer and also on the fact of the urine being voided on the introduction of a catheter. ”

“ Prophylaxis.—Certain directions are helpful and by occupying the patient's mind will overcome certain physical factors that underlie the affection. It is important that the bladder should not be allowed to be full, above all, not to be over-distended at night. Some care should be exercised in not taking too much to drink shortly before going to bed and the bladder should be faithfully emptied before retiring. The weight of a large amount of urine in the bladder pressing down upon the seminal vesicles situated below and behind it causes them to contract rather easily. ”