A condition known as irritable bladder is very common, especially among middleaged women. To the inaccurate physician the condition is one and the same in every case, and is usually treated with the same measures, and thus in many cases a failure in the treatment results.
There is always a cause for the condition and that cause should, if possible, be determined, A writer in The Hospital says that the first inquiry should be, is it nocturnal? In some cases, especially when dependent upon uterine prolapse, it occurs only when the patient is on her feet in day time.
In general, the conditions are three: those which depend upon some change in the urine; those which depend upon some change outside of the bladder; and those which depend upon some actual disease of the urinary organs. Added to these, should be that of some irritation of the nervous system, or faulty operation of the nervous system.
Probably the most common are those which depend upon changes in the urine. An excess of urates, or uric acid, or of the triple phosphates is to blame for many cases. In other cases there is a great deficiency of acids and decomposition of the urea molecule results in an ammoniacal urine which in itself is very irritating.
These faults of the urine are caused largely by diet, by impairment of the digestion and by sedentary occupation. Those which result from conditions outside of the bladder are tumors, pregnancy, uterine prolapsus, cellulitis and peritonitic adhesions.
The third class of cases which depend upon diseases of the urinary tract demand very careful examination of the urine itself for a clue to a large percentage of these cases. Others will demand a cystoscopic examination. Foreign growths, calculi, varicosis and other conditions of a similar character may be thought to be present, but they can often be determined only with a cystoscope.
Again, stone in the kidney, renal growths, nephritis, diabetes, movable kidney, pyelitis and tubercular kidney all cause frequent micturition and in many cases a close diagnosis is not difficult.
Hysterical manifestations, neurasthenia and other nervous disorders may be present as the sole cause of the difficulty, but a careful examination should be made to exclude other conditions.
When the exact conditions can be determined, we have access to reliable remedies which will meet the condition in a large percentage of cases; but to treat every case with the same remedy will result in failure in many of the cases.
Ellingwood's Therapeutist, Vol. 2, 1908, was edited by Finley Ellingwood M.D.