Irritability of the Bladder.
Other tomes: ElTh1908
We quite often meet with patients, especially with women of nervous temperaments, in whom there is a hyperesthetic condition of the bladder, usually about the urethral or ureteral orifices (vesical trigone), that is independent of structural disease of the organ or mechanical irritation from a calculus.
Etiology.—This unpleasant, and often exceedingly painful condition, generally occurs among patients of a neurotic temperament, hysterically inclined. As a result, we find the patient excited or melancholy, the appetite capricious, and, being usually poorly nourished, cross, peevish, and making life a burden to herself and those around her.
Often there is dyspepsia, with the many symptoms attendant on that lesion, or there is menstrual derangement, dysmenorrhea, menorrhagia, or amenorrhea. At other times it is the result of severe mental or physical work, overindulgence in venery, or sexual intercourse, or the many dissipations of fashionable life; such as late hours, indigestible food at unreasonable times, etc. Other cases are purely reflex and due to uterine derangements, rectal diseases, and wrongs of the vagina or urethra. There is also an irritability of the bladder developed in some cases of chronic malaria.
Pathology.—With the exception of a hyperemic condition of the bladder, there are no pathological changes.
Symptoms.—Pain, frequent calls to micturate, and rectal or vesical tenesmus are the four characteristics of an irritable bladder. The pain and tenesmus may be relieved by micturation, or may be increased, the latter being especially true where there is a spasmodic condition of the muscular walls of the bladder, the hyperemic and exquisitely sensitive mucosa being so greatly irritated as to cause excruciating pain, which persists during the intervals of micturation. This spasmodic action may be so marked as to cause retention of the urine, while at other times the urine is passed suddenly and spasmodically. Some cases will complain of a constant, dull, aching pain in the bladder. The pain extends along the urethra, and often the patient cries out in his distress.
Diagnosis.—This is readily made by the four characteristic symptoms,—pain, frequent micturition, rectal and vesical tenesmus.
Prognosis.—This is often a stubborn and chronic lesion, sometimes continuing for weeks or months, though life is never endangered.
Treatment.—These cases are frequently quite stubborn and require much care in the treatment. The patient must refrain from severe mental or physical work, be regular in her habits, and avoid dissipations of all kinds. Any wrongs of the uterus and its appendages must be corrected and the rectum should be examined for hemorrhoids, pockets, papillae, fissures, ulcers, etc., and if there be urethral troubles, these must be corrected.
In the way of remedies, we have a number that will give good results. Triticum repens drunk freely as an infusion is one of the best. The tincture of red onion, one or two drams to half a glass of water, and given in teaspoonful doses every hour, is also very good. Rhus aromatica one dram, to four ounces water, and a teaspoonful every hour, will relieve a large per cent of the cases. Where there is a burning and stinging sensation, apis is the remedy. For tenderness, eryngium is useful, and where there are spasmodic conditions present, gelsemium is among the best agents. Where the pain is severe and continues during the interval of micturition, an opium suppository will afford relief.
Most patients, being of a neurotic temperament, will need, in addition to the above remedies, agents to improve the general health. Nux vomica, hydrastis, strychnia, the hypophosphites, or acid solution of iron, as may be indicated, together with outdoor exercise and a nourishing diet, will greatly assist in effecting a cure.