Why is there residual urine in men? Urine does not completely come out of the bladder: causes, treatment What is the normal volume of residual urine

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Residual urine in bladder among women

What is residual urine in the bladder?

After urination, small amounts of residual urine remain in the bladder. Normally, in adult women and men, its amount does not exceed 30–40 ml.

Bladder pathologies

In children, this value is 3–4 ml. If its volume exceeds 50 ml, then this indicates a violation of the normal outflow of urine through the urethra.

Factors that contribute to excess residual urine in men and women are:

Increased urine output

Disruption of the innervation of the urinary tract can develop in several ways. Residual urine appears in large quantities with reduced contractility of the muscles of the bladder wall (detrusor).

In this case, it does not contract strongly enough to “push out” the entire volume of urine. In some cases, the urethral sphincters do not function properly.

Then urination stops due to premature closure of the urethral sphincter.

Failure in the nervous regulation of the urination process can occur with a back injury with damage to the spinal cord, general diseases of the nervous system (Parkinson's disease or Alzheimer's disease, etc.), and circulatory disorders in the pelvic organs.

Detrusor atony can also occur in old age for physiological reasons.

Prostate diseases affect more than half of men aged 40–45 years. Increasing in size, it compresses the walls of the urethra, which causes disturbances in the passage of urine.

As a result, the process of urination in men does not occur completely, and a large amount of residual urine remains.

Obstruction of the urethra can also be caused by tumors of nearby organs and tissues, scars on its walls after surgical interventions, and anatomical features of the structure.

If there are stones in the bladder, they can block the internal urethral sphincter.

This leads to an abrupt cessation of urination, as a result of which residual urine is constantly present in the bladder in quite large quantities.

Diseases in which the syndrome manifests itself

It should be noted that residual urine that is in the bladder is not a disease, but only a symptom. In addition to the diseases mentioned, such a syndrome can also be observed with diverticulum in women and men.

Symptoms of pathology

This is a protrusion in the form of a cavity on the wall of the organ where urine accumulates.

In children, such a pathology as vesicoureteral reflux is very common. With this disease, residual urine is “thrown” up the ureters into the kidneys.

Complications

Chronic congestion can cause the development of such complications:

urolithiasis, unless of course it became the root cause of such a syndrome;
bacterial inflammation of the bladder (cystitis);
infectious damage to the kidneys (pyelonephritis), in the presence of residual urine, pyelonephritis begins as a secondary inflammation against the background of cystitis

Symptoms

In the presence of residual urine, the primary clinical sign in women and men is the feeling of incomplete emptying of the bladder after urination.

Urinary dysfunction

There may also be a weakening of the urine stream during urination, its interruption, and the release of urine drop by drop when trying to empty the bladder.

Another characteristic symptom when the norm of residual urine is exceeded is the continuation of the process of urination after straining the muscles of the abdominal wall.

The remaining clinical manifestations are due to the underlying disease, which caused the presence of residual urine, or complications of this syndrome.

Thus, with urolithiasis, pain appears in the bladder area, increased urge to urinate, itching and burning during urination, and the appearance of blood in the urine. The pain syndrome usually intensifies during physical activity.

Prostate diseases in men, in addition to disrupting the urinary process itself, also cause pain in the groin area and impaired sexual function.

Cystitis in men and women due to too much residual urine is manifested by cutting pain in the lower abdomen, increased urge to urinate, burning and itching during urination, and an increase in temperature to subfebrile levels.

Pyelonephritis is manifested by aching pain in the lumbar region, a sharp increase in temperature to 37.5 - 38°, weakness, and increased fatigue.

Diagnostics

A large volume of residual urine can be determined by palpating the contours of the bladder. More accurately, its quantity can be seen during an ultrasound after urination.

Instrumental diagnostics

To determine the cause of residual urine in men and women, urodynamic studies are performed:

urofluometry, which measures the volumetric flow rate of urine during urination, the time it takes for urination to pass;
cystometry, this study measures intravesical pressure during urination. One of the varieties of this examination is voiding cystometry, during which pressure readings are taken during the process of filling and emptying the bladder;
electromyography, which evaluates the functioning of the muscles of the bladder and urethra;
Urethroprofilometry allows you to determine whether the sphincters and walls of the urethra are functioning correctly.

Further studies are carried out according to indications. In men, the prostate gland must be examined using palpation and rectal ultrasound.

There is no therapy for residual urine in the bladder as such. In general, treatment is aimed at combating the underlying disease and restoring normal detrusor contractility.

After recovery, the problem of too much residual urine after urination goes away on its own.

To prevent bacterial complications, antibiotics or uroseptic drugs may be prescribed.

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Bladder and residual urine norms

The amount of urine that remains in the human body after urination is called residual urine. Regardless of age, this is considered a deviation. Urine retention can be complete or incomplete. In the first case, the patient feels the urge to go to the toilet, but cannot do it. Sometimes, for several years, emptying occurs only with the help of a catheter. With incomplete retention, urination occurs, but not completely. Residual urine in the bladder often provokes the formation of stones and the development of inflammation. No treatment is unacceptable. After all, each time the disease progresses, the level of residual urine constantly increases, the bladder begins to stretch, pain appears, and in the end - urinary incontinence.

Normal residual urine in the bladder: in men, women, children

The norm of residual urine for men and women is 30−40 ml. The figure of 50 ml is considered critical. This means that the normal flow of urine is disrupted in a person, and diseases develop. As for the norms of residual urine for a child, they are as follows:

in newborns 2−3 ml;
in babies under one year of age 3−5 ml;
in children 1−4 years old, this norm is 7−10 ml;
4−10 years - 7−10 ml;
10−14 years - 20 ml;
for adolescents under 14 years of age, the norm is no more than 40 ml.

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Reasons for the increase

Residual urine can occur due to a variety of reasons. In general, they are divided into three groups:

obstructive;
inflammatory-infectious;
neurological.

Uterine fibroids and ovarian cysts in women can block urine from leaving the body.

Obstructive health problems are considered to be those that prevent urine from leaving the body. For example, stones, tumors, polyps, prostate adenoma in men, uterine fibroids and ovarian cysts in women, as well as narrowing and soldering of the urinary canals. Swelling of the urethra and compression of the bladder muscles, which occur due to inflammatory and infectious diseases, also lead to urine retention. Thus, the prostate, cystitis, and urethritis provoke the occurrence of residual urine.

The last group of reasons includes the loss of urinary control by the central nervous system. In such cases, the bladder itself is healthy, and the problem lies in the muscles of the organ or sphincter, which stop contracting at the right time. The causes of this state of the body are often sclerosis, injuries to the spinal cord and brain, congenital pathologies of the central nervous system, and diseases of the spine. The fact is that antidepressants, antiarrhythmics, diuretics, hormonal drugs, medications for Parkinson's disease, as well as some painkillers negatively affect the tone of the organ.

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Symptoms of residual urine after urination

When you leave the toilet, but you have the feeling that there are still remnants of urine inside, this is the first alarm bell and a symptom of bladder disease. Symptoms also include unstable or intermittent urine flow or when it comes out in drops. In addition, the presence of a symptom such as continuous urination after straining the muscles of the abdominal wall also determines health problems.

Doctors associate other symptoms with diseases that provoke the appearance of final urine. Thus, urolithiasis is characterized by frequent urination, pain in the bladder area, and the appearance of blood in the urine. Patients also experience itching and burning when urinating. The pain usually gets worse after exercise or hard work.

With prostate cancer, men suffer from groin pain and sexual dysfunction. And pyelonephritis leads to lower back pain, a sharp increase in body temperature to 37.5-38 degrees, and also a feeling of general fatigue. Cystitis also causes frequent urge to go to the toilet and acute pain in the lower abdomen. During urination, itching and burning occurs. And also over a long period of time the temperature rises to 37.1-38 degrees.

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Diagnostics: how to determine the volume of residual urine?

This deviation is dangerous because at the first stage of development it does not have pronounced symptoms. This contributes to the progression of the disease and it enters a more severe stage. At the second stage, the manifestations are already more obvious. But even now they can be confused with a common cold, as they are chills, fever, and lower back pain. Therefore, it is very important to determine the residual volume of urine. If it exceeds the norm, then this is the first symptom of disease.

Urinalysis in combination with other diagnostic methods will help determine pathology.

Determination of residual urine is a rather complex process and consists of a set of measures:

laboratory diagnostics;
urological studies;
neurological research.

So, first of all, in order to determine the volume of residual urine (RUR), it is necessary to conduct clinical blood tests, urine tests and a bacteriological urine culture test. The next step is an ultrasound of the bladder, prostate, uterus and ovaries. In addition, if necessary, the patient must undergo cystoscopy and urodynamic examination. Cystoscopy is considered the most effective, but it is also known to be harmful. Therefore, doctors prescribe this procedure only in extreme cases.

Also, determination of TOM is carried out using ultrasound. It is carried out twice. The first time with a full bladder, and then 5-10 minutes after urination. The amount of liquid is determined using a special formula. The height, width and length of the bubble are taken into account. In order for the OOM result to be accurate, the procedure is carried out 3 times.

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Errors in results

Unfortunately, there is a high risk that the results of residual urine volume tests may be erroneous. Therefore, if you have been diagnosed positively, do not worry and repeat all the procedures completed. So, before undergoing an ultrasound, you need to refrain from diuretic drinks, medications, as well as those foods that irritate the bladder. After all, 10 minutes after consuming them, the amount of urine increases by 100 ml, and, of course, the result will be distorted. In addition, all tests should be performed immediately after the patient has gone to the toilet. Only under such conditions will the OOM be measured correctly. Of course, in most cases it is impossible to undergo an ultrasound immediately after bowel movement.

And also, in order to completely empty your bladder of urine, you need to urinate under normal conditions, but in a hospital this is simply impossible. Also, the patient should relieve himself in connection with a natural urge, and not because it is necessary. The pose also matters; it should be familiar. If you do not follow these rules, then, of course, the diagnosis will reveal the remainder of the urine.

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Complications

At the first signs of illness, you should immediately consult a doctor.

If you suspect the presence of excess urine in the body, immediately seek qualified help. After all, the consequences of your delay can cause you many problems. Very often, doctors have to operate on patients, because treatment with drugs cannot help. And all this is only because of the late determination of the final urine. Therefore, the most common complications are:

inflammation of the kidneys and urethra;
renal failure;
stones in the kidneys;
hydronephrosis.

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Treatment of the disease

Residual urine in the body is not a disease, it only indicates its presence. That is why, first of all, it is necessary to determine the causes of excess urine. In addition, you need:

restore the patency of the urinary canals;
relieve inflammatory processes;
restore the bladder's ability to contract.

Basic principles of treatment:

it must be comprehensive;
The treatment process must not be interrupted under any circumstances;
The doctor must choose a course with minimal side effects.

Neurological abnormalities are considered much more complex. In this case, unfortunately, surgical and medical intervention cannot be avoided. If the patient has atony, the doctor prescribes medications that will help the bladder restore its contraction function. For its spasms, muscle relaxants are often prescribed. If all attempts are in vain, then an operation has to be performed, during which the doctor dissects in the spinal cord those nerves that form spastic contractions of the bladder.

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Residual urine in the bladder

Residual urine is an important criterion determining the presence of pathological changes in the lower urinary tract. In a healthy body, in the cavity of the bladder after urination, the remaining urine should not exceed 10% of the total volume of urine. Determining the amount of residual urine in the bladder has important diagnostic value for a number of pathologies, usually requiring immediate treatment.

Mechanism of urination

The act of urination (innervation) is a combination of the work of the muscular layer (detrusor) of the bladder, which, by contracting, ensures the removal of fluid, and the sphincters of the urethra, which regulate the retention of urine in the process of its accumulation until the desire to perform the act of urination arises.

Depending on the development of pathological changes in any of the structural elements of the urinary tract responsible for the removal of urine, various disorders occur, leading to damage to the detrusor of the bladder with the subsequent development of atrophy and, accordingly, the inability to contract sufficiently.

Important! Although urine amounts greater than 50 mL are clinically significant, the maximum residual amount may exceed 1 liter.

Table: Permissible volume of residual urine by age

Causes

All reasons causing the appearance of residual urine can be divided into several groups:

neurological nature;
inflammatory-infectious;
obstructive;
independent pathologies (diverticulum, urethral stricture).

Neurological disorders

Neurological disorders are always associated with disruption of the part of the nervous system that is responsible for three functions of the bladder:

reservoir (function that ensures the accumulation of urine in the bladder cavity);
evacuation (a function that facilitates the removal of urine);
valve (a function that allows you to hold a certain volume of urine in the bladder).

Damage to any level of the nervous system - from the nerve endings located on the inner surface of the bladder to disturbances in the functioning of the brain - can lead to a number of abnormalities, including hyperfunction of the urethral sphincter. As a rule, the cause of the development of this pathology is damage to the spinal cord due to:

tumor formations;
intervertebral hernia;
spinal injuries;
congenital pathology of the central nervous system (observed, as a rule, in a child).

Due to difficulties that arise during urination even with a full bladder, atony of the muscle layer develops, which, under constant pressure, loses the ability to contract and expel liquid, accumulating a large volume of residual urine.

Treatment of neurogenic bladder consists of psychological, physical and medicinal methods of influence:

correction of behavioral lifestyle (streamlining drinking and urination patterns);
stimulation of urination by massaging the back area;
physiotherapy;
drug effects on weakening sphincter tone;
drugs that regulate the functioning of the central nervous system;
physiotherapy.

The plexus of nerve endings in the lumbosacral region stimulates the process of urination

Inflammatory and infectious processes

As a rule, the role of inflammatory diseases in the formation of residual urine is the formation of urethral edema or sphincter spasm due to soreness and tissue irritation. A similar reaction can be observed with cystitis, balanitis and urethritis. Prostate inflammation in men occupies a special place among inflammatory diseases that cause persistent urination problems.

Enlargement of the prostate gland, due to an inflammatory process or the formation of a benign (prostatic hyperplasia) or malignant (prostate cancer) neoplasm, causes, in the initial stages of the disease, minor urination disorders, which subsequently lead to more pronounced:

increased urge to go to the toilet;
intermittency of the stream when urinating;
the need for abdominal tension and straining to completely empty the bladder cavity;
feeling of incomplete emptying of the bladder.

Important! With timely consultation with a doctor, prostate adenoma can be successfully treated with the complex effects of medications and physiotherapeutic procedures, and allows you to return to normal life.

Enlargement of the prostate gland towards the bladder, creating an obstruction to the outflow of urine

The presence of stones in the bladder is one of the most common causes of residual urine. Cystoliasis occurs with equal frequency in both men and women. Only the mechanism of stone formation differs - the male body is characterized by the formation of stones directly in the cavity of the bladder, and the female body is characterized by the migration of stones from the kidneys.

Feeling of incomplete emptying of the bladder

The reasons for the formation of stones can be internal or external factors:

chronic infectious diseases of the urinary tract;
violation of metabolic processes;
improper diet;
sedentary lifestyle;
work in hazardous industries;
improper drinking regime.

In addition to the main signs of the formation of residual urine, with cystoliasis pain in the lower abdomen with irradiation to the groin, scrotum or perineum is noted. Also a characteristic sign is a sudden interruption of a full stream during urination. Treatment consists of removing stones using medications or lithotripsy, followed by their removal naturally.

Important! Therapy with stone-breaking drugs helps dissolve stones in the kidneys and bladder within 2–6 months, but has many side effects.

The drug Canephron prevents the formation of stones and has a minimum of contraindications

A diverticulum is a sac-like cavity formed from the wall of the bladder. There are two types of diverticula – true and false. A true diverticulum consists of the mucous and muscular layers of the bladder tissue and, as a rule, is a congenital anomaly.

False diverticulum (acquired) develops as a result of increased intravesical pressure that occurs against the background of pathological conditions accompanied by difficulty urinating and systematic incomplete emptying of the bladder. Due to high fluid pressure, atrophy of the muscle layer develops, the destroyed fibers diverge, and the mucous membrane protrudes into the abdominal cavity under pressure.

The main difference between a false diverticulum and a true one is the absence of muscle fibers in the structure of its wall. The main clinical sign of diverticulum is urination twice with the appearance of cloudy urine.

Treatment consists, first of all, in eliminating the causes causing increased intravesical pressure (if the diverticulum is acquired) and subsequent surgical removal of the deformity.

Pathological narrowing of the urethra is called urethral stricture. Metaplasia of the tissues of the urethral mucosa can be caused by various causes of damage varying degrees severity:

thermal or chemical burns of the urethra;
inflammatory processes (cystitis, urethritis);
injuries or bruises of the perineum;
injury to the mucous membrane during catheter installation;
congenital pathologies of the urinary tract.

Due to the replacement of damaged cells with mucous connective tissue, scar formation occurs, which significantly complicates the process of urination, resulting in urine remaining in the bladder.

Stricture of the urethral canal on x-ray

Signs and complications

Urine, which remains in the bladder cavity after urination, not only causes a large amount of discomfort, but is itself an alarming symptom, the severity of which directly depends on its quantity.

Residual urine is an important clinical sign, as it leads to dysfunction of the upper urinary tract and is a consequence of pathological processes leading to functional disorders of the bladder.

The main symptoms accompanying excess residual urine are:

increased urge to urinate;
weak or intermittent stream;
the need to strain the abdominal muscles in order to begin the process of urination or prevent its interruption;
inflammatory processes in the urinary tract.

In the absence of timely treatment, the risk of developing inflammatory processes increases, since stagnation creates a favorable environment for the development of pathogenic microflora and the formation of stones. Impaired urine flow can also lead to the development of hydronephrosis, pyelonephritis and renal failure.

When treating acute urinary retention, it is removed using a rubber catheter.

Diagnostics

Determining the presence and quantity of residual urine is the main purpose of the examination, which includes asking the patient for the presence of clinically significant symptoms. Next, instrumental research methods are carried out, the list of which includes:

studying the dynamics of changes in stream pressure during urination (urofluometry);
orthostatic urine test;
measuring pressure in the bladder at different moments of urination (cystometry);
assessment of the contractility of the muscular layer of the bladder walls (electromyography);
study of the functional state of the sphincters and urethra (urethroprofilometry);
Ultrasound of the bladder before and after urination;
Ultrasound of the prostate gland.

Laboratory research methods:

clinical urine analysis (determining the presence of bacteria, proteins and nitrogen in the urine);
clinical blood test;
determination of prostate specific antigen (PSA).

A reliable method for determining the amount of residual urine is the direct catheterization method. But due to the difficulties associated with its implementation (invasiveness, risk of damage to the urethra, provocation of inflammatory processes), assessment of the amount of residual urine is mainly carried out using ultrasound.

The diagnostic technique consists of two stages:

Ultrasound of a full bladder.
Ultrasound performed 10 minutes after urination.

In this case, the dimensions of the three-dimensional image of the bladder and the length of its ultrasound shadow are estimated using mathematical formulas.

Important! In cases of suspected prostatic hyperplasia in men, the most informative diagnostic method is transrectal ultrasound.

Technique for performing transrectal ultrasound

Since residual urine is just a symptom, restoring bladder detrusor function involves treating the underlying disease and regularly removing urine using stimulating methods (washing with warm water, massage of the sacral spine, use of antispasmodics).

A positive effect can be achieved by using methods that improve blood circulation in the pelvic organs (aerobic exercise, walking, breathing exercises), relieving inflammation, and reducing the amount of fluid consumed before bed. In the vast majority, with timely consultation with a doctor, the tone of the muscle wall can be restored without the use of surgical treatment methods.

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What does the presence of residual urine indicate?

The human bladder never empties completely: normally, after urination, a small amount of liquid remains in it. However, in an adult, the amount of residual urine should not exceed 50 ml, and in a child - 10% of the volume of the bladder.

Causes
Symptoms
Diagnostics
Emergency bladder emptying
Treatment

Children (boys and girls):

newborns - 2-3 ml;
up to one year - 3–5 ml;
1–4 years - 5–7 ml;
4–10 years - 7–10 ml;
10–14 years - 20 ml;
teenagers > 14 years old - up to 40 ml.

Adult men and women -

Residual urine is considered an important clinical sign: it indicates that some painful processes are occurring in the body that interfere with normal urination. In pediatric urology, this symptom is considered one of the most alarming and means that the child needs to undergo full examination. For example, the presence of residual urine is the only clinical symptom of bladder diverticulum. With this disease, a sac-like protrusion forms on its wall, which can rupture and become inflamed if treatment is not started.

Stagnation of urine in the bladder is itself a painful condition that provokes bacterial inflammation and increases the likelihood of stone formation. Without treatment, symptoms increase every day. The volume of unremoved fluid increases, the bladder stretches and pain occurs, and over time, urinary incontinence develops.

Causes

Residual urine appears for very different reasons, and not all of them are associated with pathologies of the bladder, ureters or urethra. They are divided into several groups:

obstructive;
inflammatory-infectious;
neurological.

In the first case, we are talking about mechanical obstacles to the outflow of urine, which block the urinary tract from the inside or squeeze them from the outside. These include:

narrowing and adhesions of the urethra;
stones;
malignant and benign tumors - polyps;
prostate adenoma in men;
uterine fibroids, ovarian cysts in women.

Inflammatory and infectious diseases provoke swelling of the urethra or spastic compression of the muscles of the bladder due to its reflex irritation. Residual urine often indicates cystitis, urethritis, prostatitis and balanitis in men.

Neurological causes are associated with a violation of the innervation of the bladder, that is, with the fact that the control of the central nervous system over urination is weakened. The bladder in such patients is completely healthy, and nothing interferes with the outflow of urine. But the muscular wall of the organ (detrusor) or the muscle that locks the urethra (sphincter) no longer senses when to contract. This condition is called “neurogenic hypotonic bladder” and can be caused by:

multiple sclerosis;
congenital defects of the central nervous system, especially in children;
spinal cord or brain injuries;
diseases of the spine (disc herniation, osteochondrosis, radiculitis, tumor).

The tone of the organ weakens under the influence of certain medications: antidepressants, muscle relaxants, antiarrhythmics, diuretics, hormonal drugs, drugs for Parkinson's disease, narcotic painkillers.

Symptoms

With inflammation and blockage of the urinary tract, residual urine is just one of many symptoms of illness, and it is detected during examination for these diseases. But if it appears as a result of neurological disorders, it is more difficult to diagnose the pathology, especially in a small child.

The first sign that a person, despite being in good health, suffers from urinary retention is a mild, sluggish urge to urinate. The symptom develops gradually, along with increasing atony of the bladder. Other signs that suggest something is wrong include:

Feeling of pressure in the bladder. In a child who cannot yet talk about his sensations, it is enlarged and painless.
Sluggish or intermittent stream of urine.
Pain in the urethra.

With a diverticulum, there is no pain or pressure, but the person urinates “in two stages”: first with a large portion, and then with a scanty one. This happens because first the bladder itself is emptied, and then the diverticulum formed on it.

Diagnostics

Diagnosis of urinary disorders consists of a survey, laboratory diagnostics, urological and neurological examination. At the first appointment, the urologist prescribes:

clinical blood and urine tests, urine culture to determine bacterial infection;
ultrasound examination of the bladder, pelvic organs (prostate in men and boys, uterus and ovaries in women and girls);
if necessary, cystoscopy and urodynamic study (contrast urography).

Cystoscopy gives the most reliable answer about whether there is residual urine in the bladder and what its volume is. But this method of examination is quite traumatic, so it is used only as a last resort, especially in a child.

Ultrasound examination is carried out in two stages: with a full bladder and after urination. The doctor measures the volume and size of the full bladder, then the patient empties it, and within 5-10 minutes after urination, the ultrasound is repeated. The amount of liquid is calculated using special formulas, taking into account the height, width of the bubble and the length of its ultrasound shadow. To increase the accuracy of the results, measurements are carried out at least three times.

If you or your child are taking diuretics or have recently eaten foods or drinks that irritate the bladder (spicy, smoked, salty, coffee, soda, strong tea), tell your doctor. After taking diuretics, up to 100 ml of liquid accumulates in the bladder within 10 minutes, and the diagnosis will be erroneous.

Emergency bladder emptying

When a lot of fluid accumulates in the bladder and the patient cannot empty it naturally, he undergoes catheterization. People for whom the procedure is contraindicated, for example, with urethral sphincter spasm, may be given an injection of botulinum toxin into the sphincter area to relax the muscle.

In some cases, the patient is given a temporary urethral stent with a validity period of three to six months. It is a cylinder of thin (1.1 mm in diameter) wire spiral made from organic material, which soon dissolves.

Treatment

The presence of residual urine is only a symptom, not a disease. Therefore, in order to establish normal urination, you need to deal with the reason that disrupts it:

surgically or conservatively (for urinary tract disease) to restore urinary tract patency;
remove inflammation;
normalize bladder contractility.

The most complex treatment will be needed for neurological disorders. It can be medicinal and surgical.

If the bladder is atony, the doctor prescribes medications to the patient that will help restore its ability to contract. When it spasms, the patient is prescribed muscle relaxants. If it is not possible to relieve spasms with medication, a surgical operation called “selective dorsal rhizotomy” is performed. It consists in the fact that the doctor identifies in the bundle of spinal cord nerves those that cause spastic contraction of the bladder and dissects them.

Residual urine is the amount of waste products that remains in a person's bladder after he has used the toilet. This sign is considered a pathology in both children and adults. But here it is still very important to determine exactly the amount of this residual urine. If it exceeds a certain norm, then the person is suspected of having a urological disease.

Why does residual urine occur?

Residual urine most often appears in childhood. The reasons for this phenomenon may be hidden behind bladder dysfunction, namely:

Insufficient contraction of the walls of the bladder, as a result of which urine is not pushed out of it in full;
Disruption of the sphincter, that is, the wall that is located between the bladder and the muscles blocking the urethra. As a result, urine stagnates in the bladder and does not come out.

In medical practice, the phenomenon of residual urine is truly of great importance. After all, if urine remains in the human body and is not removed from it for a long period of time, then this leads to a rapid deterioration in well-being. Following urinary incontinence, a person develops symptoms such as the urge to urinate frequently, insufficient urine output, urinary incontinence, and bladder infection.

Possible complications

In a person with stagnation of urine in the body, the pressure of the internal organ increases. This is followed by a number of complications of a person’s well-being, ranging from infection and inflammatory processes to impaired kidney function.

In the residual stagnant urine, pathogenic bacteria begin to rapidly multiply, which leads to the spread of infection and the deposition of kidney stones.

Emptying the bladder in a healthy person

In a healthy person, the bladder should normally empty completely, without any residual urine. Only 10% of the remaining urine is allowed, depending on the age of the patient, that is, in a child it will be 3-5 ml of urine, in an adult – up to 50 ml.

If the volume of residual urine exceeds the permissible norm, this indicates that the person has begun to develop urological infectious or inflammatory processes. To truly confirm or refute the diagnosis, it is necessary to very accurately measure the amount of residual urine.

At the same time, it is important that certain conditions for the process of urination are observed - comfortable psychological conditions, a familiar, non-painful posture when urinating.

How to determine the volume of residual urine?

To determine the volume of residual urine, you need to resort to medical diagnostics. At home, you will not be able to determine exactly how much urine remains in the bladder and how much comes out of it. Therefore, the method of catheterization of the bladder or the method of abdominal ultrasound is used.

A simpler and more accurate way to determine residual urine is to insert a catheter. But, it is still recommended to use it for adult patients, and not for children. In children's clinics, the volume of residual urine is determined using ultrasound diagnostics. The uzologist measures the width of the bladder, its height, and also its length.

Errors in results

Determining the volume of residual urine can quite often have false positive results. Why is this happening? Because the measurement should normally be carried out exactly when the person went to the toilet. That is, literally in 5 minutes he should come to the diagnostic room. But this is an ideal option.

As a rule, a decent amount of time passes between the last urination and the ultrasound examination. During this time period, a portion of urine begins to accumulate in a person.

Another factor that may influence false results is the use of diuretics. medicines or a large amount of water the day before. For example, if a person drank a diuretic before taking the test, then his urine begins to rapidly accumulate - approximately 10 ml of urine per minute. It is easy to calculate that in 10 minutes a person collects 100 ml of urine in his bladder.

Some patients are unable to go to the toilet normally in a hospital setting due to certain uncomfortable conditions. Accordingly, they will have an excess amount of urine.

In order for the result of determining residual urine to be reliable, it is imperative to carry out the analysis at least 3 times (preferably more).

If a person does not see a doctor...

If a certain person has a disturbance in the process of urination and does not seek medical help and does not investigate this situation in any way, then in this case the person begins to develop pathologies.

The sign of residual urine in the bladder leads to the emergence and rapid development of kidney diseases, namely:

To the development of chronic pyelonephritis;
To the formation of kidney stones (in most cases, this problem can only be solved surgically);
To urethritis;
Hydronephrosis;
Impaired kidney function and renal failure as such.

On early stages Impaired functioning of the bladder and the formation of residual urine in it can still be corrected with the help of medications. In advanced states of the disease, they resort to hospitalization and treatment through surgical methods.

Treatment of urinary retention

Treatment of urinary retention in severe cases involves catheterization with a rubber catheter. This treatment is carried out only in a hospital setting; it will not be possible to insert a catheter correctly at home (the catheter is inserted into the urethra).

A permanent catheter is inserted for several days and treated with solutions of Furadonin, Nitroxoline, as well as other antibacterial agents.

At home, you can apply warm water to your genitals to promote urination. If this method turns out to be ineffective, then a 2% Novocaine solution or Pilocarpine solution is injected into the urethra. Do not try to insert a catheter at home, as this may cause a bladder infection.

After urination, small amounts of residual urine remain in the bladder. Normally, in adult women and men, its amount does not exceed 30–40 ml.

Bladder pathologies

In children, this value is 3–4 ml. If its volume exceeds 50 ml, then this indicates a violation of the normal outflow of urine through the urethra.

Factors that contribute to excess residual urine in men and women are:

violation of the nervous regulation of the urination process;
atony of the bladder muscles;
prostate hyperplasia in men;
violation of the patency of the urethra;
strictures of the bladder neck and urethra;
urolithiasis localized in the bladder.

Increased urine output

Disruption of the innervation of the urinary tract can develop in several ways. Residual urine appears in large quantities with reduced contractility of the muscles of the bladder wall (detrusor).

In this case, it does not contract strongly enough to “push out” the entire volume of urine. In some cases, the urethral sphincters do not function properly.

Then urination stops due to premature closure of the urethral sphincter.

Failure in the nervous regulation of the urination process can occur with a back injury with damage to the spinal cord, general diseases of the nervous system (Parkinson's disease or Alzheimer's disease, etc.), and circulatory disorders in the pelvic organs.

Detrusor atony can also occur in old age for physiological reasons.

Prostate diseases affect more than half of men aged 40–45 years. Increasing in size, it compresses the walls of the urethra, which causes disturbances in the passage of urine.

As a result, the process of urination in men does not occur completely, and a large amount of residual urine remains.

Obstruction of the urethra can also be caused by tumors of nearby organs and tissues, scars on its walls after surgical interventions, and anatomical features of the structure.

If there are stones in the bladder, they can block the internal urethral sphincter.

This leads to an abrupt cessation of urination, as a result of which residual urine is constantly present in the bladder in quite large quantities.

Diseases in which the syndrome manifests itself

Symptoms of pathology

This is a protrusion in the form of a cavity on the wall of the organ where urine accumulates.

In children, such a pathology as vesicoureteral reflux is very common. With this disease, residual urine is “thrown” up the ureters into the kidneys.

Complications

Chronic congestion can cause the development of such complications:

urolithiasis, unless of course it became the root cause of such a syndrome;
bacterial inflammation of the bladder (cystitis);
infectious damage to the kidneys (pyelonephritis), in the presence of residual urine, pyelonephritis begins as a secondary inflammation against the background of cystitis

Symptoms

In the presence of residual urine, the primary clinical sign in women and men is the feeling of incomplete emptying of the bladder after urination.

Urinary dysfunction

There may also be a weakening of the urine stream during urination, its interruption, and the release of urine drop by drop when trying to empty the bladder.

Another characteristic symptom when the norm of residual urine is exceeded is the continuation of the process of urination after straining the muscles of the abdominal wall.

The remaining clinical manifestations are due to the underlying disease, which caused the presence of residual urine, or complications of this syndrome.

Prostate diseases in men, in addition to disrupting the urinary process itself, also cause pain in the groin area and impaired sexual function.

Pyelonephritis is manifested by aching pain in the lumbar region, a sharp increase in temperature to 37.5 - 38°, weakness, and increased fatigue.

Diagnostics

A large volume of residual urine can be determined by palpating the contours of the bladder. More accurately, its quantity can be seen during an ultrasound after urination.

Instrumental diagnostics

To determine the cause of residual urine in men and women, urodynamic studies are performed:

urofluometry, which measures the volumetric flow rate of urine during urination, the time it takes for urination to pass;
cystometry, this study measures intravesical pressure during urination. One of the varieties of this examination is voiding cystometry, during which pressure readings are taken during the process of filling and emptying the bladder;
electromyography, which evaluates the functioning of the muscles of the bladder and urethra;
Urethroprofilometry allows you to determine whether the sphincters and walls of the urethra are functioning correctly.

Further studies are carried out according to indications. In men, the prostate gland must be examined using palpation and rectal ultrasound.

Treatment

There is no therapy for residual urine in the bladder as such. In general, treatment is aimed at combating the underlying disease and restoring normal detrusor contractility.

After recovery, the problem of too much residual urine after urination goes away on its own.

To prevent bacterial complications, antibiotics or uroseptic drugs may be prescribed.

When the body is healthy, it functions “like a clock,” and metabolic processes proceed at the correct speed. All residual substances (metabolic products) are filtered by the kidneys and excreted in the urine. Normally, after urination, a minimal amount of urine may remain, the rest comes out. But with some diseases and conditions, a person retains a larger amount of urine in the bladder, and congestion occurs. This provokes various complications, including severe ones.

What does stagnation of urine mean - definition

The amount of urine that is present in the bladder after urination is called residual. Even a minimal excess of the permissible volume is a deviation.

Normally, the indicators should not be more than these numbers (ml):

newborns – 1-2;
children under one year old – 3-5;
children under 5 years old – 7;
children under 10 years old – 7-10;
children 10-14 years old – 10-20;
teenagers, adults – 30 ml.

Urine stagnation is considered to be a prolonged excess of this indicator or a one-time detection of residual urine in a volume of 40-50 ml (in an adult). Congestion in the bladder occurs frequently regardless of gender and age, although it occurs less frequently in children than in adults.

Urinary retention occurs:

complete – anuria is registered, the patient feels the urge, but cannot go to the toilet;
incomplete - urination occurs, but a certain amount of liquid always remains in the bladder.

A more detailed classification of urinary retention is as follows:

acute complete - occurs suddenly in the form of a cessation of urine output;
acute incomplete - urine is released from the overcrowded organ in small portions;
chronic complete - such patients need artificial drainage of the bladder for a long time;
chronic incomplete - a person regularly urinates in scanty portions, and there is almost always stagnation (the volume of residual urine can reach 0.5-1 l);
paradoxical - the organ is overstretched with urine, it constantly comes out drop by drop spontaneously.

Stagnation of urine is also called ischuria, the ICD pathology code is R33. Without treatment, this disease inevitably provokes infectious processes, and if it continues for a long time, it causes the development of urolithiasis. Each time the bladder stretches more and more, pain and other symptoms begin.

Causes of pathology

All reasons that can provoke such unpleasant phenomena can be divided into neurological, inflammatory and obstructive. The first are associated with diseases of the nervous system, the second come from infectious pathologies, and the third leads to a mechanical disruption of the flow of urine.

In men, the most common cause of urine excretion in scanty portions and stagnation is prostate disease. They are observed in almost ½ of men over 45 years of age. An increase in size of the prostate gland occurs with and, especially, with hyperplasia (). The organ compresses the walls of the bladder and urethra, this causes a violation of the passage of urine. Obstruction can also be caused by a more severe disease - a tumor (cancer) of the prostate, in which case the stagnation quickly progresses.

In women, the causes of ischuria can be:

uterine fibroids, ovarian cysts, polyps;
proliferation of endometriosis foci;
operations performed on the uterus or other organs that caused adhesions;
structural features of the genitourinary system, congenital anomalies;
cystocele, with protrusion of hernias and depression of the bladder into the vagina;
injuries during childbirth.

During pregnancy, urine is retained in the last months, since the large size of the fetus interferes with the normal passage of fluid. Deviations are especially noticeable when the baby is breech.

Abrupt congestion can occur due to the release of a stone from the kidney and blockage of the natural opening for the removal of fluid. In addition to stones, the same result can be achieved by foreign bodies that get inside, as well as growing tumors. Bladder cancer is more common in men over 55 years of age and provokes increasing urinary retention, coupled with weight loss, weakness, and bleeding.

In some cases, the bladder itself is healthy, but the reflexes to excrete urine are impaired.

Among the nervous pathologies that change control over the process of urination, the following can be noted:

head and spinal cord injuries;
severe diseases of the spine (lumbar hernia, cauda equina syndrome);
hypotonia of the bladder muscles;
complications of diabetes;
long-term severe stress.

Taking certain medications also negatively affects the process of emptying the organ. These include antiarrhythmics, hormones, painkillers (especially narcotics), antidepressants, anticonvulsants, drugs for epilepsy, and sleeping pills.

At any age, stagnation of urine can be caused by infections and inflammation in the body. Cystitis, urethritis, pyelonephritis due to swelling and pain often cause urine retention, which only aggravates the course of the underlying pathology.

In infants and newborns, congenital risk factors for urinary stagnation may include:

, as well as fusion of the urethral opening;
swelling of the foreskin in boys due to difficult childbirth;
phimosis in boys too;
large hernias;
calcifications in the bladder.

Inflammation can also cause problems with going to the toilet in children - vulvitis in girls, balanoposthitis in boys.

Symptoms

With ischuria, the urge to urinate is usually preserved, but urine is released sparingly or does not flow at all. A person begins to go to the toilet more often, while straining his muscles with force to urinate, but even serious efforts do not always lead to a positive result. The bladder stretches, so cuttings and nagging pains appear in the lower abdomen, which then turn into acute ones.

Other possible symptoms of ischuria:

visually noticeable protrusion of the lower abdomen, tension in the abdominal wall;
pain on palpation of the abdomen, especially in people with an asthenic physique;
false urge to defecate due to intestinal compression;
uncontrolled release of urine drop by drop;
interruption of the stream in the middle of the urination process and subsequent continuation.

In men, stagnation of urine due to prostate diseases is additionally accompanied by sexual dysfunction, unpleasant sensations in the groin, and discharge from the penis. In women, long-term stagnation is almost always combined with signs of cystitis.

If urinary retention exists for a long time, the body is exposed to chronic intoxication with metabolic products. Nausea, headaches, weakness, loss of appetite, low-grade fever appear, and blood pressure increases. Arrhythmia occurs, and women may experience bleeding from the vagina. No less often, the process is complicated by inflammatory kidney disease - pyelonephritis, which is expressed by high fever, back pain, and sudden attacks of renal colic.

If stagnation of urine is acute, urine has accumulated in the bladder in a large volume, complications can be very serious:

loss of function and shrinkage of the organ;
rupture of the bladder, development of peritonitis;
sepsis.

In children, acute urinary retention causes crying and anxiety. The bladder protrudes so much that it sometimes reaches the level of the navel. This condition requires urgent hospitalization of the child.

Diagnostic measures

Chronic delays do not have obvious symptoms in the first stages, so they can only be identified through instrumental diagnostics. A simple and accessible method is ultrasound. It is done 2 times - with a full and with an empty bubble. The specialist will determine the amount of residual urine, taking into account the height, length, and width of the organ. To prevent the ultrasound from showing an erroneous result, it is important to stop taking diuretics and irritating foods before the procedure. If this is not done, the amount of urine will increase and the results will be distorted.

general urine analysis;
urine culture test;
general, biochemical blood test;
Ultrasound of the uterus, ovaries for women;
for men;
digital prostate examination;
radiography with measurements of urodynamic parameters;
CT, MRI;
radionuclide scanning;
electromyography of the bladder.

During the examination, it is important to establish the exact causes of urinary stagnation in order to maximize their impact during therapy or surgery.

Treatment

The treatment algorithm will depend entirely on the detected causes of the pathology. If the outlet from the bladder is blocked by a stone, it is crushed, dissolved or removed surgically. Next, drug therapy for urolithiasis is carried out, metabolic processes are corrected. At infectious diseases use antibacterial and anti-inflammatory agents to relieve swelling and restore urination. Tumors are operated on or irradiated, and chemotherapy is used.

In children, treatment for acquired urinary problems will be similar to that in adults. In infants and newborns, the causes usually lie in structural anomalies, so they require surgery, plastic and reconstructive operations.

In general, the doctor’s tasks in case of urinary stagnation are:

restoration of urinary tract patency;
relieving inflammation;
normalization of bladder contractility.

Medication

Infectious pathologies are treated by taking or intravenous, intramuscular administration of antibiotics. Antibacterial therapy will also be required for complicated urolithiasis, which has caused an inflammatory process.

The most commonly used means are:

Amoxiclav;
Cephalexin;
Suprax;
Ofloxacin;
Norfloxacin.

If the cause of ischuria is atony of the muscular layer of the bladder, the following drugs are used - Atropine, Proserin, and anticholinergics. For spasms, Papaverine, No-shpa are prescribed, for stress - sedatives, sedatives, herbs (valerian, motherwort). Reflex disturbances in the outflow of urine are well removed by warm baths. Women are also often given instillations into the bladder with anti-inflammatory drugs, antiseptics, and oil solutions.

Catheterization

This is a first aid measure that is performed for emergency removal of urine when it stagnates. To do this, the person lies horizontally, with a basin placed below to collect liquid. Next, the healthcare worker inserts a catheter into the urethra, and directs the second end of the device into the pelvis. As the fluid drains slowly, the specialist gently presses on the lower abdomen. Strong pressure can cause organ rupture! After the process is completed, the catheter is removed, although in a hospital setting it can be left for 2-3 days or more.

If the patient has acute urethritis or urethral trauma, instead of catheterization, a cystostomy is performed (puncture of the skin in the bladder area and removal of fluid through a tube).

Surgical

The choice of operating technique will directly depend on the type of problem the patient has. Open operations are performed in the presence of tumors, foci of fibrosis, large adhesions, and large stones. In other cases, endoscopic operations are performed, as well as laser and ultrasound techniques. Percutaneous is also used - under ultrasound control, drainage is installed, which helps urine flow normally.

To prevent urine stagnation, it is important to detect and treat infections in a timely manner, regularly visit a gynecologist and urologist, and prevent salt deposits. You need to eat right and drink enough fluids, which will help reduce the risk of urolithiasis.

The remaining urine in the bladder is one of the criteria for assessing the functioning of the entire urinary system.

By determining the residual amount of urine, one can judge the presence of a variety of pathologies, which, as a rule, require immediate treatment.

Normal residual urine in the bladder

Under no circumstances is the urethra completely emptied. A small urine residue is acceptable, and the norm for this indicator is 10% of the total urine volume. In a healthy adult, urea volume is 320–350 ml in women and 350–400 ml in men. Therefore, the normal residual urine value is 35–40 ml.

Urine residue levels in children vary depending on their age:

newborn babies up to 3 months – 2 – 3 ml;
at 1 year – up to 5 ml;
2 – 4 years up to 7 ml;
4 – 10 years up to 10 ml;
10 – 13 years – 20 ml;
adolescence (14 – 16 years) – 25 – 35 ml;
adults – 35 – 40 ml (in some cases up to 50 ml).

Attention! The dangerous amount of residual urine, established by world experts, is only 50 ml, but in some diseases, this value can reach 500 ml, causing bladder overflow.

Reasons for the increase

The remainder of the urine is formed due to various pathologies, and not all of them are related to the genitourinary system. All reasons can be divided into 3 groups:

Obstructive.
Inflammatory and infectious.
Neurological.

These include all diseases that prevent complete emptying of the bladder, namely:

From the very name it becomes clear that the causes are inflammatory-infectious in nature, caused by the presence of infection and inflammatory processes of the urinary organs. These include:

cystitis;
pyelonephritis, glomerulonephritis;
balanitis;
purulent abscesses of the bladder.

This group includes absolutely all infectious diseases that cause swelling of the urethra and damage to the muscle tissue of the urethra.

All neurological causes are based on a decrease or complete lack of control over the process of urination, which is provided by the central nervous system. As a rule, in such cases, the genitourinary organs are absolutely healthy and function perfectly, but the muscle tissue loses its ability to contract, and the person does not feel the fullness of the bladder. In medicine, such problems are identified as. The reason for this may be:

multiple sclerosis;
pathologies of the central nervous system (mostly congenital);
spinal cord and brain injuries;
chronic progressive diseases of joints and bones (osteochondrosis, radiculitis, arthritis, arthrosis);
vertebral and abdominal hernia.

In some cases, muscle tone may weaken due to taking certain medications: narcotic painkillers, antidepressants, muscle relaxants, arrhythmia relievers, hormones.

Prostatitis disease

BPH is benign prostate hyperplasia. Its characteristic feature is an increase in the volume of the prostate gland, which leads to an increase in the total number of tissue cells. Due to hyperplasia, tissue compaction occurs.

Many people believe that prostate adenoma is a tumor, but this is absolutely not true. 30% of men over 50 years of age are diagnosed with this disease. Very often, prostatitis is the cause of poor urinary emptying. Disorders of the prostate gland provoke its active growth.

At the initial stages, a person does not feel any changes, but after some time the process of urination becomes more difficult. This is due to thickening of the walls of the urinary tract. The man notices that the stream of urine becomes weaker; in order to fully empty the bladder, it is necessary to use a little effort (tighten the muscles).

If the disease remains untreated for a long time, constant straining during urination significantly weakens the muscles, they become less sensitive. Sensitivity soon disappears, which leads to incomplete emptying during urination. Doctors call this condition paradoxical, when one is unable to relieve oneself due to the lack of muscle tone.

Symptoms of residual urine after urination

As a rule, the main signs of the presence of residual urine in the bladder are symptoms of the diseases that caused it. This may include:

If we talk only about the fact of urine residue, then the main symptom will be the terrible discomfort that the patient experiences with a constantly tense bladder.

The urethra stretches and increases in size, creating great pressure on the adjacent internal organs.

Another sign will be double bowel movements. After urinating, the patient returns to his usual activities, but after two minutes he again experiences the urge, since the bladder was not completely emptied.

Diagnostics: how to determine the volume of residual urine?

Residual urine is dangerous because in the first stages it does not have any symptoms, but the disease progresses to a more severe form. To understand what the reason is, you need to undergo a full series of medical studies:

After all the above tests, it is necessary to establish the exact volume of residual urine. This is done using ultrasound in two stages. First, the patient must prepare. In the morning, two hours before the ultrasound examination, you need to drink a large amount of water (1.5 - 2 liters).

The volume of water will be determined by the doctor, based on body weight. The first stage involves a study with a full urea. Next, the patient needs to urinate, after which the study will show the amount of fluid remaining.

One more effective method determination of urine residue is . Unfortunately, this procedure has many contraindications, so it is rarely used in specific cases.

Errors in results

As already mentioned, due to the structural features of each organism, there is a high risk of unreliability of the results of the studies. To obtain accurate data on urine residual, it is necessary to undergo an ultrasound scan at least three times, with intervals of several days. If the data from each study matches, then we can say that the study was informative and accurate.

Very often, residual urine is misdiagnosed. A person can take various sedatives and antihistamines, which have a diuretic effect, which significantly affects the results of the examination.

The posture a person takes while urinating also plays a big role. It is best to do this while sitting, with a straight back (90°) to eliminate pressure on the bladder.

Effective methods and general rules of treatment

Treatment depends entirely on the underlying cause that caused residual urine, and is primarily aimed at restoring the patency of the urinary tract. It may include etiotropic therapy, catheterization and surgery.

Possible complications

The remaining amount of urine in the bladder above normal levels can cause serious disruptions to the functioning of not only the urinary system, but also the entire body. Against this background, inflammation of the kidneys and kidney failure occur.

In absolute health, urine is completely sterile. But according to practice, over the course of a lifetime, the human body acquires a huge number of different viruses, microbes and bacteria, to which it gradually develops immunity. All these bacteria and microbes partially end up in the urine.

With large volumes of accumulated urine, they begin to actively multiply, creating a danger of intoxication of the body. When urinating, contaminated urine can cause severe irritation of the mucous tissues of the urinary tract, causing urethritis, cystitis, and prostatitis.

In advanced forms, damage occurs to the uterus and ovaries in women, which causes complete infertility. In men, this can cause a lack of erection.