Causes of residual urine in the bladder. Urine residual in the bladder: norm, definition, treatment

15.03.2020

After urination, a man may have urine remaining in his bladder. Normally, this should not happen, but if less than 10% of urine remains, this condition can also be considered normal. If the volume of residual urine exceeds 10% of the total, then this is a symptom of the disease (more than 40 ml of urine). This cause is more common in children or older men. This is due to decreased tone of the muscles that are responsible for emptying the bladder or hypertonicity of the urethral sphincters. If the problem of residual urine is left unattended and not treated, there is a risk of developing diseases such as:

Pyelonephritis;
Hydronephrosis;
Diverticulitis;
Chronic inflammation of the bladder;
Malignant neoplasms of the bladder.

The development of complications is associated with the reflux of urine into the ureter and kidney or prolonged retention in the bladder and, as a result, prolonged exposure of the bladder wall to harmful substances contained in the urine.

Diagnosis of residual urine is a difficult research method. Therefore, to comply with certain measures:

Urination should occur at the request of the man (when the urge arises);
Conditions should be as close as possible to the real-life situation;
The position for urination should be familiar.

After the man has urinated, the volume of urine remaining in the bladder is determined. This can be done using two methods: bladder catheterization or ultrasound examination. Ultrasound is a non-invasive research method. The volume of residual urine normally cannot be determined by ultrasound or its small amount is determined. This method is used in clinics because of its simplicity and accessibility. However, the accuracy of the result is low due to the indirect determination of urine volume (with ultrasound, residual urine is calculated using formulas). Bladder catheterization is a reliable method for determining the volume of residual urine in the bladder in men. The disadvantage is the need to use a catheter, which can injure the urethra or bladder. Due to the fact that determining the volume of residual urine is a difficult procedure, the norm may be a false positive result. This is due to errors that were made during diagnostics:

Less than 10 minutes passed between studies. Normally, during a diagnostic procedure, there should be minimum 10 minutes. After which you can carry out the test a second time.
Before the procedure, the patient took diuretic medications or drank large amounts of fluid. Under these conditions, determination of residual urine volume in the bladder will give a false-positive result due to the kidneys producing excessive amounts of urine.
Urination occurred under conditions unusual for a man or during nervous overstrain. Because of this, the body begins to intensively produce urine. There is also a false urge to urinate.

Due to the high probability of errors occurring during manipulation, the test must be performed at least three times. Diagnostic procedures are also prescribed to identify the disease that caused residual urine. It is mandatory to prescribe a general blood and urine test, as well as culture of urethral discharge and determination of the sensitivity of the microflora.

Residual urine is a sign of a disease of the genitourinary system and is never the only symptom. Associated symptoms may include:

Feeling of incomplete emptying of the bladder;
Pain and burning during urination;
Change in urine stream (it becomes thin);
Sexual dysfunction (erectile dysfunction, pain during sexual intercourse, pain during ejaculation);
Redness and swelling of the glans penis;
Frequent urge to urinate;
Increased body temperature;
Pain in the pubic area or lower back.

Residual urine can be suspected if the urge to urinate has become less pronounced and over time the man feels the urge to go to the toilet less often and less intensely.

If these symptoms are detected, you should consult a doctor to determine the cause and prescribe appropriate treatment.

The causes of residual urine can be nervous diseases, infectious-inflammatory or malignant processes in the male genitourinary system. Neurogenic bladder is the main cause of residual urine. With this pathology, the bladder muscles become weak and do not contract; as a result, there is no urge to urinate and, as a result, urine accumulates. Due to muscle weakness, the bladder is unable to empty completely. Neurogenic urinary tract occurs when there is a disorder in the part of the nervous system responsible for urination. At the same time, the pressure remains high and urine flows into the ureters and kidneys. The disease can be combined with a lack of urge, excessive tension in the pelvic muscles when urinating, or painful sensations when going to the toilet. The outcome of this disease is the development of severe kidney pathologies. In addition to the neurogenic bladder, the causes of residual urine are:

Malignant neoplasms in the bladder (with this pathology, blood is observed in the residual urine);
Adenoma or inflammation of the prostate gland;
Inflammation of the bladder (cystitis);
Bladder stones;
Inflammation or narrowing of the urethra.

If residual urine is detected in a man, treatment should be prescribed immediately. Therapy should be aimed at eliminating the cause that caused the appearance of residual urine. In addition, there are basic principles of treatment:

Treatment must be comprehensive and affect all parts of the disease development system;
Continuity of treatment;
Treatment should have minimal side effects.

One of the first symptoms of bladder cancer is the presence of residual urine. Several methods are used to treat malignant neoplasms of this localization:

Surgery. Transurethral resection is a modern method of treating tumors. This method is indicated for tumors that are small in size and do not grow into the muscle layer. Otherwise, bladder resection or partial cystectomy is performed. In later stages, complete removal of the bladder is performed.
Immunotherapy. In this case, the BCG vaccine is injected into the tumor, which significantly slows down its growth and development. This treatment is contraindicated in patients who have tuberculosis of any location.
Radiation therapy. Interstitial irradiation is carried out together with external irradiation.
Chemotherapy. It consists of injecting doxirubicin or etoglucide into the bladder.

These methods will help eliminate the accumulation of residual urine in the bladder

To treat prostate adenoma, it is advisable to use hormonal drugs that reduce its size, as well as herbal preparations. If ineffective, surgical treatment is performed:

Transurethral removal of the prostate gland;
Prostatectomy using an open approach.

In addition, cryodestruction, the use of high temperatures or exposure of the prostate to laser radiation have positive results. To reduce the volume of residual urine, balloon dilatation of the urethra is also used so that urine can flow freely.

Considering that cystitis is an infectious pathology, treatment should be aimed at eliminating the pathogen. For this purpose:

Broad-spectrum antibiotics;
After culturing and determining the sensitivity of microorganisms, the most effective antibacterial drug is prescribed;
In case of cystitis caused by viruses, antiviral drugs are prescribed;
Non-steroidal anti-inflammatory drugs to reduce fever and pain;
Antispasmodics that help relax the tense bladder wall.

It is also necessary to strengthen the immune system with the help of immunomodulators, vitamins and hardening the body.

Bladder stones irritate the bladder wall. As a result, contractile function is impaired and the bladder empties with the formation of residual urine. To treat this disease, there are conservative and surgical methods. For small stones, a diet is prescribed depending on the composition of the stone, as well as medications. However, their effectiveness is low and they only act on stones consisting of urates. To reduce pain and spasms caused by damage to the bladder wall by a stone, analgin and no-shpa are used.

The stones are surgically removed using a cystoscope, which crushes the stones. This type of operation helps to avoid bladder injuries. If this method does not produce results, the operation is performed with open access and opening the bladder.

In addition to surgery, there are non-invasive treatment methods. External lithotripsy helps break up stones using electromagnetic waves. However, this method is not effective in all cases and is not prescribed for large stones.

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.

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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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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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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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.

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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.

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.

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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.

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;

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hydronephrosis. 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.

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.

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

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 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 push out 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

Urinary tract obstruction

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.

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

Diverticulum

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 reasons, causing damage of varying 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.

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.

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 a 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 (in case of urinary tract disease) to restore the patency of the urinary tract;
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.

The process of urination is a combination of the work of the muscles of the bladder (MB), which, when contracted, ensures the removal of fluid, and the sphincters of the urethra, which regulate the retention of urine at the time of its accumulation.

A fairly common symptom encountered in the practice of urologists is the inability of the bladder to contract properly, which leads to the formation of residual urine.

Can urine remain in the bladder after urination?

Normally, in a healthy person, the bladder should be emptied completely. However, for a number of reasons, the process of emptying the organ may turn out to be. Depending on the amount of urine residue, the phenomenon may be considered normal or indicate the presence of pathology in the urinary system.

Residual urine in the bladder in children, men and women is not a disease. If urine remains more than the permissible norm, then this symptom is a manifestation of another pathological process.

The danger of exceeding the permissible level is that the disease that gave rise to this symptom will progress and create serious problems for its carrier in the form of all kinds of complications.

Norms of residual urine in women, men and children

There is an acceptable level of residual urine. If the volume of urine that remains in the bladder after urination does not exceed 10% of the total volume before emptying, then this is a normal phenomenon that does not require medical intervention.

In women, men or children, the amount of urine remaining in the bladder after emptying differs significantly. The permissible value for women and men is no more than 50 ml. For children, the normal balance depends on the age group:

Newborns - up to 3 ml;
Children under 1 year – up to 3-5 ml;
Up to 4 years – 5-7 ml;
Up to 10 years – 8-10 ml;
Up to 14 years – 11-20 ml;
Teenagers 14-18 years old – up to 40 ml.

At the initial stages, excess of the norm usually does not manifest itself as severe symptoms. The patient does not feel pain or significant discomfort. It’s just that the process of emptying the MP occurs a little more often and shorter than usual.

Why might the residual urine deviate from the norm? What could this lead to?

Deviations from the norm are more common in older people. This is due to weakened MP tone. Insufficient contraction of the walls leads to the fact that the organ cannot expel urine in full. This symptom may also appear due to the following factors:

Presence of infection (cystitis, prostatitis, urethritis, etc.);
Anatomical pathologies (as for the male body - prostate adenoma, prostatitis; for the female - urethral adhesions, etc.);
Taking medications whose side effect is weakening the tone of the bladder (diuretics, hormonal, etc. medications);
Nervous overstrain, which leads to weakening of central nervous system control over the process of urination.

If urine is not excreted from the body for a long time, the patient will soon feel a deterioration in health:

Feeling of incomplete emptying of bladder;
Discomfort during sexual intercourse;
Urinary incontinence.

Stagnation of urine leads to increased pressure in the bladder. Ignoring this problem over time leads to all sorts of complications:

MP infection;
The appearance of inflammatory processes in the organs of the urinary system;
Impaired kidney function, pyelonephritis, stone formation, renal failure.

Stagnant urine is a favorable environment for the proliferation of pathogenic bacteria, which can lead to the development of urine, so the symptoms of pathology cannot be ignored; it is necessary to contact specialists in a timely manner.

Diagnostics to clarify pathology

To confirm or refute the diagnosis, it is necessary to accurately measure the volume of residual urine. It is not possible to conduct an accurate study at home, so it is necessary to resort to medical diagnostics.

Analyzes.

First, the doctor must collect anamnesis, palpate the area of the bladder and prescribe general blood and urine tests to the patient.

The method that will determine the volume of residual urine in the bladder is abdominal ultrasound.

But more often an x-ray is performed with a contrast agent. For the data obtained to be reliable, it is necessary that the study be carried out with a full bladder and 5-10 minutes after emptying it. Before diagnosis, the patient must comply with several conditions:

Do not take diuretic medications and significantly exceed the volume of fluid consumed;
Before diagnosis, there should not be a long delay in urination, otherwise the walls of the organ will stretch and after the first void the results may be unreliable.

In practice, not all conditions are always met, which can cause a false positive result, so studies are often carried out several times.

Also used for diagnosis is the catheterization method.

Which is more suitable for adult patients. This method allows you to more accurately determine how much urine remains in the bladder after emptying, but has the disadvantage of requiring the use of a catheter, which can damage the bladder or urethra.

In the early stages of the formation of an increased volume of residual urine, the pathology is easily corrected with the help of drug therapy, but in advanced cases, a more radical method is often used - surgery (), so it is necessary to monitor your health and seek medical help in a timely manner.

Violation of the normal emptying of the organ designed to store urine leads to the formation of residual urine in the bladder. As a result, the patient complains of a constant feeling that the bladder has not emptied completely, because the volume of residual urine normally should not exceed 50 ml. In some cases, this sensation can be eliminated by additional tension of the abdominal muscles, sometimes even catheterization is required. The appearance of such a symptom indicates the need to contact a urologist, who will prescribe an examination. If the patient has a lot of residual urine, this indicates the need for a thorough examination to identify hidden diseases.

Causes of residual urine formation in the bladder

The main reason that the amount of residual urine exceeds the norm is the weakening of a special muscle of the bladder - the detrusor (m. detrusor urinae), the tension of which leads to relaxation of the bladder sphincter and the beginning of the urination process. The following functional disorders or complications after illnesses can contribute to the formation of residual urine in the bladder:

benign prostatic hyperplasia - residual urine in adenoma is caused by compression of the urethra by the prostate enlarging due to the tumor;
persistent narrowing of the urethra (urethral stricture);
the occurrence, due to inflammatory processes, of connective tissue scarring of the bladder neck (sclerosis of the bladder neck);
prostate fibrosis (compression of the urethra and bladder neck);
abnormal congenital folds in the urethra (urethral valve);
neoplasms in the urethra;
diseases of the spinal cord or brain;
chronic urinary retention, which leads to an increase in the volume of residual urine, can be caused by damage to the nervous system;
damage to the innervation system of the bladder, which can also manifest itself in urinary incontinence.

Why is the formation of residual urine dangerous?

Since the rate of residual urine should not exceed 50 ml, it is the excess of this indicator that will indicate to the doctor the need to identify the causes. Diagnosis of the symptom is simple - if the volume is large, palpation and percussion of the suprapubic area is performed. In the event that the excess of the volume allowed by the norm of residual urine is insignificant, an ultrasound of the bladder is performed after urination.

Since residual urine is only a symptom of more severe diseases, identifying this disorder requires the doctor to establish an accurate diagnosis and treatment of the primary disease, since this deviation can lead to:

the occurrence of chronic pyelonephritis;
formation of kidney stones;
development of chronic urethritis;
the appearance of vesicoureteral reflux;
hydronephrosis;
chronic renal failure

Without the intervention of an experienced doctor, it is not possible to get rid of the formation of residual urine in the bladder, which can lead to much worse consequences.

Deviations from the norm are more common in older people. This is due to weakened MP tone. Insufficient contraction of the walls leads to the fact that the organ cannot expel urine in full.
This symptom may also appear due to the following factors:

Presence of infection (cystitis, prostatitis, urethritis, etc.);
Anatomical pathologies (as for the male body - prostate adenoma, prostatitis; for the female - cysts, ureteroceles, urethral adhesions, etc.);
Taking medications whose side effect is weakening the tone of the bladder (diuretics, hormonal, etc. medications);
Nervous overstrain, which leads to weakening of central nervous system control over the process of urination.

If urine is not excreted from the body for a long time, the patient will soon feel a deterioration in health:

Feeling of incomplete emptying of bladder;
Discomfort during sexual intercourse;
Urinary incontinence.

Stagnation of urine leads to increased pressure in the bladder. Ignoring this problem over time leads to all sorts of complications:

MP infection;
The appearance of inflammatory processes in the organs of the urinary system;
Impaired kidney function, pyelonephritis, stone formation, renal failure.

Stagnant urine is a favorable environment for the proliferation of pathogenic bacteria, which can lead to the development of bullous cystitis, so the symptoms of the pathology cannot be ignored and it is necessary to contact specialists in a timely manner.

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.

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.

The structure and mechanism of the bladder

Depending on the amount of urine accumulated, the bladder expands or contracts. The accumulation process itself occurs sequentially. The first urge to urinate appears when 150 ml has accumulated. In adults, the volume of the bladder is 250–500 ml. For some people, the norm reaches 750 ml. The extensibility of the walls of a muscular organ is predetermined by the structural features of the muscles.

Causes

The health of the bladder depends on the processes occurring inside its mucous membrane, and dysfunction of the organ in an adult significantly changes the quality of life. The causes of impaired urination differ depending on gender and due to the specifics of the disease.

A common female problem is cystitis. The disease has an infectious status and is associated with the female anatomical structure. When the mucous membrane becomes inflamed, a symptom appears such as incomplete emptying of the bladder in women. Difficulty urinating in men is associated with inflammatory processes and changes in the prostate or kidneys.

This phenomenon is often observed in childhood. Its key causes are often hidden behind the following dysfunctions in the bladder:

Lack of contractile activity of the walls of the organ, as a result of which the fluid is not expelled in full.
Malfunctions in the functioning of the sphincter, the result of which is stagnation of urine in the bladder.

For medical examinations, the phenomenon of residual urine plays an important role. This is due to the fact that if urine stagnates in the body for a long period of time, a person’s health may rapidly deteriorate. Urinary incontinence is often accompanied by symptoms such as:

Frequent urge to go to the toilet.
Insufficient amount of fluid released.
Infectious processes in the bladder.

This symptom can manifest itself due to various pretexts, and some of them are not even related to pathologies of the genitourinary system. Conventionally, they can be divided into several categories.

Norms of residual urine in women, men and children

Newborns - up to 3 ml;
Children under 1 year – up to 3-5 ml;
Up to 4 years – 5-7 ml;
Up to 10 years – 8-10 ml;
Up to 14 years – 11-20 ml;
Teenagers 14-18 years old – up to 40 ml.

In a healthy man, the emptying of the bladder should be complete. The permissible amount of residue is about 10% of urine, that is, for an adult it is no more than 50 ml. If its volume is higher than the permissible norm, we can say about the development of urological pathologies. To confirm or refute the diagnosis, it is necessary to accurately determine the volume of residual urine.

There may be complete or incomplete urinary retention. With complete retention, even with strong straining, the man cannot excrete urine at all. Partial delay is due to incomplete emptying of the bladder.

Additional signs indicating an increase in the amount of residual urine:

feeling of incomplete emptying after urination;
sluggish stream of urine;
severe straining when urinating;
Possible pain when passing urine.

Characteristic signs and symptoms

Residual urine is just one of the various symptoms found when the genitourinary tract becomes blocked and becomes inflamed. But if its appearance is associated with neurological disorders, then such a problem is much more difficult to detect, in particular, if the problem is in a small child.

If before this you felt like a healthy person, then the first sign of urinary retention will be the presence of a sluggish urge to urinate. This symptom develops gradually, like organ atony. This can be felt by several signs.

If you have a diverticulum, there will be no pressure or pain, but urination will occur “in two steps.” First a large portion will come out, and then a meager one. This process occurs because first the bladder itself is emptied, and then the diverticulum that appears there.

Diagnostics

Analyzes.

First, the doctor must collect anamnesis, palpate the area of the bladder and prescribe general blood and urine tests to the patient.

The method that will determine the volume of residual urine in the bladder is abdominal ultrasound.

Do not take diuretic medications and significantly exceed the volume of fluid consumed;
Before diagnosis, there should not be a long delay in urination, otherwise the walls of the organ will stretch and after the first void the results may be unreliable.

In practice, not all conditions are always met, which can cause a false positive result, so studies are often carried out several times.

Also used for diagnosis is the catheterization method.

In the early stages of the formation of an increased volume of residual urine, the pathology is easily corrected with the help of drug therapy, but in advanced cases, a more radical method is often used - surgery (cystostomy of the bladder), so it is necessary to monitor your health and seek medical help in a timely manner.

To determine this indicator, medical diagnostic methods should be used. Independent determination of the level of residual urine is impossible. The most common methods of examination are bladder catheterization and abdominal ultrasound.

The simplest and most accurate method of determination is the insertion of a catheter. This method is used for adults. To determine the indicator in childhood, ultrasound is used. During this procedure, the specialist takes measurements of the width, height and length of the bladder.

This process consists of several neurological, urological, laboratory tests and interviews. When you first visit a urologist, you will be prescribed the following procedures.

Ultrasound of the bladder and pelvic organs. This study is carried out in two phases. The first is when the bladder is full to measure its volume and size. The second ultrasound is 5-10 minutes after emptying. To ensure accurate results, calculations are carried out at least three times. There are special formulas for calculating the amount of liquid, which require the following parameters:

height;
width;
length of the ultrasound shadow of the bladder.

If the patient is currently taking diuretics, or before the examination, drank drinks or ate foods that could irritate the organ for examination, then the doctor must be warned about this, since the diagnosis may be erroneous due to these influencing factors.

Ultrasound is considered a non-invasive method, since the rate of residual urine in men and women is not determined accurately. But it is used more often due to its general availability.

Clinical analysis of blood and urine, urine culture to determine bacterial infection.

Cystoscopy and contrast urography – if necessary. The first type of examination is prescribed as a last resort, as it is quite traumatic. But it quite accurately indicates the volume of residual urine, if any was detected.

Do not forget that the calculation of volume and urine analysis for prostatitis and other diseases in which this symptom appears may turn out to be erroneous during ultrasound and other examinations due to nervous strain.

It is impossible to independently determine the volume of residual urine. To do this, they resort to research methods such as bladder catheterization and abdominal ultrasound.

Quite often the diagnosis gives false positive results. The fact is that normally it is carried out within 5 minutes after urination. But, as a rule, more time passes between visiting the toilet and the examination and a new portion of urine has time to accumulate in the bladder.

Treatment of cystitis

Residual urine is not a separate disease, but only one of its symptoms. In order for there to be a normal bowel movement, it is necessary to eliminate the factor that violates it. The following measures may be taken.

Removing the inflammatory process.
Restoration of urinary tract patency. An operative or conservative method can be chosen.
Normalization of bladder contractility.

For neurological disorders, more complex therapy will be required. Both surgical and medical methods can be used here.

If you are diagnosed with bladder atony, the doctor will prescribe medications that restore contraction skills. When the organ spasms, muscle relaxants are prescribed. If they do not help, then a surgical procedure called selective dorsal rhizotomy is performed. During this, the doctor isolates the bundle of nerves of the spinal cord - only those that are responsible for the spastic contraction of the bladder, and dissects them.

The main thing is to adhere to complex therapy, which will act not only on the symptoms, but also on their causes.

If you identify these symptoms, be sure to consult a doctor, because only he can correctly diagnose the problem and prescribe appropriate treatment.

Treatment must be comprehensive and affect all parts of the disease development system;
Continuity of treatment;
Treatment should have minimal side effects.

One of the first symptoms of bladder cancer is the presence of residual urine. Several methods are used to treat malignant neoplasms of this localization:

Surgery. Transurethral resection is a modern method of treating tumors. This method is indicated for tumors that are small in size and do not grow into the muscle layer. Otherwise, bladder resection or partial cystectomy is performed. In later stages, complete removal of the bladder is performed.
Immunotherapy. In this case, the BCG vaccine is injected into the tumor, which significantly slows down its growth and development. This treatment is contraindicated in patients who have tuberculosis of any location.
Radiation therapy. Interstitial irradiation is carried out together with external irradiation.
Chemotherapy. It consists of injecting doxirubicin or etoglucide into the bladder.

These methods will help eliminate the accumulation of residual urine in the bladder

To treat prostate adenoma, it is advisable to use hormonal drugs that reduce its size, as well as herbal preparations. If ineffective, surgical treatment is performed:

Transurethral removal of the prostate gland;
Prostatectomy using an open approach.

Considering that cystitis is an infectious pathology, treatment should be aimed at eliminating the pathogen. For this purpose:

Broad-spectrum antibiotics;
After culturing and determining the sensitivity of microorganisms, the most effective antibacterial drug is prescribed;
In case of cystitis caused by viruses, antiviral drugs are prescribed;
Non-steroidal anti-inflammatory drugs to reduce fever and pain;
Antispasmodics that help relax the tense bladder wall.

It is also necessary to strengthen the immune system with the help of immunomodulators, vitamins and hardening the body.

Bladder stones irritate the bladder wall. As a result, contractile function is impaired and the bladder empties with the formation of residual urine.

To treat this disease, there are conservative and surgical methods. For small stones, a diet is prescribed depending on the composition of the stone, as well as medications.

However, their effectiveness is low and they only act on stones consisting of urates. To reduce pain and spasms caused by damage to the bladder wall by a stone, analgin and no-shpa are used.

The stones are surgically removed using a cystoscope, which crushes the stones. This type of operation helps to avoid bladder injuries. If this method does not produce results, the operation is performed with open access and opening the bladder.

To get rid of residual urine, you need to restore the patency of the urethra.

Since the pathological condition is a symptom and not a separate disease, normal urination can be restored only after its root cause has been eliminated:

conservatively or surgically restore urinary tract patency;
stop the inflammatory process;
normalize the contractile function of the organ.

Etiotropic therapy

Its main task is to cure the disease that led to residual urine. For bladder atony, medications are prescribed to restore the ability to contract. For spasms, it is recommended to take muscle relaxants. If they do not have the desired effect, selective dorsal rhizotomy is performed. This is a dissection in the bundle of nerves of the spinal cord that provoke spastic contraction of the organ.

If incomplete emptying in men is caused by cystitis, treatment should include taking antibacterial drugs, which the doctor selects based on the type of pathogen. Antibiotics from the group of macrolides and fluoroquinolones are effective. Additionally, antispasmodics, diuretics, vitamins, immunomodulators, and dietary nutrition are prescribed.

For urolithiasis, treatment consists of removing the stones. Depending on the type, size, and shape of the stones, the doctor may prescribe conservative therapy using stone-dissolving drugs.

But in most cases, surgical intervention is used, since drug therapy is ineffective in the presence of large formations and those that cannot be dissolved. An effective surgical treatment method is lithotripsy (crushing stones using ultrasound or laser).

The operation is low-traumatic and does not violate the integrity of the patient’s skin. Recovery after crushing occurs fairly quickly, without serious consequences.

To treat narrowing of the urethra, bougienage is often used - the insertion of special instruments into the urethra that widen it. This method does not eliminate the main cause of the narrowing and gives only a temporary effect.

Catheterization

When a large amount of fluid accumulates in the bladder and it is impossible to empty it naturally, you have to resort to the catheterization method - inserting a rubber catheter into the urethra. The procedure is performed by a doctor in a hospital. Self-insertion of a catheter at home is prohibited - there is a high risk of bladder infection.

First, the urethral opening is treated with a disinfectant. The catheter is moistened with glycerin and inserted into the urethra using tweezers. Movements should be made progressively, gradually moving 2 cm at a time. The catheter should not be forcibly pushed forward. For some diseases (for example, urolithiasis), such a procedure can lead to serious consequences.

Medical therapy

In advanced situations, therapeutic measures consist of inserting a rubber catheter and removing excess urine from the bladder artificially. Such therapy is possible only in a hospital setting; self-medication is unacceptable. At home, it is impossible to correctly place a catheter in the urethra.

This device is introduced for 2-3 days; it must be constantly treated with various antibacterial agents (Nitroxoline, Furadonin).

Treatment at home involves treating the external genitalia with heated water, this stimulates urination and elimination of excess urine. If this method is ineffective, Novocaine or another drug prescribed by the doctor is injected into the urethra. It is not recommended to insert a catheter at home; this can lead to infection of the organ and the development of additional inflammatory processes and infections.

It is important to seek medical help in a timely manner. This will make it possible to carry out less painful treatment and prevent pathological and inflammatory processes in the kidneys.

Possible complications

If a person suffers from urinary dysfunction, but does not visit a doctor, ignoring this problem, various pathological processes often develop in his body.

Congestion in the bladder can cause various inflammatory and infectious processes of a urological nature, such as:

The appearance of chronic pyelonephritis.
The formation of stones in the kidneys, such a disease can only be cured with the help of surgery.
Urethritis.
Hydronephrosis.
Dysfunctions in the kidneys.
Kidney failure.

If you consult a doctor in a timely manner, it is possible to eliminate the problem of congestion in the organ by taking medications. If the disease is at an advanced stage, the person will require hospital treatment. To completely recover, they resort to surgical treatment.

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Causes of residual urine in the bladder. Urine residual in the bladder: norm, definition, treatment

Causes

Symptoms

Diagnostics

Emergency bladder emptying

Treatment

Can urine remain in the bladder after urination?

Norms of residual urine in women, men and children

Why might the residual urine deviate from the norm? What could this lead to?

Diagnostics to clarify pathology

Causes of residual urine formation in the bladder

Why is the formation of residual urine dangerous?

The structure and mechanism of the bladder

Causes

Norms of residual urine in women, men and children

Characteristic signs and symptoms

Diagnostics

Treatment of cystitis

Etiotropic therapy

Catheterization

Medical therapy

Possible complications

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