Dysury, (from painful, and urine). A difficulty of voiding the urine; stillicidium, ardor urinae, culbicio, obstruction, heat, difficulty of voiding urine, and strangury.
A total suppression is called ischuria; a partial suppression dysuria; and this may be with or without heat. When there are frequent painful or uneasy urgings to discharge the urine, and it passes off only by drops, or in very small quantities, the disease is called a strangury. When a sense of pain or heat attends the discharge, it passes with difficulty, and is styled heat of the urine.
The dysuria is acute or chronic. Dr. Cullen places this disease is the class locales, and order epischeses, and defines it, a painful, and by some means impeded, emission of urine. He distinguishes six species.
1. Dysuria ardens, when the urine burns in passing off, and there is not any evident disorder in the bladder.
2. Dysuria spasmodica, when a spasm affects the parts which communicate with, and are communicated to, the neck of the bladder.
3. Dysuria compressionis, from parts contiguous pressing on the bladder.
4. Dysuria phlogistica, when the parts around are inflamed.
5. Dysuria irritata, when there are signs of a stone in the vesica.
The causes are various: as, caruncles in the urethra; a stone in the neck of the bladder, or in the urethra; spasm, or inflammation in either; acrimony in the urine, abrading the mucus from either; the venereal disease, and the scurvy; and ulcer, or a deficiency of mucus for lubricating the urinary passages. The chronic dysury is generally occasioned by a metastasis of gout; sometimes, it is said, of scurvy, or rheumatism; but we know distinctly of no such effect, except from gout, or the irritation of a stone. Catarrhus vesicae sometimes leaves a tender state of this organ easily excited to inflammation by accidental cold; by excess in the use of spirituous liquors; and from hence, perhaps, sometimes supposed to be rheumatic.
The diagnostic signs of a dysury sometimes so much resemble those of a stone in the bladder, that no little difficulty attends the distinction, especially when the dysury is of the chronic kind. However, in general, the difficulty of discharging urine is unattended with pain or heat, except during the endeavours to void it, or its actual passing off; and for a short time the pain perceived afterwards is in the glans, a circumstance not so particularly attendant in the stone: in the chronic dysury, bloody urine is more frequently caused by exercise, and voided in large quantities after violent exertions than in calculus; the pain does not come on in violent paroxysms without an evident cause; tenesmus more seldom attends; nor is the flow of urine, when begun, at once checked.
Heat of urine does not arise from an increase of its natural heat; but from its irritating a tender, and often an inflamed, part. If the burning heat proceed from acrimony in the urine, it will be known by the high colour and paucity of the discharge, or from a mixture of unusual matter.
Blood, and sometimes pus, when in contact with the neck of the bladder, produce violent pain. The discharge of mucus appears rather to be the effect than the cause of pain; but, in both, the pain is felt at the extremity of the glans, for, when any membrane is affected, the irritation is chiefly felt at its most sensible termination: thus irritation, in any of the small branches of the aspera arleria, is sensible only at its upper part; and a stone, even in the pelvis of the kidney, is felt at the extremity of the glans penis.
The dysury is not a dangerous disorder, but it is both troublesome and difficult of cure, particularly in the aged. The principal distinction necessary in this disease is, to ascertain the nature of the discharge. Dysury is usually-attended with a mucous sediment in the urine, which is sometimes mistaken for pus. The mucus is, however, white, light, and flocculent, without smell: pus more filamentous, heavy, and of a greenish colour, with, generally, some fever; often remitting.
The cure must greatly depend on the cause. We have remarked that we seldom perceive the influence of acrimony except in gout; we meant of acrimony generated in the constitution, for large quantities of spices, even of spirits, particularly gin, will produce it; and the stimulus of cantharides from a blister is a very common cause. In every instance of dysuria, dilution is necessary; and it is of service to give the diluting liquors in a mucilaginous form. Gum arabic, the altheae root, the jelly of the orchis (salep), infusion of linseed, of oatmeal, and barley, have been employed. There is little foundation for choice, since each is effectual, in proportion to its quantity of mucilage; and in this respect they do not generally differ: the gum arabic, in barley water, is as effectual as any other; but from one to two ounces of the gum should be taken daily. An elegant form of althaea, styled pate de Gaim-auve, we have found very useful; more so, perhaps, because it is pleasant, and taken, on that account, more freely. Injecting these fluids is useless, for the injection does not, penetrate far into the urethra; and, except in cases of gonorrhoea, the seat of the complaint is very distant.
Bathing the penis, and particularly its glans, will often relieve, by communicating the relaxation to the vessels above, the only way in which injections can be useful; and warm brandy, or other stimulant applications to the perinaeum,willbe often beneficial. A blister to that part, removed before any of the cantharides can be absorbed, is equally effectual. A starch clyster, with opium, may be considered as an external application, since it is external to the part affected, and often almost immediately relieves.
Internally, opium and camphor are highly useful. The cooling power of the latter is very soon felt in the urinary organs, and it appears to be quickly effectual. In the form of Dover's powder we have found the opium particularly useful. Cooling laxatives and diuretics, which operate without any stimulus, particularly the neutral purging salts, often relieve. Nitre, which seems in almost every view useful, is suspected of sometimes irritating the neck of the bladder. If employed, it should be given in small quantities, copiously diluted, and generally with camphor. Oil has been recommended, and particularly olive oil, as a laxative; but is is not peculiarly beneficial: the balsams, except in chronic dysury, from weakness, are generally injurious. When dysury arises from caruncles, bougies are necessary.
In the chronic dysury, after other means fail, a salivation excited by the use of mercury has succeeded; and an issue in the inside of one thigh, a little above the knee, is said to have prevented the return, or at least rendered relapses very moderate; and this effect may, perhaps, follow, if the disease arises from gout. When the patient is too weak to admit of salivation, a dose of the uva ursi may be taken every morning, and after it half a pint of lime water, mixed with a strong decoction of the great water-dock root. The uva ursi, however, though warmly recommended in this complaint, has seldom succeeded in our hands, and never except it be taken in enormous doses.
Dr. Percival observes, that there is a species of chronic dysury to which persons of an arthritic or scorbutic habit, and who have passed the meridian of life, are peculiarly liable. It is often mistaken for the stone, and aggravated by the use of lithontriptics. He adds, that it hath many symptoms in common with that disorder: such as frequent and urgent calls to make water; pain at the extremity of the urethra; a mucous discharge; tenesmus, and sometimes a suppression of urine. But the patients who labour under it feel no uneasy weight in the perinaeum, and always void their water with much less difficulty in an erect than in a horizontal posture. The complaint, also, may be further distinguished from the stone, by having shorter intervals of ease; by more frequently injuring the retentive power of the bladder; and by occasioning no sudden interruption to the stream of urine in the absence of pain. It seems to arise from a catarrh on, and increased sensibility of, the coats of the bladder, as we have already explained. The efforts to discharge the urine should, however, be restrained as much as possible, because they increase the pain and irritation. Of all the remedies which Dr. Percival tried, he says that mercury was the most successful; it seldom failed to afford re lief, and generally cured, if administered with perseverance and in sufficient quantity. According to the urgency of the case, one, two, or three scruples of the ung. hydrargyri fortius should be rubbed into the thighs every night,till a slight ptyalism ensues: the symptoms for the most part abate before the spitting comes on; and after it has continued a little while, they disappear. Sometimes, in slighter cases, he advises half a grain of calomel, with two grains of James's fever powder, twice a day; and this small dose of mercury, if duly continued, will effect a cure, without producing any salivation, or even soreness of the mouth. In such cases, however, an affection of the prostate gland may be suspected to have been the cause; and it so frequently occasions chronic dysury, that its state should be always ascertained by examination, if chronic dysury is obstinate. See Lond. Med. Journ, vol. iv. p. 69.
Violent heat in the urinary passages of women has been cured by the use of the bark.
See the authors under the article Ischuria; Biss's Essays; Lobb on Painful Distempers; Gooch's Cases and Remarks, vol. ii.