Clinically, patients with anorectal diseases often experience difficulty urinating after surgery, which is medically called urinary retention. It usually occurs 4-6 hours after surgery, manifested as poor urination, urinary waiting, and dysuria. Middle-aged and elderly men, especially those suffering from prostate hyperplasia and hypertrophy, are more prone to postoperative urinary retention.
What are the main factors that cause dysuria after surgery?
1. Anesthesia factors
The bladder and urethra are adjacent organs of the anus, and some of the nerve fibers that innervate them intersect each other. Therefore, when performing anesthesia for anorectal surgery, the nerves in the anus are anesthetized, and the nerves in the bladder and urethra are also affected by anesthetics. When the anesthesia is not relieved, there will be temporary dysuria, and as the anesthetic gradually loses its effect, the urination function will gradually return to normal.
2. Surgical factors
Some muscle fibers between the anal sphincter and urination-related muscle groups are intertwined, interact and influence each other. After anorectal disease surgery, the anal sphincter is stimulated by surgery, pain, and defecation, which will cause the anal sphincter to spasm and contract, and this spasm contraction is connected with the nerves that innervate the bladder and urethral sphincter through nerve conduction. Therefore, when the anal sphincter is contracted by spasm, the sphincter of the urethra and bladder will also contract spasmodically, resulting in dysuria and urinary retention. After anorectal diseases, local wounds often need dressings to compress and stop bleeding, and these compressive dressings will compress the prostate and urethra and cause dysuria.
3. Other factors
After anorectal diseases, it is often necessary to stay in bed for several hours due to the effect of anesthesia, and some patients have temporary dysuria because they are not used to urinating in bed. Other patients have poor urination or difficulty urinating due to psychological factors.
How to deal with dysuria after surgery?
1. For mentally stressed patients, they should do a good job of comfort and eliminate fear. Because the more nervous the patient, the more difficult it will be to urinate;
2. Before surgery, you can carry out bed urination training;
3. The anal dressing is suitable for packing and compression. When the patient has difficulty urinating, the dressing can be removed to relieve symptoms;
4. For patients with benign prostatic hyperplasia or urethral stricture, please consult the urology department for proper treatment before surgery, and give some medications to help urination after surgery;
5. For patients with obvious pain in anal wounds, local drug suppositories can be administered to the anus, or oral analgesics can be given;
6. Warm water and compress the lower abdomen or perineum area and massage the bladder area;
7. Acupuncture treatment;
8. Indwelling urinary catheterization Indwelling urinary catheterization can quickly and effectively relieve the symptoms of dysuria, but it is often found clinically that patients have difficulty urinating again after the catheter is removed 24 hours after anorectal surgery. In the short term, urinary tract infection with indwelling catheter again is proportional to the frequency of injury, and the chance of urinary tract infection increases. The treatment team of our department believes that the above situation has the following reasons through observation and analysis of large cases:
(1) Discomfort symptoms such as pain and bulging of anal wounds were not significantly relieved 24 hours after the operation.
(2) The damage to the urethral mucosa was not recovered when the catheter was indwelled.
(3) The function of bladder sphincter is not fully recovered.
(4) Middle-aged and elderly male patients, especially those with prostate hyperplasia and hypertrophy, are more likely to occur. In view of the above factors, we generally give indwelling catheterization to patients with dysuria after anorectal surgery for 72 hours, and at the same time, assist in the application of drugs to relieve urethral spasm and acupuncture treatment in the bladder area. The probability of having difficulty urinating again after the catheter is removed by the above methods is greatly reduced, and the pain caused by multiple catheterizations of the patient is reduced.