On diseases of the bladder and prostate gland / By William Coulson.

  • William Coulson
Date:
1840
Catalogue details

Licence: Public Domain Mark

Credit: On diseases of the bladder and prostate gland / By William Coulson. Source: Wellcome Collection.

    92/310 page 66
    muscle lias lost its power, and the urine cannot be discharged by the patient, though no obstruction exists. We are further to recollect, that the other power that so mainly assists in the evacuation of the bladder, I mean the action of the abdominal muscles, is counteracted in its effects by the ab- normal position of the bladder. Though all the muscles of the abdomen assist by their contraction in the expulsion of the urine, still this is more particularly accomplished by the compression made immediately over the bladder by the lowest or hypogastric sections of the recti muscles. Now, when the bladder, through distension, rises as high as the umbilicus, any contraction of these sections, instead of pressing the urine downwards against the sphincter vesicse and overcoming its resistance, pushes the urine in an opposite direction, from the axis of action being changed. Patients, therefore, ought never to resist the first desire to make water. When the bladder is distended to a certain degree, the urine will sometimes flow off involuntarily; and it has happened, at this stage, that the paralysis has been overlooked, especially in corpulent persons, and incontinence has been supposed to exist, whilst in reality, the bladder was full and could hold no more. In the case, therefore, of a person who complains of not being able to hold his water, and especially in that of an old person, in whom the water is flowing off involuntarily, the surgeon ought not to give any opinion till after he has laid the hand upon the abdomen, and felt whether the
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