PARALYSIS OF THE SPHINCTER 93 



urinate, pain, great discomfort, and anxious ex- 

 pression are evidence of the trouble. Upon exami- 

 nation the bladder is found to be quite full and 

 often enormously distended. If not relieved, rup- 

 ture is almost always the result, although in some 

 cases the patient dies, exhibiting symptoms of 

 uremic poisoning. The symptoms of rupture of 

 the bladder are sudden collapse, constant pain, the 

 presence of fluid (urine) in the abdominal cavity, 

 and upon examination (palpation and catheteriz:a- 

 tion) the bladder is found to be empty. 



Treatment. — As soon as spasm of the sphincter 

 vesicae is recognized the bladder must be emptied, 

 great care being taken, because of the danger of 

 rupture, that the patient does not struggle. If any 

 difficulty is experienced in passing the catheter the 

 attempt should be abandoned and the bladder 

 emptied by puncturing it through the abdominal wall 

 with a fine trocai^ and cannula. The puncture is 

 made immediately anterior to the os pubis, just to 

 one ^ide of the penis in the male and in the median 

 line in the female. In any event, when the catheter 

 is being passed or when the trocar is being inserted 

 the patient should be in a standing position. 



Hyoscyamin sulphate, 1-60 to 1-30 of a grain, or 

 tincture of hyoscyamus, one half to four drams, 

 should then be given to overcome the spasm. 



Paralysis of the Sphincter Vesicae 



The condition is often associated with chronic 

 cystitis, continued overdistention causing weakening 

 of the bladder walls and spasm of the sphincter. 

 Spinal diseases, general debility, and old age are 

 further causes. 



Symptoms. — Constant dribbling of urine, while 

 upon examination the bladder is found to be empty, 

 is evidence of paralysis of the sphincter. 



