The Symptoms of Stricture. To an observant patient the first symptom to present itself is usually a gleety discharge of mucus, or of mucus mixed with pus, which comes from the meatus in the morning, or at intervals throughout the day. He will probably very soon notice that the stream of urine has become narrower than it should be, and divided into two or three jets, or perhaps given a peculiar screw shaped twist. If the stricture is well advanced there will probably be a constant dribbling away of urine, so that the unfortunate man must wear cloths to receive it. This is due to the fact that the dense and inelastic stricture tissue does not permit the urethra to firmly close, and the urine escapes in drops through the more or less rigid tube.
Long after a gonorrhoea has been supposed to be cured the patient may, on account of an unrecognized stricture, complain of uneasiness or actual pain in the penis and peri naeum, and especially at the end of the penis.
Sometimes the patient notices that he is required to make greater straining efforts in order to expel his urine; but this symptom eventually passes away in a few weeks, since the bladder walls become thickened and hypertro phied in order to overcome the increased resistance which the stricture offers to the flow of urine.
An unobservant person might not notice these symptoms unless they were very well marked.
As the disease becomes more advanced the bladder becomes so irritable, as a rule, that the sufferer must rise very frequently during the night in order to urinate, the act being accompanied with pain. Sometimes he must strain for a long time before he can start the flow of urine, and when it does come it may suddenly stop before he has emptied the bladder. In many cases of stricture the first thing to attract attention to the trouble is the alarming symptom of "retention of urine", or the inability to void urine, which may have been brought about by exposure to cold, a drinking bout, indiscretions in diet, or by any cause which inflames the bladder and urethra. The stricture may have been present for months, but in these cases does not, perhaps, manifest itself until irritation is produced from some cause or other.
There is hardly any symptom which is so likely to terrify the patient as this for he knows that every moment will make his condition worse instead of better, and that his very life depends upon his emptying his bladder. Some men who have stricture suffer with retention of urine almost every time they go on a spree, while others never have it. This is due to the fact that retention is more frequent when the stricture is situated far back in the urethra behind the peno-scrotal angle, and very infrequent when the trouble is in the anterior part of the canal.
Some patients, on the other hand, suffer from "incontinence of urine", or the inability to retain their urine. This is especially frequent in cases of very tight stricture where the canal is much reduced in calibre. In this condition the bladder is never completely emptied the patient being relieved of the imperative desire to urinate by the passage of only a part of the secretion. Incontinence of urine is due to a paralysis of the external sphincter vesicas and compressor urethra, muscles, the function of which is to keep the neck of the bladder and the urethra firmly closed until the individual voluntarily decides to urinate.
When this miserable condition of incontinence exists the bladder never being completely emptied, the retained urine becomes foul and ammoniacal and sets up severe inflammation in the bladder, which ultimately extends to the kidneys. The overflow of urine continually dribbles away, keeping the genital organs and thighs constantly wet, so that the patient has a markedly urinous odor about him.
In some of these cases the urine accumulates to such % > degree that it gives rise to distention of the bladder. A this distention increases the walls of the bladder become paralyzed and lose their power of contracting, so that after a time the amount of urine becomes so great that it overflows, and finds its way out involuntarily. This condition Gross called the "incontinence of retention", and in such cases the bladder may become so greatly distended as to reach as high as the navel.
Important changes also take place behind the stricture. Owing to the mechanical impediment to the flow of urine, that part of the urethra behind the stricture dilates, so that sometimes a pouch is formed. The increased hydrostatic pressure and the irritating properties of the foul urine cause ulcerations in the posterior urethra, and eventually a few drops of urine percolate into the tissues through the spots where the mucous membrane has been eroded. This starts an abscess in that region, and the urine will now burrow under the skin and ultimately force its way out by fistulous openings either in the perineum or on the surface of the scrotum, or thighs, or as high up on the belly as the navel.