Elderly incontinence
Summary/Definition
Urinary incontinence means involuntary discharge of urine. This condition occurs in 35-40% of adult women and in 2.1–5.7% of adult men. Among the elderly, the incidence is the same for both men and women. Urinary incontinence can significantly reduce the quality of life and can cause additional health problems, such as urinary tract infections. There are various types of urinary incontinence, including urgent urinary incontinence, stress urinary incontinence, functional urinary incontinence, and overflow urinary incontinence. The causes of urinary incontinence are related to age and associated diseases. Deterioration of bladder function due to aging can be divided into changes occurring in the central nervous system and changes associated with peripheral organs. The central nervous system controls urination and retention of urine, and various degenerative diseases of the central nervous system, strokes or injuries of the central nervous system resulting from accidents can cause various symptoms of urinary incontinence. On the other hand, aging also affects peripheral organs, including the bladder and urethra, which play an important role in the process of urination and retention of urine. As a result of aging, the following changes may occur: a decrease in the contractility of the detrusor muscle, a decrease in the capacity of the bladder and a decrease in the rate of urine flow.
The causes of urinary incontinence in the elderly are very diverse, but, in general, they can be classified as neurological diseases and anomalies of peripheral organs. Neurological diseases include stroke, Parkinson’s disease, meningitis, myelitis and pelvic nerve damage. These conditions can contribute to excessive bladder contractions and cause urinary incontinence. Anomalies of peripheral organs, in turn, include changes in the bladder, prostate and urethra. These changes can lead to a decrease in the ability of the bladder to retain urine or to a narrowing of the urethra, which also contributes to urinary incontinence. In addition, urinary incontinence with overflow may occur in the event of a violation of the systemic functions of the body due to serious surgical interventions or other internal diseases. Usually this condition improves as physical health is restored. Diseases of the peripheral organs can also cause urinary incontinence. For example, this may include benign enlargement of the prostate gland, stress urinary incontinence, overactive bladder and decreased contractility of detrusor muscles.
Symptoms
In everyday life, the symptoms relate to urinary incontinence.
Diagnostics
Urinary incontinence in the elderly can occur for various reasons, and one of the common symptoms is difficulty urinating. Since it is difficult to diagnose and treat the cause based only on the patient’s symptoms, it is important to go to the hospital as early as possible and undergo diagnosis and treatment. Urinary incontinence can cause not only its inherent symptoms, but also other mental disorders, such as depression. Therefore, it is important to take the initiative, for example, to discuss this problem with loved ones and relatives, and not to consider it as something that needs to be hidden because of shame or discomfort. In serious cases, it is important to contact a medical institution and get professional advice from a doctor. Since urinary incontinence in the elderly can manifest itself without pronounced disorders of the bladder and urethra, it is also important to establish whether there was any special event that could provoke this symptom. In addition, given that many elderly people regularly take medications to treat high blood pressure, diabetes, arthritis and other chronic diseases, the effects of these medications on urination function should be taken into account. Therefore, it is important to collect an anamnesis regarding medications taken by elderly patients.
In addition, it is necessary to diagnose the underlying disease that caused urinary incontinence. Depending on the nature of the concomitant disease, various checks can be carried out, including anamnesis collection, physical examination, assessment of symptoms, clinical tests, urine flow test, imaging, urodynamic studies, endoscopy and ultrasound examination of the prostate gland.
Treatment and course of the disease
Treatment of each causal disease that causes urinary incontinence.
If a neurological disease causes urinary incontinence, then, despite the possibility of relieving or improving symptoms with medication, it should be remembered that the symptoms of urinary incontinence are unlikely to improve until progress is made in the treatment of neurological disease. In the case of prostatic hyperplasia, medications such as alpha-1 blockers, 5-alpha reductase inhibitors, etc. are used. Surgical intervention may also be required, including methods such as transurethral predialectomy, photo-selective predialectomy, holmium laser prostatectomy, etc. Surgical treatment of urinary incontinence may be required to completely cure stress urinary incontinence. Pelvic floor exercises, electrostimulation therapy, biofeedback and extracorporeal electric field therapy are also performed. In the case of an overactive bladder, spontaneous contraction of the bladder is suppressed by antimuscarinic drugs, and it is also recommended to make lifestyle changes and exercise the bladder. In case of ineffectiveness of drug treatment, sacral neurography or intravesical botox injection may be required. Reduced detrusor muscle contraction can make it difficult to improve symptoms, and in such cases, periodic clean catheterization may be necessary.
