Thursday, December 31, 2009

Thursday, December 17, 2009

Urinary Incontinence in Seniors

Urinary incontinence is the leaking of urine from the bladder. It’s especially common in women, especially those who have had children. Urinary incontinence (UI) is a common but poorly understood problem in the elderly population.

Causes of Urinary Incontinence

Temporary incontinence:A number of conditions can cause temporary incontinence, including urinary tract infections, excess fluid intake, constipation, severe depression, and restricted mobility, drugs like alpha–adrenergic, caffeine, sedatives, anti–depressants, anti–psychotics, and anti–histamines.

Stress incontinence:Stress incontinence is caused by poor functioning of the urethra and sphincter muscles. The weakening and stretching of the pelvic floor muscles allows the bladder to sag down within the abdomen. This sagging pulls the bladder neck and changes its angle in relation to the urethra which prevents the internal sphincter from closing completely. In severe cases the sphincter itself may tear. This occurs when urine leaks during exercise, coughing, sneezing, laughing, lifting heavy objects or other body movements that put pressure on the bladder. Women who have had several children through vaginal deliveries are particularly at risk for stress incontinence, because pregnancy and childbirth strain the muscles of the pelvic floor. Hysterectomy, which may damage the pelvic floor muscles, the sphincter itself, or the nerves which make the sphincter muscles to contract, is a common cause of stress incontinence in women. After menopause, the loss of estrogen causes the urethra to thin out so that it may not close properly, thus causing incontinence. Prostate surgery is a leading cause of stress incontinence in men. Both surgery and radiation treatment for prostate cancer commonly cause incontinence.

Urge incontinence:In urge incontinence, the bladder contracts more frequently than normal which can be due to infections, anxiety, the normal aging process, damage to the central nervous system caused by stroke, multiple sclerosis, and Parkinson’s disease causing the bladder to become over–active. An outer layer of muscle fiber, called detrusor muscles, becomes unstable and contracts inappropriately. It can also be a warning signal of early bladder cancer. In men, it is often a sign of an enlarged prostate.

Overflow incontinence:Overflow incontinence is the result of an impediment to the normal flow of urine out of the bladder. It can be caused by tumors, medications, benign prostatic hyperplasia, or scar tissues. Overflow incontinence may also be caused by spinal cord injuries or diseases such as diabetes, and multiple sclerosis which can desensitize the nerves so much so that they fail to sense fullness and don’t trigger off the contraction of the bladder.

Functional incontinence:In functional incontinence, the urinary system is itself normal, but the patient cannot use it properly because of severe physical disorders, such as in Parkinson’s disease, or mental diseases, including Alzheimer’s disease and other forms of dementia, as there is failure in recognition of the need to void and locating a bathroom.

Diagnosis of Urinary Incontinence

The first and most important step in treating bladder control problems is to see a doctor for a complete medical examination. The doctor will ask for a detailed history of your health and put you through a physical examination. The doctor may want to check your urine samples. You may be referred to a urologist, a doctor who specializes in diseases of the urinary tract, or to a gynecologist, a specialist in the female reproductive system.

Treatment of Incontinence

  • Behavioral techniques such as pelvic muscle exercises, biofeedback and bladder training can help control urination. These techniques can help you sense your bladder filling and help delay voiding until you can reach a toilet.
  • Anticholinergic agents inhibit the involuntary contractions of the bladder, increase its capacity. They are useful in treating urge incontinence.
  • Antispasmodic drugs help relax the bladder muscle and are used for urge incontinence.
  • Alpha–adrenergic agonists are used to strengthen the smooth muscle that opens and closes the internal sphincter and are most effective in patients with stress incontinence not caused by nerve damage.
  • Retropubic suspension is used in stress incontinence to correct the position of the bladder and urethra by sewing the bladder neck and urethra directly to the surrounding pelvic bone or nearby structures.
  • For severe stress incontinence, a sling procedure is preferred. The procedure is performed through the vagina and also through a small incision in the abdomen. A piece of body tissue or synthetic material is attached under the urethra and bladder neck, and then secured like a sling to the abdominal wall and pelvic bone. This sling then compresses the urethra back to its original position.
  • You can get special absorbent underclothing that is no more bulky than normal underwear and can be worn easily under everyday clothing.

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