Sunday, November 27, 2022

Urinary Incontinence In Elderly Female

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Private Duty Nursing Services

Urinary Incontinence in Women | Dr. Prabir Basu

Sometimes, seniors need help with more than daily living tasks and require a licensed medical professional. Centric Healthcare offers the services of private duty nurses who attend to your or your loved ones medical needs in your home. Examples of our services that can assist in the treatment and prevention of UTI include assistance with catheter care, medication administration, and a trained eye that can help identify self-care needs and watch for classic and non-classic UTI symptoms.

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How Urinary Tract Infections Affect The Elderly

Elderly patients who need catheters to urinate are at increased risk for urinary tract infections, especially if they recently had surgery for urinary dysfunction.

Older people who have a depressed immune system, like diabetes, may also not be able to naturally protect themselves against the bacteria. This can lead to current urinary tract infections.

Elderly men who have an enlarged prostate can suffer complications that increase their risk for urinary tract infections. The abnormal prostate can trap urine inside the bladder, which leads to recurrent urinary tract infections.

Empty Your Bladder After Sex

Following sex, be sure to use the bathroom and empty your bladder as soon as possible. You should also drink extra water to flush any bacteria out of the urinary tract.

If you suspect you have a urinary tract infection and need relief from your symptoms, schedule a diagnostic evaluation at Primary Care & Walk-In Medical Clinic online, , or visit the clinic in person.

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What Happens To The Urinary System With Aging

The urinary system includes:

  • the muscles of the pelvic floor.

There are sphincters that open or close the urethra, and nerves that run to the bladder muscles and sphincters which helps to control urinary release and flow. The brain and legs are also part of the urinary system: a person has to be able to decide when its time to go to the toilet, and have the ability to get to one when the time is right.

In this article, well focus mainly on the bladder and urethra, and the bladder outlet.

Normal Aging

With age, some of the muscle fibers in the bladder are replaced with stiffer, fibrotic tissue, and the neurological responses that we rely on to maintain normal urinary function decline slightly.

In practical terms, this means that:

  • The sensation that the bladder needs to be emptied happens when the bladder is fuller than in a younger person
  • The bladder muscle contracts less forcefully
  • The urethral sphincter is looser in older women
  • The larger prostate gland can obstruct the urethra in men
  • Theres a more frequent need to pass urine
  • 80% of those over 80 get up at least once in the night to pass urine

Nighttime urination or nocturia is a urinary symptom thats hard to ignore, or cope with. As Dr. Wagg told me: The magic number for nighttime frequency where it has an effect on your quality of life is two and more. And intriguingly, daytime frequency. If you look at peoples self reported quality of life and daytime frequency, the unlucky number is indeed 13.

Drugs Stopping Sudden Bladder Muscle Contractions

Women Elderly Incontinence Urine Collection Funnel Pot Urination Device ...

Six approved antimuscarinic drugs work because they block nerve signals regulating bladder muscle contractions the drugs help to relax the bladder muscle and to decrease urges to void. Several studies have shown that these drugs resolve urinary incontinence in one woman among every eight or nine treated . These drugs include:

However, these drugs, especially oxybutynin, may cause adverse effects which may include:

  • dry mouth and eyes,
  • blurred vision or headaches, and
  • other less common harms .
  • For oxybutynin, one out of every 16 women stopped using it because of intolerable side effects.

    When researchers compared the benefits and harms across these six different antimuscarinic drugs, they found that although these drugs demonstrate similar benefits, the potential for adverse effects was not the same . Women should discuss with their doctor what adverse effects are the most troubling for them. They can then choose the medication with the least risk for those specific side effects.

    Unfortunately, none of the clinical studies evaluated the long-term safety of these antimuscarinic drugs. All drugs were tested in older women . However, we do not know long-term safety of these drugs in real-life geriatric settings. Future research should look at long-term safety in older women who are also taking several medications because of other chronic diseases.

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    Pelvic Floor Muscle Training

    Pelvic floor muscle training has been prescribed for over 60 years to improve both SUI and UUI. PMFT require tightening of the pelvic muscles and holding the contraction for a few seconds, followed by a rest period. PMFT may prevent urgency and UUI by inhibiting and aborting inappropriate detrusor contractions , while stimulating the guarding reflex in adults with SUI .

    Dumoulin and Hay-Smith concluded in their Cochrane review that PFMT should be included in first-line conservative management programs for women with SUI, UUI or MUI. The treatment effect seemed to be greater in women with SUI alone, who participated in a supervised PFMT program for at least 3 months.

    A recent Cohrane review evaluated the impact of PFMT with or without biofeedback for men who had urinary incontinence after radical prostatectomy. Findings were conflicting limited benefit was seen in improving UI in studies that aimed at both treatment and prevention.

    What Is The Bottom Line About This Health Issue

    If you have trouble with leaking urine, know that you are not alone many women suffer from urinary incontinence. There is no shame in discussing this problem with your doctor or an incontinence professional . The real harm is in ignoring incontinence. Non-drug treatments, such as healthy lifestyle changes or pelvic floor exercises, should be the first choice. Once you start adopting healthy behaviors, sticking to these good habits will serve you well in the long run.

    Currently there are no effective medications for women with stress incontinence. In contrast, women with urgency incontinence have good evidence that several medications can be helpful. There are eight drug choices available and women can make informed decisions with their doctors. We “urge” you to take into account the balance between benefits and harm for each of eight available drugs and to make informed treatment decisions after discussions with incontinence professionals.

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    Occult Urinary Incontinence In Elderly Women And Its Association With Geriatric Condition

    K. Silay, S. Akinci, A. Ulas, A. Yalcin, Y.S. Silay, M.B. Akinci, I. Dilek, B. Yalcin

    Department of Internal Medicine and Geriatrics, Yildirim Beyazit University, Ataturk Research and Training Hospital, Ankara, Turkey. kamilesilay@hotmail.com

    OBJECTIVE: Many older women are hesitated to initiate discussions about urinary symptoms and their incontinence. The aim of this study is to determine the prevalence of occult urinary incontinence in outpatient older women and to evaluate its association with other geriatric conditions.

    PATIENTS AND METHODS: 100 female patients 65 years and older were assessed at the geriatric outpatient clinic. The validated form of the Turkish version of the International Consultation on Incontinence Questionnaire-Short Form was used to evaluate urinary incontinence and quality of life. Comprehensive geriatric assessment including activities of daily living, instrumental activities of daily living, mini mental state examination and geriatrics depression scale was performed. The number of falls, comorbid conditions and number of medications were noted. The association between urinary incontinence and geriatric domains were evaluated with logistic regression analysis.

    Is Urinary Incontinence A Normal Part Of Aging

    Treatment for stress urinary incontinence in women: Mayo Clinic Radio

    What exactly is urinary incontinence? Its the involuntary loss of urine, according to the National Association for Continence . Although incontinence can happen at any age, its generally more common in seniors.

    As you age, changes in the body can make elderly urinary incontinence more likely. One out of two women older than 65 experience bladder leakage sometimes, according to the Urology Care Foundation. It can be caused by typical aging, lifestyle choices, or a range of health conditions.

    Elderly urinary incontinence can take on a few forms:

    • Some people may only leak urine occasionally
    • Others may constantly dribble urine
    • Some experience a complete lack of both bladder and bowel control

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    Caring For Someone With Incontinence

    So far, weve covered managing your own incontinence, but what if youre caring for an older adult? Incontinence is a common issue faced by dementia caregivers, and can be one of the most challenging parts of providing care. Research shows that:

    • Those with dementia have a 2-3-fold increased chance of urinary incontinence
    • The more severe the dementia, the more likely that there will be incontinence
    • Urinary incontinence contributes to caregiver burden and increases the risk that someone will be admitted to a nursing home.

    Steps to take

    Dementia may not be the only cause of incontinence, so the first step is to look for other causes, like those reversible ones mentioned earlier .

    If there doesnt seem to be any of those issues going on, then managed continence is the approach that is most likely to help. Rather than using the bladder medications, which can worsen confusion and dampen alertness, managed continence includes the use of continence products and a schedule of timed toileting .

    In some cases, environmental adjustments and equipment, like bedside commodes, catheters, and urinals, can make frequent toileting easier and less disruptive, especially overnight.

    Bladder Structure And Function

    The bladder, urethra and urinary sphincters work in concert to store urine at low pressure and to void voluntarily at socially convenient or appropriate times. The detrusor muscle and internal urethral sphincter are predominantly smooth muscle, whereas the external urethral sphincter and pelvic floor muscles are predominantly striated muscle. The bladder lumen is lined with epithelial cells and the basement membrane that protect the underlying detrusor muscle from toxins contained in the urine and enable communication with neural cells that coordinate storage and voiding phases .

    Anatomy and histology of the female bladder

    The sympathetic nervous system predominates during the storage phase and maintains continence through the paravertebral ganglia, the hypogastric nerves and hypogastric plexus. The parasympathetic system coordinates the voiding phase, through the sacral plexus and pelvic nerves 39. Afferent signals from the urothelium and bladder wall are transmitted through to the thalamus the balance between storage and voiding is maintained by the central pontine micturition centre . The neurotransmitters responsible for execution of these commands are acetylcholine and noradrenaline.

    Neurological control of the urinary bladder

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    Can Incontinence Be Prevented

    Different events throughout your life can lead to many of the things that cause incontinence. The muscles that support your pelvic organs can weaken over time. For women, these muscles can also be weakened by big life events like pregnancy and childbirth. However, in the same way you work out to build strength in your legs or arms, you can do exercises to strengthen your pelvic floor muscles. Doing exercises to strengthen your pelvic muscles may not prevent you from having any issues with incontinence, but it can help you regain control of your bladder. Maintaining a healthy body weight can also help with bladder control. Talk to your healthcare provider about the best ways to maintain strong pelvic floor muscles throughout your life.

    What Is The Evidence For Effective Treatments For Urinary Incontinence

    Urinary incontinence surgery in women: The next step

    Women have several options to manage their urinary incontinence and these primarily include either drug or non-drug treatments. Many studies have shown that the majority of women improve their symptoms using non-drug conservative interventions and these include:

  • specialized pelvic floor muscle exercises,
  • normalizing weight ,
  • scheduling when they drink and when they go to the bathroom .
  • Intra-vaginal electrical or magnetic stimulation may help some women with incontinence . However, some women do not benefit from these non-drug treatments, or they are unable to access these treatments, or make the necessary lifestyle changes. In this case, doctors may suggest the use of drugs to help with incontinence problems. We review the current scientific evidence about the effectiveness of these drugs to help manage incontinence.

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    How Is Continence Maintained

    Maintaining continence is a complex process, and depends on:

    1.

    An intact bladder, sphincter, and pelvic floor function with normal innervation,

    2.

    An ability to communicate the need to go to the toilet if immobile,

    3.

    Adequate cognition to know how to find the toilet and to keep continence until on the toilet

    4.

    Sufficient mobility and manual dexterity to remove clothing,

    5.

    Ability to voluntarily initiate micturition at the appropriate time.

    The frontal cortex is responsible for voluntary control of micturition

    Urinary Incontinence In Women: What You Need To Know

    • Urinary incontinence is the accidental loss of urine.

    • Over 25 million adult Americans experience temporary or chronic urinary incontinence.

    • This condition can occur at any age, but it is more common in women over the age of 50.

    • There are four types of urinary incontinence: urgency, stress, functional and overflow incontinence.

    • Behavioral therapies, medications, nerve stimulation and surgery are some of the treatments available for managing urinary incontinence.

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    What Are The Symptoms Of Urinary Incontinence

    The following are common symptoms of urinary incontinence. However, each individual may experience symptoms differently. Symptoms may include:

    • Needing to rush to the restroom and/or losing urine if you do not get to the restroom in time

    • Urine leakage with movements or exercise

    • Leakage of urine that prevents activities

    • Urine leakage with coughing, sneezing or laughing

    • Leakage of urine that began or continued after surgery

    • Leakage of urine that causes embarrassment

    • Constant feeling of wetness without sensation of urine leakage

    • Feeling of incomplete bladder emptying

    The symptoms of urinary incontinence may resemble other conditions or medical problems. Always consult your doctor for a diagnosis.

    Treatment Can Improve Quality Of Life

    Urinary Incontinence in Women Over 50: National Poll on Healthy Aging

    US Pharm. 2006 31:20-34.Urinary incontinence can have a negative impact on an individual’s quality of life by lowering self-esteem and affecting psychological and physical well-being. According to a study supported in part by the Agency for Healthcare Research and Quality, elderly Americans who are incontinent often experience shame, disgust, embarrassment, and a less active social life, all of which can lead to depression.1 Furthermore, elderly individuals with UI are more likely than those without it to have symptoms of depression.1According to a recent survey, called What Older Women Want, women ages 55 to 95 rated UI as number 5 among the top 10 unmet health priorities.2 This finding is consistent with previous data showing that elderly women express more concerns about living with disabilities than developing common illnesses.2Despite these findings, UI is underdiagnosed and often underreported by patients due to embarrassment or acceptance of the condition as a consequence of aging, although it is not actually caused by aging.3,4This article encourages pharmacists to raise awareness of UI, educate patients about the condition, and provide appropriate recommendations for treatment. By approaching UI as a condition with underlying, though sometimes irreversible causes, pharmacists can help manage patients well enough to improve symptoms and minimize complications.5

    Overflow Incontinence

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    Why Do Elderly Become Incontinent

    Urinary incontinence increases with rising age. Ageing is associated with changes in the lower urinary tract which predispose an elderly to UI. As we age, bladder capacity and contractility reduce, with reduced ability to defer voiding once the urge to do so arises.

    Is Cranberry good for incontinence?

    Many people claim that cranberry juice relieves symptoms of urinary tract infections, but cranberries are acidic. Much like tomatoes and citrus fruits, cranberries can potentially irritate your bladder and cause urge incontinence. You might be tempted to try cranberry juice for relief, but it may worsen your symptoms.

    Types And Causes Of Incontinence In Aging Adults

    Simply put, the bladder does two things: it stores urine and empties of urine.

    When storage goes wrong, this can result in symptoms of urgency, frequency, and stress incontinence. When these symptoms are severe, like having to void more than 13 times a day, or more than twice at night, quality of life can be significantly impaired.

    There can also be problems with getting the bladder to empty at the right time and place. Two types of issues that often come up for older adults are:

  • Blockage of the bladder outlet, which can happen with a large prostate gland, a constipated bowel, or some other cause, and leads to constant minor dribbling of urine all the time
  • Functional incontinence , where the incontinence is related to difficulty getting to the toilet in time and using it effectively.
  • Heres a chart reviewing the different types of incontinence:

    Symptom
    A mixture of the above symptoms

    So far, Ive talked mostly about chronic incontinence, but there can be a few reasons why an older person would suddenly start losing bladder control. As a geriatrician, I always want to rule out these potentially treatable issues before embarking on a long-term continence management plan.

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    Will I Have Incontinence For My Entire Life

    Sometimes incontinence is a short-term issue that will go away once the cause ends. This is often the case when you have a condition like a urinary tract infection . Once treated, frequent urination and leakage problems caused by a UTI typically end. This is also true for some women who experience bladder control issues during pregnancy. For many, the issues end in the weeks after delivery. However, other causes of incontinence are long-term and related to conditions that are managed throughout your life. If you have a chronic condition like diabetes or multiple sclerosis, you may have incontinence for a long period of time. In those cases, its important to talk to your provider about the best ways to manage your incontinence so that it doesnt interfere with your life.

    A note from Cleveland Clinic

    It can be embarrassing to talk about bathroom habits with your healthcare provider. This embarrassment shouldnt stop you from treating incontinence, though. Often, your healthcare provider can help figure out the cause of your bladder control issue and help make it better. You dont need to deal with it alone. Talk to your healthcare provider about the best ways to treat incontinence so that you can lead a full and active life without worrying about leakage.

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