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.
Management Of Urinary Incontinence
- Face the problem and seek early medical advice
- Learn how to cope with negative emotions
- Treat it as a health problem and not something which is to be ashamed of
2. Pelvic floor exercises
- Pelvic floor exercises can strengthen muscle power and restore voiding control. For further information about the exercise, please contact health professionals
- Drug therapy aims at tackling infections and controlling incontinence. It should be prescribed by the doctor and self-medication is not recommended
When Should I See A Doctor About Incontinence
Its important to know that incontinence can be treated. Many people believe that its something that just goes along with aging and is an unavoidable issue. If you find that incontinence is disturbing your daily activities and causing you to miss out on things you typically enjoy, talk to your healthcare provider. There are a wide range of options to treat incontinence.
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What Happens To The Urinary System With Aging
The urinary system includes:
- the ureters
- the bladder
- the urethra
- 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.
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
On top of the normal changes of aging, some age-associated conditions can also worsen incontinence, such as limitations in mobility, cognitive impairment, diabetes, obesity, congestive heart failure, medications that can affect urine output, and more.
Treatment Can Improve Quality Of Life
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
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Is Urinary Incontinence A Natural Aspect Of Growing Older
What is urine incontinence, and how does it affect your life? According to the National Association for Continence , involuntary urine loss is what it is. Incontinence can strike anyone at any age, but it is more common among the elderly.
Urinary incontinence in the elderly is more common as the body changes with age. According to the Urology Care Foundation, one out of every two women over 65 had bladder leakage at some point. It might be brought on by normal aging, lifestyle decisions, or a variety of health issues.
Urinary incontinence in the elderly can take several forms:
- Some people only leak urine once in a while.
- Others may leak pee on a regular basis.
- Some people have total bladder and bowel control issues.
How Do Patients Present
Chronic urinary incontinence is classified according to how it presents and its cause . Stress incontinence is caused by weakness of the pelvic floor muscles and bladder neck and is associated with obesity, pregnancy, vaginal delivery, and hysterectomy in women1011 and prostatectomy in men.12 Typically patients complain of leaking small volumes of urine when they exert themselves, cough, or sneeze. In contrast, patients with urge incontinence tend to complain of voiding large volumes of urine involuntarily owing to uninhibited contractions of the detrusor muscle. They complain of a strong desire to void urine , which may be accompanied by frequency and nocturia . Urge incontinence may be idiopathic, secondary to bladder outflow obstruction, or neuropathic.9
Box 1 Classification of urinary incontinence
StressâInvoluntary urinary leakage on effort or exertion, sneezing, or coughing
UrgeâInvoluntary leakage accompanied by or immediately preceded by urgency
MixedâInvoluntary leakage associated with urgency and also with exertion, effort, sneezing, or coughing
OverflowâLeakage owing to bladder outflow obstruction of any cause resulting in large post-void residual volume
FunctionalâIncontinence resulting from an inability to reach or use the toilet in time
The Artificial Urinary Sphincter
The artificial urinary sphincter for the management of severe stress UI was first introduced in 1973. This implantable device comprises a reservoir, urethral cuff and control pump, which requires manual dexterity and reasonable cognitive function to operate. The requirement for surgical revision is up to 30% of implants . Newer devices in development may provide more automated control systems and allow use in frailer or more cognitively impaired people with severe stress or post-prostatectomy incontinence .
Reasons For Loss Of Bladder Control:
- Vaginal infections
- Blockage from an enlarged prostate
- Medication interactions
- Damage to nerves that control the bladder from diseases such as multiple sclerosis or Parkinson’s disease
- Diseases such as arthritis that make walking to the bathroom painful or slow
- Confusion regarding the toileting process because of cognitive decline
- Loss of awareness of the need to urinate due to dementia or Alzheimer’s
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What Causes A Urinary Tract Infection
Bacteria entering through the urethra is the primary cause of UTIs at any age. Escherichia coli, also known as E. coli bacteria, causes 85% of all UTIs. A range of other bacterias make up the additional 15%. E. coli appears naturally in the gastrointestinal tract, so poor hygiene surrounding bowel movements is a major cause of UTIs.
Treating Utis In The Elderly
Most commonly, a prescription of antibiotics is required to treat a UTI. Amoxicillin and nitrofurantoin are often prescribed to treat UTIs, but there are some more severe cases that will call for stronger antibiotics like ciprofloxacin or levofloxacin. You should go to the doctor to receive an antibiotics prescription as soon as you suspect a potential UTI. Starting as soon as possible can help to minimize discomfort and other related issues. Because some bacteria will still exist in your urinary tract even as symptoms fade, its crucial you take antibiotics for the duration of of your prescription, rather than stopping when you feel better. If you stop treatment early, bacteria can regrow, and youll build up a resistance to antibiotics if you are prescribed them again too soon.
If an older person is at a high risk for UTIs or experiences them multiple times a year, it is possible to disguss taking daily antibiotics to fend off UTIs. If it doesnt conflict with other medications or conditions, patients may also take over-the-counter pain relievers like ibuprofen or acetaminophen to ease the immediate pains associated with UTIs.
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Essentials For Older People: Urinary Incontinence
Although incontinence is more common among older people, it is not a normal part of aging.
With aging, bladder capacity decreases, ability to delay urination declines, involuntary bladder contractions occur more often, and bladder contractions weaken. Thus, urination becomes more difficult to postpone and tends to be incomplete. The muscles, ligaments, and connective tissue of the pelvis weaken, contributing to incontinence. In postmenopausal women, decreased estrogen levels lead to atrophic urethritis and atrophic vaginitis and to decreasing the strength of the urethral sphincter. In men, prostate size increases, partially obstructing the urethra and leading to incomplete bladder emptying and strain on the bladder muscle. These changes occur in many normal, continent older people and may facilitate incontinence but do not cause it.
The most effective drugs for many kinds of incontinence have anticholinergic effects . These effects, such as constipation, dry mouth, blurred vision, and sometimes even confusion, can be particularly troublesome in older people.
Catheterisation For Detrusor Under
The main treatment strategy for a poorly contractile bladder is clean intermittent catheterisation. Drugs with parasympathetic activities are not widely used because of poor efficacy and poor side effect profile. New treatment modalities like neuromodulation, neurostimulation or reconstruction with muscle transposition have been explored but data is limited for the elderly .
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What Causes Urinary Incontinence In The Elderly
From not drinking enough water to childbirth to a health condition such as diabetes, there are many different reasons behind urinary incontinence.
The following health issues can cause urinary incontinence in both women and men:
- Multiple sclerosis
For men, prostate problems are a common cause of urinary incontinence.
Is Urinary Incontinence A Normal Part Of Aging
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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How To Deal With Incontinence In The Elderly
Your loved one may avoid going to the doctor because they are embarrassed by their mishaps. Although they may be utilizing absorbent pads or protective underwear to help, urinary incontinence is often treatable with medical care.
They may also put off seeing a doctor because they arent sure which one to see.
A general care physician, a geriatrician, a nurse practitioner, or a urologist are all feasible possibilities. Its best to start with your loved ones primary care physician if they are comfortable with him or her.
What Is Bladder Control
The body stores urine in the bladder. During urination, muscles in the bladder contract or tighten forcing urine out of the bladder and into a tube called the urethra that carries urine out of the body. At the same time, muscles surrounding the urethra relax and let the urine pass through. Spinal nerves control how these muscles move. Incontinence occurs if the bladder muscles contract or the muscles surrounding the urethra relax without warning or control.
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Common Causes Of Urinary Incontinence In Older Adults:
Heres a list of issues that a geriatrician would consider when sorting out incontinence in an older person. It makes a little mnemonic DIAPPERS:
Delirium a sudden change in thinking and alertness, caused by an underlying acute medical illness. When this condition is present, a person could be too drowsy or too confused to get to the toilet on time. For more on delirium, see here.
Infection When theres a urinary tract infection in an older adult, it can cause burning, pain, confusion, and also urinary frequency and urgency, and often incontinence.
Atrophic urethritis and vaginitis in women, shrinkage of the urinary and genital tissues leads to urinary incontinence, and can get better with topical hormone therapy .
Pharmaceuticals its not just diuretics, or water pills that can cause incontinence., but they do top the list .
Psychologic disorders especially depression, and delirium as mentioned above. Dementia can worsen incontinence, especially in the later stages when overall function is more severely impaired.
Excessive urine output this may be obvious if there are other symptoms like shortness of breath and swelling in the legs, but it may require lab tests or x-rays to diagnose these conditions.
Restricted mobility not getting to the bathroom on time because of arthritis or Parkinsons disease, for example, leads to more accidents
Mediations that can worsen urinary incontinence include:
- Some antidepressants
- Allergy medications
Top Urinary Incontinence Treatment
For many people, simple lifestyle changes or medical treatment can ease discomfort or stop urinary incontinence. A wide range of medical treatments is available and the choice of the top one for you will rely on your doctor, who will prescribe it depending on the type, severity and the underlying cause of incontinence.
Besides medical treatment there is a lot you can do yourself to minimize this rather irritating condition:
-Water is the best fluid for bladder health. Not less than half of the necessary 8 glasses of fluid per day should be water.
-Cut down on alcohol, coffee, tea, sodas and chocolate
-Eat healthy diet, especially food rich in fiber food in order to avoid constipation, which can put extra pressure on bladder
-Maintain a normal weight, as obesity is one of the main risk factors.
-Quit smoking, if you havent buy now. Among other serious problems, it causes a chronic cough, which can trigger stress incontinence.
-Exercise regularly. It will contribute to your overall health and better metabolism.
-Give yourself enough time and stay relaxed when emptying your bladder, so it can empty completely. Do it at least every 3 to 4 hours.
-try training yourself :
-Start slightly delaying urination after getting the urge, gradually increasing the time, until you feel you are able to control how long it will take before you go to the toilet.
-get into a habit of urinating twice to empty the bladder more completely
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Treating Stress Urinary Incontinence
Pelvic floor muscle training is the first line treatment for stress incontinence in men and women . NICE guidelines recommend a trial of such muscle training for at least three months.15 This recommendation is based on a recent Cochrane review of randomised controlled trials involving 672 women with stress incontinence that found improvement among women who performed pelvic floor muscle training compared with those who did not.19 A small, single blind randomised controlled trial found that pelvic floor muscle training achieved significantly greater subjective and objective cure rates compared with no training .20 For patients who are unable to contract their pelvic floor muscles, electrical stimulation and biofeedback can be used.1517
Box 4 Pelvic floor muscle training
The patient performs several contractions of their pelvic floor muscles several times a day
Over time this causes an inward lift of the muscles, resulting in increased urethral closure pressure and reduced urinary leakage
Training is continued for at least three months
Supervision of pelvic floor muscle training by a continence nurse adviser or specialist physiotherapist can be useful to ensure the exercises are done correctly and to monitor progress
Why Does Pregnancy Cause Incontinence
During pregnancy, your body goes through a lot of physical changes. As your uterus stretches to hold the growing baby, a few things happen. Your bladder can be squished by the expanding baby, making your bladder hold less than before. You might experience an increased urgency to pee during pregnancy because your bladder cannot hold as much as before. This might become even more challenging towards the end of pregnancy when the baby is at its largest.
Another reason for incontinence during pregnancy is the weakening of your pelvic floor muscles. These muscles are the support structures for all of the organs in your pelvis. During pregnancy, they can be stretched and weakened as your uterus expands.
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