Urinary Incontinence in Older Adults and the Most Affected Population
Urinary incontinence (UI), also known as involuntary urination, is any uncontrolled leakage of urine. It can also be referred to as a loss of bladder control. Urinary incontinence is a common and distressing problem, which may have a large impact on quality of life. This is because many people with the condition are afraid to do normal activities as they usually do not want to be far from a toilet.
Urinary incontinence is thought to affect millions of people and the chances of having it increases with age.
- It has been identified as an important issue in geriatric health care
- Pelvic surgery, pregnancy, childbirth, and menopause are major risk factors
- Urinary incontinence is often a result of an underlying medical condition, but it is underreported to medical practitioners.
Types and causes of urinary incontinence in older adults
There are different types of urinary incontinence in older adults, and they include:
- Stress urinary incontinence:
With this type, a weakened pelvic muscle floor and tissue cause urine to leak, this may be due to extra pressure placed on the bladder and the muscles involved in urine control.
This is the most common type of urinary incontinence in older adults. It is common in women, especially older women who have gone through menopause or women who have given birth.
Stress urinary incontinence may be triggered by coughing, laughing, sneezing, exercises, heavy lifting.
Causes of stress urinary incontinence in older adults
- Increasing age
- Vaginal delivery
- Pelvic surgery
2. Urge urinary incontinence:
This is also called overactive bladder and it is the second most common type of urinary incontinence in older adults. With this type of urinary incontinence, a sudden involuntary contraction of the muscular wall bladder, causes an intense urge to urinate. In this condition, the detrusor muscles are overactive.
Urge urinary incontinence may be triggered by a sudden change in position, sex, especially during orgasm.
Causes of urge urinary incontinence
- Over 90% of urge urinary incontinence are idiopathic, that is, over 90% of urge incontinence causes are unknown.
- Detrusor muscle instability
- Central nervous system lesion, for example, spinal cord injuries.
- Benign prostate enlargement
- Bladder neck obstruction
- Increasing in age
3. Overflow urinary incontinence:
With this type of urinary incontinence, the bladder cannot hold or retain as much urine as the body is making or the bladder does not empty, causing a small amount of leakage.
This type of urinary incontinence is more common in men with prostate cancer problems such as a blocked urethra or damaged bladder. It is the opposite of urge incontinence where there is impaired detrusor contractility.
Causes of overflow urinary incontinence
- Benign prostate enlargement
- Central nervous system lesion
- Multiple sclerosis
4. Functional urinary incontinence:
In this case, a person recognizes the need to urinate but cannot make it in time due to physical or mental impairment such as stroke, dementia, or arthritis.
Causes of functional urinary incontinence
- Environmental barriers to toilet
- Physical barriers
5. Mixed urinary incontinence:
With this type of urinary incontinence, you are experiencing more than one type of urinary incontinence. Many women have both stress urinary incontinence and urge urinary incontinence.
Symptoms of urinary incontinence in older adults
The main symptoms of urinary incontinence are the involuntary leakage of urine. How and when this happens is dependent on the type of urinary incontinence.
Diagnosis of urinary incontinence in older adults
To make the diagnosis, the doctor will review medical history and carry out a physical examination. During the physical examination, in women, the doctor will examine your vagina and check the strength of the pelvic floor muscles. For a Male patient, the rectum is examined to determine if the prostate is enlarged.
The doctor may recommend a urinalysis, where your urine is checked for signs of infections, traces of blood or other abnormalities.
A bladder diary can be used to help keep track of how much fluid you drink when urination occurs, the amount of urine and the number of incontinence episodes.
Post-void residual measurement is used to measure the amount of urine left in your bladder.
Urodynamic testing is used to determine the amount of pressure the bladder and urinary sphincter can hold.
Pelvic ultrasound can also be conducted in the pelvic region of the patient to diagnose urinary incontinence.
Treatment of urinary incontinence in older adults
Treatment for urinary incontinence depends on the type, the severity and the underlying causes of the urinary incontinence.
Treatment options may include:
- Behavioural techniques including bladder training
- Fluids and diet management
- Toilet trips schedule
- Pelvic floor muscle exercises to help strengthen the muscles that help control urination
- Medications including alpha-blockers, topical oestrogen, anticholinergic and mirabegron
- Medical devices designed for females including urethral inserts, pessary
- Interventional therapies including bulking agents, nerve stimulators, Botox injections
- Surgery including artificial urinary sphincter, sling procedures, bladder neck suspension or prolapse surgery
Prevention of urinary incontinence in older adults
- Older adults should try and maintain a healthy body weight
- Eat more fibre rich foods
- Don’t smoke or quit smoking
- Avoid foods that irritate the bladder such as alcohol, caffeine, and acidic foods
- Engage regularly in pelvic floor exercises
Frequently asked questions
Who is most affected by urinary incontinence and why?
Urinary incontinence can happen to anyone and at any age, but it is more common in older women. This may be because, at this age, they are more likely to have had children, or be experiencing hormonal changes brought about by menopause.
What is DIAPPERS?
If you have heard DIAPPERS, it is an acronym for the possible causes of Urinary incontinence. It stands for Delirium, Infection, Atrophic urethritis and vaginitis, Pharmaceuticals, Psychological disorders, Excessive urine output, Restricted mobility and Stool impaction.
What type of exercise can be done to strengthen the pelvic muscles?
Pelvic floor exercises such as the Kegel exercises can be carried out on a routine basis to strengthen the pelvic muscles.
Older adults should not be embarrassed to visit the doctor about urinary incontinence. Urinary incontinence is a very common condition among different people of all ages.
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