Urinary incontinence in the elderly

Urinary incontinence in the elderly is the involuntary discharge of urine from the urethra. Incontinence is a problem for the elderly and bedridden patients. Every 43 out of 100 elderly citizens need medical assistance, in constant qualified medical care - 11.4%. Some of these patients find it difficult to send out natural needs, some of them recover and urinate in bed.

Causes of the urinary incontinence in the elderly

Urinary incontinence in the elderly can be described as "inability to limit, restrain the fulfillment of their elementary desires." The main types of urinary incontinence are:

• stress type - with coughing, laughing, exercises associated with increased intra-abdominal pressure;
• stimulating type - it is impossible to delay the contraction of the bladder (due to a violation of the nervous regulation of its activity);
• excess type - is caused by functional insufficiency of internal and external sphincters of the bladder;
• functional type - in the absence of habitual conditions for urination or with physical, mental disorders.

Urinary incontinence in the elderly predisposes to inflammatory and ulcerative changes in the skin of the perineum, urinary tract infections, accompanied by depression, social isolation of the elderly. The development of this condition is facilitated by age-related changes in the urinary tract: a decrease in the contractility of the bladder, a decrease in its capacity, the presence of residual urine due to involuntary detrusor cuts, a decrease in the functional length of the urethra in women. Quite often - up to 30-50% - incontinence in the elderly is transient, due to the following reasons:

1. disorders of consciousness in neurological and other diseases, the use of medications (sedatives, anticholinergic, antagonists of alpha-adrenoreceptors, diuretics, etc.);
2. symptomatic urinary tract infections, atrophic urethritis and vaginitis;
3. increased diuresis, due to excess fluid intake and metabolic disorders in  diabetes mellitus  , etc .;
4. reduced physical activity in arthritis and trauma;
5. congestive heart failure.

All these reasons are reversible, and, if they are eliminated, a successful relief of transient urinary incontinence occurs.

The problem of urinary incontinence is relevant for every second woman aged 45 to 60 years, because this is one of the typical manifestations of the climacteric period. Often in women involuntary emission of a small amount of urine occurs when coughing, sneezing and other effort.

Urinary incontinence in elderly men can be caused by a pronounced degree of prostate adenoma (weakening of the contractile capacity of the bladder and the presence of a significant amount of residual urine).

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Treatment of the urinary incontinence in the elderly

Urinary incontinence in elderly people is treated individually, treatment should be directed not only to the organs of urination. With increased detrusor activity, conservative measures with normalization of the rhythm of urination and the amount of fluid consumed, systematic exercises that promote the strengthening of the muscles of the pelvic floor and anterior abdominal wall, anticholinergic drugs (patepic), combined anticholinergics and smooth muscle relaxants (oxybutynin), calcium channel blockers nifedipine).

Improvement of the condition of elderly women suffering from a stressful type of urinary incontinence can be facilitated by weight loss in obesity and the effective treatment of atrophic urethritis and vaginitis.

If there is infection, trimethoprim may be used. It should be recommended to the patient to drink more liquid, first of all, cranberry juice (180 mg 33% cranberry juice twice a day). This drink increases the acidity of urine and prevents the bacteria from sticking to the mucosa of the bladder. Amitriptypin (25-50 mg per night) promotes an increase in the tone of the circular muscle of the urethra (sphincter). A good effect is given in the morning by diuretics.

With frequent nighttime urination, relief may result from taking antispasmodics and limiting fluid intake in the afternoon, just before bedtime (with a mandatory maintenance of a daily amount of liquid of at least 1 liter).

How should I care if there is incontinence in the elderly?

When performing care, every effort should be made to prevent complications. The most important thing is to encourage the patient to lead the most mobile way of life, to monitor the condition of his skin - it must always be dry and clean (this is provided by washing 4-6 times a day with subsequent treatment of the perineum with Vaseline or glycerin). If the patient uses "diapers", then often (every two hours) check their purity, if necessary, use protective creams. It is necessary to convince the patient to empty the bladder whenever possible every 2-3 hours. In order for this emptying to be complete, the patient during urination should be in the habitual position for him: women - sitting, men - standing.

It is necessary to control the symptom of pain and take action at the first signs of infection, including fungal infection. When using the urine receiver, it must be emptied and disinfected with a chlorinated disinfectant in a timely manner, introducing 50-100 ml of antiseptic solution (potassium permanganate, furacilin in a 1: 10,000 dilution). In the actions of the nursing staff, the patient should feel kindness and sympathy. It is necessary to make sure that the patient is in the most comfortable environment, and you need to provide him with the necessary privacy.