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Urinary incontinence in the elderly
Last reviewed: 04.07.2025
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Urinary incontinence in the elderly is the involuntary release of urine from the urethra. Incontinence is a problem for the elderly and bedridden. Every 43 out of 100 elderly citizens need medical care, and 11.4% need constant qualified medical care. Some of these patients have difficulty performing their natural needs, and some of them relieve themselves and wet the bed.
Causes urinary incontinence in the elderly
Urinary incontinence in the elderly can be described as "the inability to limit, restrain the fulfillment of one's elementary desires." The main types of urinary incontinence are:
- stress type - when coughing, laughing, exercises associated with increased intra-abdominal pressure;
- motivating type - it is impossible to delay the contraction of the bladder (caused by a violation of the nervous regulation of its activity);
- excessive type - caused by functional insufficiency of the internal and external sphincters of the urinary bladder;
- functional type - in the absence of the usual conditions for urination or in the presence of physical or mental disorders.
Urinary incontinence in the elderly predisposes to inflammatory and ulcerative changes in the skin of the perineum, urinary tract infections, and is accompanied by depression and social isolation of the elderly. The development of this condition is facilitated by age-related changes in the urinary tract: decreased contractility of the bladder, decreased capacity, residual urine due to involuntary contractions of the detrusor, decreased functional length of the urethra in women. Quite often - up to 30-50% - urinary incontinence in the elderly is transient, associated with the following reasons:
- disturbances of consciousness in neurological and other diseases, taking medications (sedatives, anticholinergics, alpha-adrenergic receptor antagonists, diuretics, etc.);
- symptomatic urinary tract infections, atrophic urethritis and vaginitis;
- increased diuresis due to excessive fluid intake and metabolic disorders in diabetes mellitus, etc.;
- decreased physical activity due to arthritis and injuries;
- congestive heart failure.
All these causes are reversible, and if they are eliminated, transient urinary incontinence is successfully relieved.
The problem of urinary incontinence is relevant for every second woman aged 45 to 60 years, since it is one of the typical manifestations of the climacteric period. Often, women involuntarily release a small amount of urine when coughing, sneezing and other efforts.
Urinary incontinence in elderly men can be caused by a pronounced degree of prostate adenoma (weakening of the contractile ability of the bladder and the presence of a significant amount of residual urine).
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Treatment urinary incontinence in the elderly
Urinary incontinence in the elderly is treated individually; the treatment should be aimed not only at the urinary organs. With increased detrusor activity, conservative measures with normalization of the urination rhythm and the amount of fluid consumed, systematic exercises that help strengthen the muscles of the pelvic floor and anterior abdominal wall, anticholinergic drugs (propatepic), combined anticholinergics and smooth muscle relaxants (oxybutynin), calcium channel blockers (nifedipine) are clinically effective.
Weight loss in obese women and effective treatment of atrophic urethritis and vaginitis may help improve the condition of elderly women with stress urinary incontinence.
If there is an infection, trimethoprim may be used. The patient should be advised to drink more fluids, primarily cranberry juice (180 mg of 33% cranberry juice twice a day). This drink increases the acidity of urine and prevents bacteria from adhering to the mucous membrane of the bladder. Amitriptypine (25-50 mg at night) helps to increase the tone of the circular muscle of the urethra (sphincter). Taking diuretics in the morning gives a good effect.
In case of frequent nighttime urination, relief can be provided by taking antispasmodics and limiting fluid intake in the afternoon, immediately before bedtime (while maintaining the daily fluid intake of at least 1 liter).
How to care for urinary incontinence in the elderly?
When providing care, every effort must be made to prevent complications. The most important thing is to encourage the patient to lead a maximally active lifestyle, monitor the condition of his skin - it should always be dry and clean (this is ensured by washing 4-6 times a day with subsequent treatment of the perineum with Vaseline or glycerin). If the patient uses "diapers", then they should be checked frequently (every two hours) for cleanliness, and protective creams should be used if necessary. The patient should be convinced to empty the bladder, if possible, every 2-3 hours. In order for this emptying to be complete, the patient should be in his usual position during urination: women - sitting, men - standing.
It is necessary to control the symptom of pain and take measures at the first signs of infection, including fungal. When using a urine bag, it is necessary to empty it in a timely manner and disinfect it with a chlorine-containing disinfectant, administer 50-100 ml of an antiseptic solution (potassium permanganate, furacilin in a dilution of 1:10000). The patient should feel kindness and sympathy in the actions of the nursing staff. It is necessary to ensure that the patient is in the most comfortable environment possible, and it is necessary to provide him with the necessary privacy.