Anti aging guide

Precipitating Factors of The bladder Incontinence



What age changes predispose to incontinence and how to treat it?

Firstly, it should be noted that the kidney conveniently arranges to produce more urine during the day than at night, unless a considerable amount of fluid is taken late in the evening. This rhythm is often disturbed as we grow older and getting out of bed to pass urine during the night becomes a regular event. This situation will clearly make nocturnal bed-wetting more likely, especially if the bladder is unstable.

Attention has been drawn to the greater propensity of women to become incontinent, and this is partly due to the inherently less efficient sphincter mechanism related to the shorter female urethra, which also makes the bladder more prone to infection. It may sometimes also result from the damage commonly sustained by the pelvic nerves and musculature during childbirth. The female urogenital tract is also affected by the menopause, when the oestrogen-sensitive lining undergoes degeneration and the function of the urethra deteriorates. In men, a degree of enlargement of the prostate is almost universal in later life (except in those unfortunate enough to have been castrated). Only about 10 per cent of men will require surgery for this.

The bladder in old people tends to become a little shrunken and the walls thicken and become less elastic so that its capacity is somewhat reduced. Finally, and most important of all, it may contract during filling and during the postponement of micturition instead of waiting for permission to void. This is known as instability of the bladder and is extremely common. The contractions are sometimes spontaneous and random, and are sometimes triggered by coughing, standing up, or walking. The characteristic symptom is urgency: the meaning is reasonably self-evident and its presence is betrayed by the instant look of recognition on the patient’s face when asked by the doctor, ‘Can you hold your urine, or do you need to go at once?’ This symptom, in combination with poor mobility and a distant (or occupied) toilet, can readily lead to accidents. Both these changes-the low-capacity, unstable bladder-are more likely if there is other local disease such as marked prostatic enlargement. Spontaneous contractions also occur if there has been damage to the central nervous system so that messages to postpone contraction are either not initiated or fail to get through, and this can happen as a result of strokes, Alzheimer’s disease, and other illnesses, A further reason why demented patients are liable to become incontinent is their failure to pass urine prophylactically, for example prior to a concert, a formal dinner, or a shopping expedition: they tend to wait until desperate and are then unable to locate a handy toilet. It should be stressed that curtailing fluid intake is not usually a good idea and can have undesirable consequences in older people.

Urgency occasionally progresses to the stage of urge incontinence, when there may be sudden flooding. Usually, it predisposes to incontinence, and other factors actually precipitate it.

precipitating factors

In elderly people these include the following:

  • weakness of pelvic muscles (in women exercise may help for example stop in mid-stream and hold on);
  • senile atrophic vaginitis—a course of oestrogen may help;
  • cystitis—frequency of micturition, burning discomfort, and general unwellness may point to this possibility;
  • diuretics—these frequently turn urgency into urge incontinence;
  • tranquillizers and hypnotics—these may prevent the SOS message desperately being transmitted by the bladder from waking you up in time;
  • constipation, especially if severe.

Some of the factors mentioned above can be easily treated, even if the underlying bladder instability cannot. The nurse may suggest trying to retrain the bladder by instructing the patient to keep a chart and to start by emptying the bladder at two-hourly intervals throughout the day, increasing the interval when successful. Occasionally, drugs can be helpful. If the incontinence is refractory but not especially severe, pads can sometimes be sufficient, but otherwise a sheath-type appliance for men, or a catheter for either gender, will be necessary.

Posted by Carol Hudgens - May 17, 2012 at 2:26 pm