Anti aging guide

The Bladder Incontinence in Old People



What is the bladder incontinence and how common is incontinence?

It is fashionable to think positively in order to avoid accusations of ableism, and continence is easily defined as ‘the ability to pass urine in the right place at the right time’. Incontinence, on the other hand, has been described as ‘the involuntary loss of urine to a socially or hygienically unacceptable degree’, and it has been suggested that what constitutes an unacceptable frequency might be twice a month.

What incontinence is not, is the occurrence of  ‘accidents’ due to inability to reach the toilet in time on account of a combination of immobility and poorly situated toilets or strange surroundings. Nor, in a more institutional context, is it making a mess because of fumbling with the bottle.

Epidemiological surveys to indicate the prevalence of a condition yield differing results according to the definition adopted and the population studied. The most consistently incontinent section of the population is, of course, the under-three age group. But this book is concerned with later life, and one commonly quoted survey found that among men aged 15-64, only 1.6 per cent admitted incontinence, whereas over the age of 65 the figure rose to 6.9 per cent. Women are considerably more liable to incontinence than men, and the corresponding figures were 8.5 per cent for the younger ones and 11.6 per cent when aged 65 and over.

Overflow incontinence

Less commonly, incontinence can be due to difficulty in voiding urine which is occasionally unrecognized by the patient. Most people are familiar with acute retention which quite commonly afflicts men with prostatic enlargement, especially if given a powerful diuretic or following the consumption of three or four pints of beer. The condition is an exceedingly uncomfortable and sometimes agonizing one but sitting in a warm bath may permit the urine to flow. Otherwise, catheterization is required and relief is ecstatic: prostatic surgery may then be advised, particularly if there have previously been suggestive symptoms such as difficulty in initiating micturition, a poor stream, and dribbling. During the interval at the theater, it is always advisable to queue behind the young men and not the old ones!

Not infrequently, enlargement of the prostate leads to chronic retention with overflow, producing a painless but grossly distended bladder containing perhaps 1.5 or 2 liters of urine. This results in a constant dribbling form of incontinence, and also damage to the kidneys through back-pressure. Other causes of outflow obstruction include urethral stricture and severe constipation. The same situation can arise if there is neurological disease affecting the micturition reflex, which may occur, for example, as a complication of diabetes or as a result of certain drugs which affect the nervous system. Treatment will be dictated by the cause, but if unsuccessful will again need to be by catheterization—occasionally intermittent, but more often on a long-term basis.

Posted by Carol Hudgens - May 17, 2012 at 2:09 pm