Urinary Problems in Older People - Urinary Incontinence

Urinary incontinence (UI) is one of the Geriatric Giants. It is the involuntary leakage or passing of urine. It affects mostly the elderly, and is more common in females mostly in post menopausal ladies. Due to the hormonal disturbance in menopause cause pelvic floor muscles dysfunction leading to urinary incontinence.

Types of urinary incontinence –

• Stress incontinence - urine leaks due to increased intra-abdominal pressure that exceeds on bladder due to coughing, sneezing, laughing, exercising or lifting heavy objects there is an intense or increased urge to urinate followed by an involuntary passing out of urine. 
• Urge incontinence - when there is an intense or increased urge to urinate followed by an involuntary passing out of urine. Urge incontinence may also be caused by urinary tract infection, or neurological disorder or diabetes
• Overflow incontinence – there is frequent or constant dribbling of urine as the bladder do not empty completely
• Functional incontinence - A physical or mental impairment restricts going to the toilet in time.
• Mixed incontinence – there can be a combination of more than one type of urinary incontinence — most often is a combination of stress and urge incontinence

 Problems:

·        Urinary incontinence can be embarrassing for social activity and can restrict your activities and limit your social interactions

·        Negatively impact the quality of life

·        Increase the risk of falls in older people since they need rush to the toilet

·        Sometimes may be an indication of a more serious underlying condition

Consultation with a Geriatrician or a Urologist is a must since they need to identify the type of problem and the diagnosis. Sometimes its due to some medications also. 

Prevention  

·        Stopping the responsible medicine causing urinary incontinence

·        Life style or Behavioural changes – reducing fluid intake after evening or evacuating before going to bed

·        Bladder training, to delay urination after getting the urge to urinate. You need to try to hold off urination for 10 minutes every time you feel an urge to urinate. The goal is to lengthen the time between urination to every 2.5 to 3.5 hours.

·        Double voiding is urinating and then waiting a few minutes and trying again. This helps to empty the bladder more completely and avoid overflow incontinence.

·        Periodic trips to toilet to urinate every two to three hours rather than waiting for the need to go.

·        Pelvic Floor Exercises - these exercises help to strengthen the muscles that control urination. 

To do pelvic floor muscle exercises you need to imagine that you're trying to stop or hold your urine flow.

Then tighten or contract the muscles you would use to stop urinating and hold for five seconds, and then relax for five seconds and gradually work up to holding the contractions for 10 seconds at a time. Aim for at least three sets of 10 repetitions each day.

Medications

Medications commonly used to treat incontinence work by calming an overactive bladder or reducing the urge to urinate by relaxing the bladder muscle so that bladder can hold more urine. They also help to empty the bladder more completely at a time by relaxing the bladder neck muscles. 

In females estrogen tablets or local application of estrogen creams also help to increase the tone of pelvic floor muscles and also rejuvinate them and  help in controlling urinary incontinence.