Overcoming urinary incontinence in the elderly

The article is expertly consulted by Master, Doctor Le Phuc Lien - Urologist - Department of General Surgery - Vinmec Central Park International General Hospital. The doctor has more than 12 years of experience in the field of urology and specialized urology.

Urinary incontinence in the elderly is a common condition with an increasing incidence with age and the degree of weakness of the body. This condition causes quite a lot of effects on the health and psychology of the patient, even causing other dangerous complications.

Urinary incontinence is also known as urinary incontinence. This is a urinary tract dysfunction characterized by involuntary leakage of urine, causing discomfort to the patient.
Urinary incontinence is common in the elderly, more women than men, the incidence increases with age and the degree of body weakness. This condition varies in severity, from slight leakage of urine due to increased intra-abdominal pressure (when coughing, straining, sneezing, ...) to constant leakage and even urinary incontinence. Urinary incontinence with bowel incontinence.
Urinary incontinence affects health, causing patients to have low self-esteem, guilt, and even lead to mental disorders. Patients are at risk of bacteriuria upstream, if not treated promptly, it can lead to bacteremia, pyelonephritis, kidney failure, hypertension,...

Symptoms of urinary incontinence depend on the form of the disease. Specifically:
Stress incontinence: Is the involuntary drainage of urine when the patient exerts himself, not due to bladder contractions. This condition is more common in women than in men, occurs when the patient makes an effort such as coughing, sneezing, laughing, pushing, lifting heavy objects, ... The amount of urine that is released is small, occurring in more than 2 times/month. People with stress incontinence are mainly obese women, menopause, multiple births or men after prostate surgery; Urgency incontinence (urinary incontinence): This is a condition of urine drainage combined with urgency, the patient has not been able to go to the toilet, has leaked urine. This condition is mainly due to impaired bladder function to store urine (detrusor instability), common in mental disorders, cold weather,... In men, urgency can be manifestations of detrusor instability, urinary flow obstruction, neuropathy, radiotherapy to the pelvic region,...; Urinary incontinence (urinary leakage): Due to chronic urine retention, the patient has frequent urinary incontinence, never urinating normally. This condition is common in people with impaired bladder contractility, bladder outlet obstruction (in men it is an enlarged prostate gland, in women it is due to uterine prolapse or constipation);

Urinary incontinence (continuous urinating): The patient has urine leakage day and night. The cause is usually bladder dysfunction (caused by stroke, spinal cord injury, post-prostatectomy in men, peripheral nerve damage); Urinary incontinence: The urinary organs are still functioning normally, but the patient suffers from dementia and mental disorders, so he has no control over his ability to urinate.

Overactivity of the urethral sphincter: Makes the patient unable to inhibit the contraction of the bladder, leading to urinary incontinence, urine outflow. Overactivity of the urethral sphincter can be caused by bladder stones, tumors, so it can be accompanied by symptoms such as blood in the urine; Mental instability: Stress, delirium, restlessness, sleep disturbance; Abnormalities in the urinary tract: Kidneys, bladder, urethra are inflamed, there are stones, tumors,...; Limited movement: Paralysis, old age, weakness, difficulty moving; Bladder disorders: Increased or decreased activity of bladder muscles, bladder neck muscles or congenital bladder malformations, bladder dilatation; Atrophic vaginitis or atrophic urethritis: Mucosal wear, capillary dilation and inflammation, spread to the bladder causing urinary incontinence; Some diseases of the prostate gland: Inflammation, benign proliferation, tumor, prostate cancer; Other causes: Drug use, obesity, diabetes,...

4.1 Diagnosis Take the medical history to determine the duration and severity of the disease; Clinical examination: Determine the cause, classify urinary incontinence. The doctor will examine the abdomen, psychiatric, neurological, mobility; rectal and prostate examination in men; pelvic, gynecological and rectal examination in women; Basic tests: Urinalysis, serum glucose and serum calcium, urinary ultrasound, urine culture, urinary X-ray; Special tests: Diaper test, urine residual measurement, cystoscopy, urogram, urodynamics, central nervous system magnetic resonance imaging.

4.2 Treatment of urinary incontinence in the elderly Depending on the cause, the classification of urinary incontinence will have different treatment methods. Some of the methods being applied include:
Conservative treatment
Treatment of underlying conditions causing urinary incontinence: Background diseases causing polyuria, nocturia, increased intra-abdominal pressure, nervous system disorders central, ... causing urinary incontinence and aggravate the disease. Predisposing medical conditions include heart failure, chronic obstructive pulmonary disease, diabetes, neurological disorders, stroke, multiple sclerosis, dementia, cognitive disorders, sleep apnea syndrome, and sleep apnea. ... Treatment of these conditions can treat or relieve urinary incontinence; Regulate the use of medications that can cause urinary incontinence; Use diapers, a vasectomy in men, and a vulva cap in women to collect urine or place a nebulizer; Change living habits: Do not use caffeinated beverages because coffee can stimulate the central nervous system, cause diuresis, relax the urethral sphincter, easily leading to urgency and frequency of urination; Control the amount of water put into the body: Use about 1,500ml/day, limit drinking water in the evening; Exercise regularly and focus on contractions of the perineal muscles; Quit smoking, alcohol; Practice bladder and urination habits, avoid immediate urination but need to schedule urination by the hour (this method is suitable for patients with urinary urgency and mixed incontinence); Drug use: Antimuscarinic drugs (anticholinergics), adrenergic agonists, estrogens, desmopressin, alpha-adrenergic blockers; Non-invasive intervention: Electrical stimulation by electrodes at the perineum, pubic skin, vaginal wall; Using an electrical pulse needle inserted under the skin above the ankle to stimulate the posterior tibial nerve; Use pulses of magnetic fields at the perineum and sacrum. Surgery
This method is indicated for the treatment of urinary incontinence in the elderly when conservative and drug therapy is not effective. The treatment includes:
For patients with abnormal sphincter: Treatment techniques can be selected such as: Bio-glue injection, autologous fat through cystoscopy; Place a mesh to support the urethra; Postpubic suspension surgery; Vaginal preconception surgery; Place the prosthetic valve; Injection of botulinum toxin A into the submucosa of the bladder; For patients with reduced bladder capacity: The following treatment techniques can be selected: Enlargement of the bladder by bowel; Urine circulation through the skin, through the ileum,...

To limit the risk of urinary incontinence, it is necessary to pay attention to the following:
Elderly people always keep a comfortable mentality in daily life, without anxiety or stress; Move your body every day with healthy exercises such as walking 60 minutes/day (divided into 2 times); Increase mental activity: Watch TV, read books, join elderly clubs; Have a suitable diet, do not drink alcohol, do not smoke; Limit drinking water, coffee, and tea in the evening. Urinary incontinence in the elderly is a common condition that can be effectively prevented and treated. Therefore, when suffering from this health problem, the patient should not be too worried, just follow all the instructions of the doctor to be able to reverse the disease, enjoy a healthy and useful life.
Periodic health check-ups help to detect diseases early, so that there are treatment plans for optimal results. Currently, Vinmec International General Hospital has general health checkup packages suitable for each age, gender and individual needs of customers with a reasonable price policy. Currently, Vinmec Central Park Hospital has a pelvic floor exerciser with biofeedback that can treat urinary incontinence without surgery.
The patient's examination results will be returned to the home. After receiving the results of the general health examination, if you detect diseases that require intensive examination and treatment, you can use services from other specialties at the Hospital with quality treatment and services. outstanding customer service.