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Surgery For Incontinence In The Elderly

The 3 Types Of Urinary Incontinence

Urowebinar: Surgical options for the treatment of stress urinary incontinence among the elderly

Urinary incontinence is frustrating for both seniors and family carers to deal with. The unpredictable leaks, the seemingly never-ending bathroom trips Symptoms can be exhausting to manage.

Customers at often speak about the social challenges they experience, such as feelings of embarrassment and worrying what other people will think of them.

We realize it isnt easy

To manage the issue as well as possible, the first thing to find out is which type of incontinence you or your loved one has.

Heres an outline of the three types of urinary incontinence:

Do you get sudden urges to pee and cant seem to hold it long enough to reach the bathroom? You may have whats called urge incontinence.

Neurological conditions such as dementia, multiple sclerosis, and Parkinsons Disease can lead to urge incontinence because of changes in the nervous system. The brains signals to contract and relax the bladder at the right times can be affected.

Diabetes is another condition that may lead to urge incontinence, due to an increase in urine production.

Many of us will experience an episode of stress incontinence at some point in life. Unexpected pressure on the bladdersuch as sneezing, coughing, or lifting heavy objectscan cause a temporary loss of control.

The symptoms are more of a concern if they become a regular, or even daily, issue.

Overflow incontinence happens when the bladder cant fully empty.

Pelvic Muscle Exercises: Kegels

This exercise works the muscles that you use to stop urinating. These muscles are the ones used to stop the flow of urine or to keep from passing gas. Making these muscles stronger helps your parent hold urine in their bladder longer. These exercises are easy to do. They can lessen or get rid of stress and urge incontinence.

Often doctors suggest that your parent squeeze and hold these muscles for a certain count, and then relax them. Then repeat this a number of times. Your parent will probably do this several times a day. Your doctor will give you exact directions.

Am I At A Higher Risk Of Incontinence At An Older Age

Your body constantly changes throughout your life. As you age, the muscles that support your pelvic organs can weaken. This means that your bladder and urethra have less support often leading to urine leakage. Your risk for developing incontinence as you age might be higher if you have a chronic health condition, have given birth to children, went through menopause, have an enlarged prostate or have had prostate cancer surgery. Its important to talk to your healthcare provider over time about the risks of incontinence and ways you can manage it without interference to your daily life.

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Botulinum Toxin A Injections

Botulinum toxin A can be injected into the sides of your bladder to treat urge incontinence and overactive bladder syndrome.

This medicine can sometimes help relieve these problems by relaxing your bladder.

This effect can last for several months and the injections can be repeated if they help.

Although the symptoms of incontinence may improve after the injections, you may find it difficult to completely empty your bladder.

If this happens, you’ll need to be taught how to insert a thin, flexible tube called a catheter into your urethra to drain the urine from your bladder.

Botulinum toxin A is not currently licensed to treat urge incontinence or overactive bladder syndrome, so you should be made aware of any risks before deciding to have this treatment.

The long-term effects of this treatment are not yet known.

Tips For Managing Enuresis

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  • Remember, your child cant control the problem without help. Make sure not to scold or blame. Make sure your child is not teased by family or friends.

  • Keep in mind that many children outgrow enuresis.

  • Protect your childs mattress bed with a fitted plastic sheet.

  • Have a change of clothes on hand while out and about.

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How Is Incontinence Treated

There are many different factors that your healthcare provider will consider when creating a treatment plan for your incontinence. The type of incontinence and the ways it affects your life are both big considerations. Your provider will also talk to you about the type of treatment you are most comfortable with. There are three main types of treatment you can explore for incontinence medications, lifestyle changes and surgery. Each option has pros and cons that your provider will discuss with you.

Medications to treat incontinence

There are quite a few medications that can reduce leakage. Some of these drugs stabilize the muscle contractions that cause problems with an overactive bladder. Other medications actually do the opposite thing relaxing muscles to allow your bladder to empty completely. Hormone replacement therapies can often involving replacing estrogen thats decreased during menopause may also help restore normal bladder function.

In many cases, medications can work very well to return normal function to the bladder. Your provider will carefully select a medication that matches your specific needs. Often, your provider will start you on a low dose of the medication and then increase it slowly. This is done to try and reduce your risks of side effects and to keep track of how well the medication is working to treat your incontinence.

Common medications that can be used to treat incontinence include:

  • Oxybutynin , oxybutynin XL , oxybutynin TDDS .

Medication For Incontinence In The Elderly

Medications are frequently used in combination with behavioral therapies. Here are some commonly prescribed options:

Anticholinergic or antispasmodic drugs

These are usually prescribed for urge incontinence. Examples include Vesicare®, Detrol LA®, Ditropan XL®, Oxytrol skin patch®, and Santura®. The most common side effect is dry mouth. Less common side effects include blurred vision, constipation, and mental confusion.

Antibiotics

These are prescribed when incontinence is caused by a urinary tract infection or an inflamed prostate gland.

H4) Tofranil® and Sudafed® These are used to treat stress urinary incontinence, and they work by tightening muscles around the bladder.

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Timed Voiding And Bladder Training

This technique can help your aging parent control their bladder by charting urination and leaking to determine the pattern. Once you see a pattern, help your parent to the bathroom at those times to empty the bladder before they might leak. When combined with biofeedback and pelvic muscle exercises, these methods may help your parent control urge and overflow incontinence.

Going Home With A Urinary Catheter

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Your provider may send you home with a urinary catheter if you cannot urinate on your own yet. The catheter is a tube that drains urine from your bladder into a bag. You will be taught how to use and care for your catheter before you go home.

You may also need to do self-catheterization.

  • You will be told how often to empty your bladder with the catheter. Every 3 to 4 hours will keep your bladder from getting too full.
  • Drink less water and other fluids after dinner to keep from having to empty your bladder as much during the night.

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What To Expect At A Doctors Appointment For Urinary Incontinence

At your medical appointment, youll likely have:

  • A urinalysis to rule out infection or blood in the urine
  • Blood tests to check on kidney function, calcium, and glucose levels
  • A thorough discussion of your medical history
  • A complete physical exam, including a rectal and pelvic exam for women, or a urological exam for men

A patient may also be asked to bring a bladder diary to the first visit, or to create one before the second appointment.

In this journal, they will likely record:

  • Types of drinks they consume
  • Times they urinate throughout the day
  • How much they urinate, which is measured by placing a special measuring cup over the toilet to record volume
  • A description and frequency of their accidents

Incontinence In Alzheimers Disease

People in the later stages of Alzheimers disease often have problems with urinary incontinence. This can be a result of not realizing they need to urinate, forgetting to go to the bathroom, or not being able to find the toilet. These tips may help:

  • Avoid drinks like caffeinated coffee, tea, and sodas, which may increase urination. But dont limit water.
  • Keep hallways clear and the bathroom clutter-free, with a light on at all times.
  • Provide regular bathroom breaks.
  • Use underwear that is easy to get on and off, and absorbent briefs or underwear for trips away from home.

Visit Alzheimers Disease: Common Medical Problems for more tips.

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Physiological Changes Associated With The Ageing Lower Urinary Tract

Urinary incontinence increases with rising age. Ageing is associated with changes in the lower urinary tract which predispose an elderly to UI. As we age, bladder capacity and contractility reduce, with reduced ability to defer voiding once the urge to do so arises. The post-void residual urine volume increases with age. During the storage phase, detrusor shows increased uninhibited contractility .

Among the elderly postmenopausal women, the pelvic muscles show loss of volume and tone. The ligamentous and connective tissue support for the pelvic organs gradually fail because of ageing. The weakened pelvic floor increases the risk of pelvic organ prolapse causing cystocele, rectocele and uterine prolapse. Stage 3-4 prolapse of pelvic organs can cause UI. A weakened pelvic floor also allows a hypermobile urethra to slide downwards during sudden increase in intraabdominal pressure .

How To Get Help For Female Urinary Incontinence

Stress Urinary Incontinence in Females

Still feeling unsure about your first step? Remember, incontinence doesnt have to stop you from enjoying daily life on your terms. Getting the right diagnosis and treatment can be a life changer.

If you think that you might have urinary incontinence, reach out to one of our primary care doctors. Well answer any questions you may have and guide you to treatment that will work for you. If specialty care is needed, well refer you to our team of compassionate urogynecology specialists.

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Basic Neurophysiology Of Micturition

The bladder is innervated by the autonomic nerves as well as the somatic nerves. The sympathetic innervation originates at T11-L2, supplying the bladder via the Hypogastric nerve. The parasympathetic nerves originate at S2-S4 and innervate the bladder via the Pelvic and Pudendal nerves.

The sensation of bladder fullness as it fills ascends via the spinal cord to be conveyed to the Pontine Micturition Centre, which promotes micturition via the parasympathetic supply to the urinary bladder. However, micturition may not be appropriate at all times. The central nervous system determines the “correct timing” of micturition, taking into account the social and behavioural part of micturition. Micturition is coordinated and triggered through simultaneous activities of the bladder contraction with relaxation of the urethral sphincters via the somatic and autonomic nerves.

In addition to the complex neuroanatomical and physiological reflexes to maintain continence, there are other faculties needed to maintain continence. An intact cognition is important to perceive the sensation of bladder fullness with the ability to postpone micturition after the first sensation, motivation and desire to pass urine, sufficient mobility and coordination to reach the toilet with hand dexterity to manipulate clothing items in order to do so. In addition, the ability to locate the toilet with clear direction and access also contribute to continence .

How To Deal With Elderly Incontinence

Your loved one may feel embarrassed by their accidents and avoid scheduling a doctors appointment. They may be using absorbent pads or protective underwear to help, but urinary incontinence is very treatable with medical assistance.

They may also hold off because theyre unsure what kind of doctor to see. A primary care doctor, geriatrician, nurse practitioner, or urinary specialist are viable options. If your loved one feels comfortable with their primary care doctor, its generally good to start there.

Women can also find a urogynecologist, while men can visit a urologist.

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Catheterisation For Detrusor Under

The main treatment strategy for a poorly contractile bladder is clean intermittent catheterisation. Drugs with parasympathetic activities are not widely used because of poor efficacy and poor side effect profile. New treatment modalities like neuromodulation, neurostimulation or reconstruction with muscle transposition have been explored but data is limited for the elderly .

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How Is Incontinence Diagnosed

Controlling Bowel Incontinence

Often, the diagnosis process for incontinence will start with a conversation with your healthcare provider about your medical history and bladder control issues. Your provider might ask you questions like:

  • How often do you urinate?
  • Do you leak urine between trips to the toilet, how often does this happen and how much urine do you leak each time?
  • How long have you been experiencing incontinence?

These questions can help your provider figure out a pattern with your leakage, which often points to a specific type of incontinence. When your provider is asking about your medical history, its important to list all of your medications because some medications can cause incontinence. Your provider will also ask about any past pregnancies and the details around each delivery.

There are also several specific tests that your provider might do to diagnose incontinence, including:

While at home, your provider might recommend you keep track of any leakage in a journal for a few days. By writing down how often you experience incontinence issues over the span of a few days, your provider might be able to identify a pattern. This can really help in the diagnosis process. Make sure to write down how often you need to urinate, how much you are able to go each time, if you leak between trips to the bathroom and any activities you might be doing when you leak urine. Youll then bring this journal with you to your appointment and talk about it with your provider.

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Surgical Management Of Ui

Data on surgical management of UI among the frail elderly is scarce. Outcome measures are often confounded by comorbidities and postoperative complications among the elderly. Age related physiological changes like pelvic floor weakness and impaired bladder function also affect the success of surgical treatment. The elderly is at a higher risk of postop morbidity and mortality than the younger patients, and the elderly with dementia have a high risk of developing postop delirium. Recent recommendations by the American College of Surgeons and American Geriatric Society for preoperative assessment of the elderly patients include assessment of comorbidities with optimization, medication management, nutritional improvement, screening for frailty, cognitive impairment and function preoperatively .

For the elderly women with stress incontinence, options include injection of bulking agents at the proximal urethra, midurethral sling, colposuspension, transvaginal/retropubic/transobturator tension-free vaginal tape are all recognized surgical interventions for stress UI. They are effective for women well selected to enroll in large trials with good gain in quality of life, with a risk of postop complications like infection. However, the more frail, disabled elderly with cognitive impairment have not been well studied .

The Artificial Urinary Sphincter

The artificial urinary sphincter for the management of severe stress UI was first introduced in 1973. This implantable device comprises a reservoir, urethral cuff and control pump, which requires manual dexterity and reasonable cognitive function to operate. The requirement for surgical revision is up to 30% of implants . Newer devices in development may provide more automated control systems and allow use in frailer or more cognitively impaired people with severe stress or post-prostatectomy incontinence .

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What Questions Should I Ask My Surgeon If I Am Considering Surgery To Treat Stress Urinary Incontinence

Ask your surgeon about all SUI treatment options, including non-surgical options and surgical options that do and do not use mesh slings. It is important for you to understand why your surgeon may be recommending a particular treatment option to treat your SUI.

Any surgery for SUI may put you at risk for complications, including additional surgery. One complication that may occur when mesh slings are used is vaginal mesh erosion, which could require additional surgery to resolve.

If mesh erosion occurs through the vaginal tissue, it is possible that men may experience penile irritation and/or pain during sexual intercourse.

Ask your surgeon the following questions before you decide to have SUI surgery:

Is Urinary Incontinence A Normal Part Of Aging

Urinary Incontinence Strategies for Frail Elderly Women

What exactly is urinary incontinence? Its the involuntary loss of urine, according to the National Association for Continence . Although incontinence can happen at any age, its generally more common in seniors.

As you age, changes in the body can make elderly urinary incontinence more likely. One out of two women older than 65 experience bladder leakage sometimes, according to the Urology Care Foundation. It can be caused by typical aging, lifestyle choices, or a range of health conditions.

Elderly urinary incontinence can take on a few forms:

  • Some people may only leak urine occasionally
  • Others may constantly dribble urine
  • Some experience a complete lack of both bladder and bowel control

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Prepare For Accidents With Amica

When it comes to Incontinence care for the elderly, Amica is your one-stop-shop for all the supplies youll need. Weve made it our mission to provide the highest quality incontinence products so you dont have to worry about accidents. As the largest online distributor for top brands in the medical supply industry, we have everything youll need to make living with incontinence just a little easier.

Give us a call today at 1-888-939-0774 to learn more about our incontinence products!

This entry was posted in Lifestyle on September 23, 2021 by Brett F. Previous PostNext Post

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