14. Urinary incontinence

One of the major geriatric symptoms is the urinary incontinence. Patients who suffer this, lose urine unintentionally, in a time and place inadequate. Likewise, occurs with frequently enough to be a hygiene problem, social and psychic to the patient. Typically, this syndrome affects more women than men.

One type of incontinence that exists is stress incontinence (grouped into chronic urinary incontinence).

This type of incontinence is an involuntary loss of urine that occurs during physical activity / Valsalva maneuver (coughing, estornudad, laughing, walking or lifting).

One of the causes related to incontinence are weak pelvic sphincter muscles that support the bladder and urethra (the sphincter can not stop the flow of urine when pressure is exerted on the abdomen). This weakness can be caused by childbirth, injury to the urethral area, medication or surgery of the prostate or pelvic area.

Risk factors for stress incontinence include female gender, labor, prolonged coughing (bronchitis, asthma), older age, obesity and smoking.

Complementary testing that can be carried out on physical examination are:

• Electromyography (EMG) to study muscle activity in the urethra or pelvic floor.
• Exam of the towel health: the patient is asked to perform physical activity while wearing a towel and, after exercise, weigh the towel to find out the amount of urine lost.
• Abdominal or pelvic ultrasound.
• Test to view the inside of the bladder (cystoscopy).
• Urinalysis (urine culture) to rule out urinary infection.
• Urinary stress test (the patient is asked to stand with a full bladder, and then cough)
• Radiography with contrast kidney and bladder

There are four types of treatment for urinary stress incontinence:

• Changes in behavior:
• Drink less liquid
• Urinating more often
• Avoid jumping and running
• Take fiber to be regular bowel movements.
• Quitting smoking (reduces coughing)
• Avoid alcohol and caffeine (stimulate the bladder).
• Medications:
• Anticholinergics (overactive bladder control)
• Alpha-adrenergic agonists (increase sphincter strength)
• Estrogens (improve symptoms of urinary frequency and urgency)
• Training the muscles of the pelvic floor:
• Kegel Exercises
• Surgery:
• Anterior vaginal repair (if the bladder protrudes inwardly of the vagina)
• Artificial urinary sphincter (mainly in men)
• Collagen injections (become thicker urethra à helps control urine leakage or seepage)
• Tension-free vaginal tape

I understand that urinary incontinence is a major problem in the elderly, but I think it is not as severe as other geriatric syndromes. Fortunately, today we have many resources and methods of prevention.

Bibliography

• Medline. [Monografía de internet]. [Fecha de consulta 30 de abril de 2013]. Disponible en: http://www.nlm.nih.gov/medlineplus/spanish/ency/article/000891.htm
• Vicente Solá, D; Jack Pardo, S; Paolo Ricci, A; Enrique Guiloff, F; Humberto Chiang, M. cirugía mínimamente invasiva en el tratamiento de la incontinencia urinaria femenina de esfuerzo: TVT-O. Chil. obstet. ginecol. V.71 (n.1). Satiago: 2006. Disponible en: http://www.scielo.cl/scielo.php?pid=S0717-75262006000100002&script=sci_arttext