Urinary incontinence in the elderly
Introduction
Introduction to urinary incontinence in the elderly Urinary incontinence, that is, urine in the bladder can not be controlled and flow out by itself. Urinary incontinence can occur in patients of all ages, but it is more common in elderly patients. Because urinary incontinence is more common in the elderly, people are mistaken for urinary incontinence is an inevitable natural consequence of aging. In fact, there are many reasons for urinary incontinence in the elderly, many of which can be controlled or avoided. Urinary incontinence is not a normal manifestation of aging, nor is it irreversible. You should look for various reasons and take reasonable treatment. basic knowledge The proportion of illness: 0.02% Susceptible people: the elderly Mode of infection: non-infectious Complications: Eczema, Fracture, Depression, Senile Acne, Acne
Cause
The cause of urinary incontinence in the elderly
(1) Causes of the disease
1. Central nervous system disorders: such as cerebrovascular accident, brain atrophy, cerebrospinal tumor, lateral sclerosis and other neurogenic bladder.
2. Surgery: such as prostatectomy, bladder neck surgery, rectal cancer radical surgery, cervical cancer radical surgery, abdominal aortic aneurysm surgery, etc., damage the bladder or sphincter movement or sensory nerve.
3. Urinary retention: Prostatic hyperplasia, bladder neck contracture, urethral stricture and other urinary retention.
4. Unstable bladder: Bladder tumors, stones, inflammation, foreign bodies, etc. cause unstable bladder.
5. After menopause: Estrogen deficiency causes a decrease in muscle tension in the urethral wall and pelvic floor.
6. Childbirth injury: sphincter function caused by uterine prolapse, bladder bulging and the like.
(two) pathogenesis
Normal urination and voluntary control are associated with a series of complex physiological responses. As the bladder fills, the bladder wall stretch receptor sends a signal to the sacral spinal cord. When the bladder volume reaches a critical value, spinal cord reflex (urinary reflex) stimulates bladder emptying. The emptying process is completed by the detrusor rhythmic contraction and the external urinary sphincter relaxation. The urination control is completed by the neuronal circuit of the cerebral cortex to inhibit the urinary reflex. The random control requires the individual to pay attention to the bladder emptying threshold to avoid reaching the threshold. Urination, the formation of urinary incontinence, that is, to feel the degree of bladder filling, inhibition of reflex contraction until the degree of urination, unconstrained bladder contraction or cough, sneezing caused by sudden increase in pressure to close the urethra to prevent Urinary incontinence, the ability to empty the bladder at will is also important in maintaining random control. All the above links can not function properly at the appropriate time, and urinary incontinence can occur. Common types of urinary incontinence are:
1 urge urinary incontinence, bladder contraction is not inhibited;
2 stress urinary incontinence, when the transient pressure increases, can not effectively prevent urine outflow;
3 overflowing urinary incontinence, the bladder can not be completely empty, urine from the long-filled bladder outflow;
4 functional urinary incontinence, normal physiological response, but due to other reasons such as emotional or motor impairment, can not go to the toilet or the use of toilet, about 1/3 of functional urinary incontinence is caused by urinary tract infection or acute mental illness or dyskinesia Temporary symptoms caused.
Prevention
Elderly urinary incontinence prevention
1, to prevent urinary tract infections
After getting into the urine, the habit of going to the back to wipe the toilet paper to avoid infection of the urethra. Before sex, the husband and wife first wash the vulva with warm water. After sexual intercourse, the woman immediately empties the urine and cleans the vulva. If urinary pain and frequent urination occur after sexual intercourse, you can take anti-urinary tract infection drugs for 3 to 5 days, and cure quickly in the early stage of inflammation.
2, regular sex life
Studies have shown that menopausal women continue to maintain a regular sex life, can significantly delay the physiological degeneration of ovarian synthetic estrogen function, reduce the incidence of stress urinary incontinence, while preventing other senile diseases and improve health.
3. Strengthen physical exercise
Strengthen physical exercise and actively treat various chronic diseases. Emphysema, asthma, bronchitis, obesity, huge tumors in the abdomen, etc., can cause increased abdominal pressure and lead to urinary incontinence. It should actively treat such chronic diseases and improve systemic nutritional status. At the same time, proper physical exercise and pelvic floor muscle training should be carried out. The easiest way is to wake up before going to bed every morning and after lying down in the evening, doing 45 to 100 times to tighten the anus and lift the anus, which can significantly improve the symptoms of urinary incontinence.
Complication
Urinary incontinence complications in the elderly Complications, eczema, depression, depression, acne, acne
Common genital eczema, ulcers, urinary tract infections, bacteriuria, and even falls and fractures, individuals suffering from depression.
Symptom
Symptoms of urinary incontinence in the elderly Common symptoms Urinary incontinence Urinary frequency Urinary urinary tract reflexes Digestive diabetes Hematuria Sclerosis Prostatic hyperplasia Bladder Dementia
1. Urgent urinary incontinence:
This type of urinary incontinence includes bladder instability, detrusor hyperreflexia, bladder spasm and neurogenic bladder (uninhibited bladder), and urinary incontinence is associated with uncontrolled contractile detrusor contraction.
Failure to inhibit detrusor contraction is a neurological disease or injury that interferes with central nervous system control, such as cerebrovascular accident, brain tumor, dementia, Parkinson's disease, multiple sclerosis or spinal cord injury, urinary tract infection, fecal incarceration Bladder or urethral local inflammation or irritation caused by benign prostatic hyperplasia, uterine prolapse and bladder cancer can also produce bladder dysfunction. Poor urination habits such as frequent urination can cause unstable bladder, repeated low volume urination can make the bladder unable Contains normal amounts of urine, frequent urination and urgency, and typical urge incontinence occurs when bladder filling is high.
2. Stress urinary incontinence:
When the body works like coughing, sneezing, bumping or pushing heavy objects, the intra-abdominal pressure rises sharply and then involuntary urine effluent occurs. When there is no detrusor contraction, urinary incontinence occurs when the intravesical pressure rises above the urethral resistance. Defects in urinary incontinence are in the bladder outflow tract (sphincter dysfunction), resulting in insufficient urethral resistance to prevent leakage of urine.
Stress urinary incontinence is more common in women. It is rare in men after urinary tract surgery such as prostatectomy. It is generally believed that the cause of female stress urinary incontinence is pelvic floor support tissue damage caused by perinatal period, and urine leaks. The exact mechanism is still controversial. From the explanation of the anatomical changes, it emphasizes that due to the excessive pulling or damage of the pelvic floor tissue, the acute angle of the bladder urethra disappears in the pathogenesis. When the bladder bottom and the urethra are at a normal acute angle, the physical activity can be The pressure is transmitted to the urethra and the bladder at the same time. Therefore, the urethral pressure increases when the intravesical pressure increases, preventing the urine from flowing out. When the urethra loses support, the position changes, the pressure is transmitted to the bladder when the abdominal pressure rises sharply, and the urethral pressure is not. Changes, leading to urinary incontinence, functionally explain the stress urinary incontinence, that is not consciously controlled by the pelvic floor muscles, that is to say, when the intra-abdominal pressure is transiently elevated, the distal urethral sphincter fails to contract, Stress urinary incontinence in postmenopausal women is often accompanied by atrophic vaginitis.
3. Overflow urinary incontinence:
When the long-term filling bladder pressure exceeds the urethral resistance, overflow urinary incontinence occurs, which may be caused by no tension (can not contract) bladder or bladder outflow tract functional or mechanical obstruction, and tension-free bladder is often caused by spinal cord trauma or diabetes. In the elderly patients, bladder outflow obstruction is often caused by fecal incarceration. About 55.6% of patients with constipation have urinary incontinence. Other causes of outflow obstruction are benign prostatic hyperplasia, prostate cancer and bladder sphincter coordination are not possible, and individual cases are mental urinary retention.
4. Functional urinary incontinence:
The patient can feel the bladder filling, but can not help or intentionally urinate due to physical exercise, mental state and environment.
Resnick et al reported the results of urodynamic examination in 94 elderly patients with urinary incontinence and found that detrusor activity is the main cause of female urinary incontinence, accounting for 61%, of which half of the patients had detrusor contractile disorder and other causes of female urinary incontinence. Stress urinary incontinence, decreased detrusor activity and outflow obstruction. In male patients, the cause is mainly detrusor hyperreflexia, followed by outflow obstruction, and 35% of patients have at least two possible causes. When the detrusor hyperreflexia is accompanied by bladder contraction disorder, the patient may have urinary retention, which is similar to the manifestation of benign prostatic hyperplasia. The treatment is different from those with normal bladder contraction.
Examine
Elderly urinary incontinence check
Laboratory tests should be performed: urine routine, urine culture, urea nitrogen, creatinine, serum potassium, sodium, chlorine, blood sugar, such as urinary records suggest that patients have polyuria, blood glucose, blood calcium, albumin check, such as frequent urination Urinary urgency accompanied by microscopic hematuria should exclude urinary tuberculosis.
Urodynamic examination: Urodynamic examination can ensure the accuracy of the diagnosis, such as patients can not be diagnosed by general examination, or empirical conservative treatment failure, or should be performed before surgery should be urodynamic examination, for the elderly Urodynamic examination is safe and reliable.
1. Urodynamic examination of detrusor overactivity:
Generally, during the filling period, the bladder pressure can be used to understand whether the patient has excessive detrusor hyperactivity, the patient is in a semi-sitting position, and the urethral pressure tube and the rectal pressure tube are indwelled. The low-speed perfusion (10 ml/s) is used at the beginning of the examination, and the patient is coughed. Or increase the abdominal pressure to stimulate the bladder, such as biphasic contraction wave of the detrusor and more than 15cmH2O, while urgency or urge incontinence can diagnose detrusor overactivity (such as nerve damage) Excessive activity is called uninhibited contraction, and neurogenic bladder type is detrusor hyperreflexia. If the patient does not have excessive detrusor hyperactivity, it can be moderately (50ml/s) or fast (100ml/s). Perfusion of the bladder, maximally induced detrusor overactivity, the presence of detrusor activity within 100ml of perfusion has obvious clinical significance, normal people may also have detrusor contraction close to the maximum volume of the bladder.
2. Urodynamic examination of stress urinary incontinence:
The main purpose of urokinetic examination of stress urinary incontinence is to exclude the detrusor overactivity. Because of the placement of the pressure catheter in the urethra, even if the patient has stress urinary incontinence, it may not be induced during the examination. Urethral pressure gauge to understand whether the posterior urethra is moved down or the pressure of the abdominal pressure leaks to determine the function of the urethral sphincter (see the relevant section for the examination method), and to classify the pressure urinary incontinence and determine the surgical method. If only the urethral descending factor, simple bladder neck suspension can achieve good results, such as the presence of urethral sphincter loss, the need for cuff type bladder neck suspension or bladder neck posterior urethral submucosal graft injection.
Diagnosis
Diagnosis and identification of urinary incontinence in the elderly
Diagnostic criteria
According to the patient's clinical manifestations, a preliminary diagnosis can be drawn. Patients with urge incontinence often have urinary incontinence when they have a strong sense of urinary urgency. They cannot reach the toilet in time. The typical cause of urge incontinence is to hear the sound of running water. Want to go to the toilet, look at the toilet or cold weather, patients with stress urinary incontinence often have physical activity that induces urinary incontinence such as coughing, sneezing, lifting weights, standing up from the seat and going up the stairs.
Physical examination should look for signs of autonomic dysfunction, fecal incarceration, neurological diseases, benign prostatic hyperplasia and pelvic disease. Laboratory tests do not need to be comprehensive, including urine routine, urine culture and biochemical tests, and urine when there is hematuria. Exfoliative cytology, residual urine volume after urinary observation can be found in overflow urinary incontinence.
Differential diagnosis
Urodynamic testing is important in determining primary abnormalities and suggesting feasible treatments.
Urinary incontinence must be distinguished from the following:
1. Leakage of urine is the flow of urine from an abnormal path, such as vaginal fistula caused by birth injury.
2. The ureteral orifice is ectopic, the urine does not flow into the bladder, and the female flows out from the urethra or the vagina. In males (rarely seen), it flows out from the urethra, but all are normal urination.
3. Severe cystitis caused by tuberculosis or high bladder contracture, and urine continuously flows out of the urethra.
