Urinary Considerations in the Elderly Lecture Powerpoint

Question 1

Over 50% of elderly suffering from incontinence do not seek help because of these 3 reasons

Answer 1

• embarrassment
• belief that it is normal part of aging
• assumption that nothing can be done but surgery to correct it

Question 2

Physiology of urination

Answer 2

Requires correct functioning and interaction of CNS, sacral PNS, thoracolumbar SNS, bladder muscle (detrusor), urinary sphincter muscle, and mechanical support of the pelvic fascia and floor - if bladder pressure exceeds urethral then end up urinating (the problem of incontinence).

• Bladder relaxation and filling and closure of bladder neck and sphincter is done by inhibiting parasympathetic tone AND sympathetic stimulation via B adrenergics
• bladder contraction is done via parasympathetic stimulation upon sensory signal being sent that bladder is being stretched and filled, the internal sphincter relaxes
• somatic control of relaxation of pelvic floor via the pudendal nerve including external sphincter

Question 3

Causes of acute incontinence (5) which 2 are most common?

Answer 3

• Infection (UTI)***
• delirium
• polypharmacy
• fecal impaction***
• restricted mobility

Question 4

Causes of urinary incontinence in nongeriatric patient (5)

Answer 4

• loss of fascial support of urethra (stress incontinence)
• overactive bladder muscle
• intrinsic sphincter deficiency
• neuropathies
• urinary tract fistulas

Question 5

Bladder changes in the elderly (5)

Answer 5

• bladder contractility, capacity, urine flow rate, and ability to postpone voiding declines in males and females
• urethral length and maximal closure pressure decline with age
• prostate enlarges in most men (obstruction)
• prevalence of involuntary detrusor contractions
• decline in functional status and increase in comorbid medical conditions

Question 6

4 medications that increase incontinence

Answer 6

• diuretics
• anticholinergics
• Ca2+ channel blockers
• alcohol

Question 7

Urge incontinence and treatment (1)

Answer 7

Sees detrusor muscle contractions (premature parasympathetic stimulation) at low volumes** (overactivity or instability) caused from sensory stimulation, UTI’s, CNS lesions, etc

-anticholinergic drugs (oxybutyin or tolterodine)

Question 8

Stress incontinence and treatment (4)

Answer 8

Incompetent internal sphincter (normally relaxes with parasympathetic stimulation) causes leakage with increased abdominal pressure (coughing, sneezing, lifting)

-kegels, pessaries, surgery, alpha adrenergic agonists such as pseudoephedrine (have to watch for causing high BP)

Question 9

Overflow incontinence and treatment (2)

Answer 9

Loss of detrusor muscle contractility via parasympathetic stimulation or sensation due to urethral blockage (in neuropathies, DM, trauma, or bladder outlet obstruction due to BPH or constricture), bladder can’t empty properly so urine just leaks out

-alpha adrenergic antagonists or cholinergic agonists (bethanechol)

Question 10

Reflex incontinence

Answer 10

Derived from spinal cord damage mostly above the sacral level

Question 11

Functional incontinence

Answer 11

Situations in which physical, functional, or mental disability makes it impossible to void independently even though the urinary tract may be intact (can’t make it to the toilet)**

Question 12

Majority of HEALTHY elderly have one or 2 episodes of ____ even in the absence of disease states

Answer 12

nocturia

Question 13

Urodynamic testing

Answer 13

Measuring of postvoid residual urine volume (PVR) 50 mL’s normal but over 100mL is a problem or cystometry where the bladder is filled with different capacities and volumes to test for when the sensation and urge is felt by the patient