What to do with senile urinary incontinence. Methods for treating senile urinary incontinence in women. Medications to treat urinary incontinence in older women

Data on the prevalence, pathogenesis and treatment in older people are presented. There is a high incidence among patients who have had a stroke, dementia and other neurological diseases. The ideas about the pathogenesis and manifestations of bladder hyperactivity and stress are presented. Modern medications (anticholinergics, antidepressants, botulinum toxin preparations), methods of behavioral therapy, physical therapy and urinary incontinence are discussed. Modern treatment methods can improve the quality of life of older people and their environment.

Elderly people have a serious medical and social problem. This is due to an increase in the number of elderly patients who suffer from diabetes, Parkinson's disease, dementia (Alzheimer's disease, etc.), have had a stroke or have other diseases leading to urinary incontinence. In Germany, it affects 11% (2 million) of people over 60 years of age and 30% of people over 80 years of age. In our country, due to imperative urges, it is observed in 17% of women. On average, urinary incontinence is more common in women than in men. Only a small proportion of older people with urinary incontinence seek medical advice and receive effective treatment. However, it worsens the quality of life of older people and can contribute to the development of depression, falls, skin lesions, social isolation and referral to nursing homes (boarding homes for people with chronic diseases).

Neurological aspects of urinary regulation

The bladder is a hollow organ, the main part of which is the detrusor muscle, or pubovesical muscle (smooth muscle). Urination occurs when the detrusor muscle contracts and the internal sphincter (smooth muscle) and external sphincter (striated muscle) relax.

Filling the bladder causes it to stretch and excite the detrusor receptors, which leads to a flow of impulses along afferent fibers into the conus (sacral section SII–IV) of the spinal cord. The resulting activation of parasympathetic neurons is transmitted along their fibers and causes contraction of the detrusor and relaxation of the internal sphincter, which leads to emptying of the bladder. This is how involuntary, or reflex, urination occurs, which occurs in children under one year of age and in diseases that lead to voluntary (central) control of urination.

Voluntary control of urination is carried out as follows. When about 200 ml of urine accumulates in the bladder, impulses are transmitted to the brain, where a decision is made to whether or not to urinate. Impulses to fill the bladder are transmitted along the sensory fibers of the peripheral nerves, dorsal roots, posterior cords to the reticular formation of the pons and further to the paracentral lobe, located on the medial surface of the frontal lobes. Voluntary urination is carried out from the motor part of the paracentral lobule through impulses that reach the anterior horns of the spinal cord at level SII–IV (along fibers located next to the fibers of the corticospinal tract), and from them go along the fibers of the somatic peripheral nerves to the external sphincter and cause its relaxation . In addition, parasympathetic nerves release acetylcholine, which binds to muscarinic receptors in the detrusor muscle and causes its contraction. This leads to a reflex relaxation of the internal sphincter and emptying of the bladder. Contraction of the abdominal muscles can promote urination. When the decision to urinate is negative, the sympathetic nerves release norepinephrine, which binds to β-adrenergic receptors, causing detrusor relaxation. Urinary retention is also achieved by contraction of the external sphincter.

Causes and manifestations of neurogenic urination disorders

In many cases, it is possible to determine the cause of urinary incontinence in older people based on a thorough collection of complaints and anamnesis, and a somatic examination. In unclear cases, a study of the volume of fluid consumed and urine output, consultation with a neurologist, urologist, and a special urological examination may be required.

Due to damage to the nervous system, it is regarded as neurogenic. This disorder is usually combined with other lesions of the nervous system (cognitive impairment, paresis, sensitivity disorders, etc.), less often it is the only symptom of a neurological disease. Neurogenic dysfunction of the bladder manifests itself in the form of incontinence and/or urinary retention. It occurs when the paracentral lobule, the sacral part of the spinal cord, peripheral nerves going to the bladder are damaged, as well as when there is bilateral damage to the conductors between the sacral part of the spinal cord and the paracentral lobe (cerebral hemispheres, brain stem and spinal cord). If the conus spinal cord or cauda equina roots are affected, urinary retention may occur due to bladder atony. If paralysis of the sphincters develops, then true urinary incontinence (continuous release of urine in drops) or paradoxical ischuria (urine is released in drops, but due to detrusor atony a large amount of it accumulates in the bladder) may occur. If the sensory fibers coming from the bladder are completely damaged, its filling and the passage of urine during urination are not felt; Atony and fullness of the bladder and urinary retention occur more often. In the acute stage of spinal injury above the conus (above the sacral segments SII–IV), urinary retention usually develops, but subsequently it usually gives way to urinary incontinence due to bladder overactivity. In the case of incomplete damage to the spinal cord (for example, with multiple sclerosis), patients experience difficulty in holding urine and there are imperative (imperative), sometimes false urges to urinate.

With brain diseases (stroke, tumor, Alzheimer's disease, etc.), both urinary retention and incontinence can develop, but the latter is more common.

Urinary incontinence can be caused by urological, gynecological and neurological diseases, which are often combined in older people. It is important to identify the cause of incontinence, this will alleviate the condition of severe, incurable patients. Among older people in care homes, dementia is also the most common cause of urinary incontinence. The majority (60–90%) of these patients cannot move independently and suffer from severe cognitive impairment. Limited mobility makes it difficult for medical personnel and caregivers who are forced to accompany patients to the hospital, and the presence of dementia reduces the motivation to urinate independently.

Bladder overactivity is manifested not only by urinary incontinence, but also by an imperative urge to urinate, pollakiuria (frequent urination). Bladder overactivity can be not only neurogenic, but also a consequence of various urological and gynecological diseases. The neurogenic theory of overactive bladder considers increased spinal reflex (hyperreflexia) as the main cause of the disorder caused by neurological diseases. The myogenic theory highlights the important role of aging-related changes in muscle fibers leading to bladder overactivity. In a significant proportion of cases, it is not possible to find out the cause of bladder overactivity, so it is regarded as idiopathic. Some authors note that idiopathic bladder overactivity is much more common than neurogenic overactivity.

Stress urinary incontinence is associated with insufficiency of the bladder sphincter. It occurs due to increased pressure in the bladder caused by a number of physical stimuli, such as coughing, sneezing, and abdominal muscle tension. The main differences between stress urinary incontinence and manifestations of overactive bladder are presented in table. 1.

Patients with diabetes are more likely to develop urinary incontinence. With age, the number of patients with diabetes increases, and after 75 years, this disease is observed in almost 25% of cases. The likelihood of urinary incontinence increases with the duration of diabetes; Severe urinary incontinence occurs in this case almost 2 times more often than in the rest of the population. Urinary incontinence is significantly associated with the development of diabetic neuropathy.

Treatment

If possible, it is necessary to eliminate the cause of urinary incontinence - effective treatment of an existing neurological disease, for example, removal of a spinal cord tumor or herniated disc. In many cases, effective treatment of a comorbid disease or disorder (urinary tract infection, cognitive impairment, depression) leads to improved urinary control. Optimization of therapy is of great importance, because urinary incontinence often increases or even occurs as a consequence (side effect) of taking certain medications, in particular diuretics.

Treatment of urinary incontinence can improve the quality of life of patients, as well as their caregivers, if the patient. Even among older people in care homes, spending on urinary incontinence treatment is justified from an economic point of view. A comparative analysis shows that in industrialized countries the diagnosis and quality of management of patients with urinary incontinence are improving.

Drug therapy. Among the medications that reduce the manifestations of bladder overactivity, we can distinguish: 1) drugs that reduce efferent stimulation of the detrusor (anticholinergics); 2) polysynaptic inhibitors, or drugs that increase inhibitory control (antidepressants); 3) drugs that reduce the sensitivity of the bladder (botulinum toxin drugs); 4) drugs that reduce urine formation (vasopressin analogues).

Behavioral therapy and physical therapy. Behavioral therapy and physical therapy may be effective in some older patients with urinary incontinence. Their combination with drug therapy makes it possible to reduce the dose of drugs and, accordingly, reduce the risk of side effects associated with them. Behavioral therapy for overactive bladder is based on the assumption that this condition is caused by a partial loss of control over the urinary reflex developed in childhood or a pathologically formed reflex. At least 20% of patients (especially women) suffering from overactive bladder have an abnormal urination pattern, based on the advisability of emptying the bladder when there is an urge. The patient is explained that the normal volume of urination is 1500–2500 ml/day, the average volume of urination is 250 ml, the average capacity of the bladder is 400–600 ml, the desired number of urinations is no more than 7–8 times a day. If the patient drinks excessive amounts of fluid, which contributes to urinary incontinence, it is necessary to advise her to avoid taking fluids unless necessary (drink only with meals, avoid excessive consumption of tea and other drinks), limit spicy foods and salt in the diet. Many patients should avoid poor urination patterns: always urinate before eating or leaving the house. Patients are asked to keep a voiding diary and urinate at regular intervals. A voiding diary provides the physician with important information about the patient's drinking habits. Keeping a diary allows you to obtain information about the possible presence of factors that provoke urination, which, undoubtedly, is of great importance for choosing the correct tactics of behavioral therapy. Bladder training involves gradually lengthening the intervals between urinations, which leads to an increase in the functional capacity of the bladder.

Exercises to strengthen the pelvic floor muscles in women significantly reduce the degree of urinary incontinence, as evidenced by a meta-analysis of 13 randomized trials that included 734 women. Urinary control significantly increases in the group of women performing exercises to strengthen the pelvic floor muscles. Exercises to strengthen the pelvic floor muscles involve alternately contracting and relaxing the levator ani muscles. They are performed on average 3 times a day, the duration of contractions is gradually increased from several seconds to 2 minutes. Exercises can also be used in situations that provoke urinary incontinence (when coughing, sneezing, running, etc.). A positive effect is achieved only if the exercises are performed regularly.

Peripheral electrical stimulation, which is thought to be based on suppressing stimulatory influences and increasing inhibitory sympathetic influences on the bladder, may be effective for bladder overactivity. Certain relaxation techniques may also be helpful in reducing the severity of urinary incontinence.

Modern absorbents. In many cases, in older people, all available means of preventing urinary incontinence do not solve this problem. This applies not only to bedridden patients, but also to healthy people whose physical activity is limited due to urinary incontinence, which significantly worsens the quality of life. In such cases, adult pads or absorbent panties may be effective. Modern absorbents have a 3-layer absorbent pad with protective sides, which reliably holds liquid and prevents unpleasant odors. This is achieved by the fact that the supersorbent contained in the absorbent pad instantly turns urine into a gel and neutralizes the unpleasant odor. Absorbent panties can be worn like regular underwear; they are soft, invisible under clothing and provide comfort, allowing the healthy patient to lead a normal lifestyle.

Thus, urinary incontinence is common in older people, significantly reducing their quality of life. Overactive bladder and/or stress urinary incontinence are the most commonly reported causes and are prevalent in patients with dementia, stroke, and other neurological diseases. In many cases, medications (anticholinergic drugs, etc.), behavioral therapy, physical therapy, and properly selected absorbents can eliminate or significantly reduce the severity of the problem and improve the quality of life of older people and their environment.

Urinary incontinence in old age in women (synonym: incontinence) is a severe negative impact from a medical, personal and social point of view.

The frequency of the phenomenon varies according to conditions and ranges from 5-15% of the total adult population living at home, 20-30% of those hospitalized, up to 70% in nursing homes. In general, problems with incontinence in women begin at the age of 50-70 years.

Urinary incontinence is often associated with significant medical conditions, including the insertion of an indwelling catheter into the bladder, urinary tract, etc.

Signs and symptoms

imperative (urgent) urinary incontinence (periodic uncontrolled leakage of urine);
a woman who has the urge cannot wait to go to the toilet;
frequent and unusual urges to urinate.

Types and causes of urinary incontinence in old age

Incontinence is the inability to control urination.

It can be temporary or permanent, and it can also be the result of multiple problems in the urinary tract.

Incontinence is generally divided into four types:

Stressful type of pathology– occurs due to weakening or malfunction of the urethral sphincter and, in the event of a stressful situation, will manifest itself with negative symptoms and the release of urine. In addition to a stressful situation, the development of this type of pathology can also be triggered by pregnancy, childbirth, surgery and age-related changes.
Imperative type– if the bladder is over-reactive, even a minimal amount of urine can provoke an urge to go to the toilet, etc. The reason for the development of this type of incontinence is stress.
Iatrogenic type of pathology– This type of urinary incontinence can be triggered by certain medications, diuretics, antidepressants and certain hormonal drugs.
Other types of pathology– they can be provoked by organic root causes, such as oncology, injuries and strokes, certain diseases, for example, or. In each individual case, the cause is determined by the urologist after a complete examination and examination of the woman. You should never practice self-diagnosis.

Provoking factors

Urinary incontinence in women over 50 years of age can be caused by the following factors and reasons:

stretching of the pelvic muscles due to frequent pregnancy and childbirth; women with gestational diabetes are at higher risk;
weakened muscles that control urination (urethral sphincter and pelvic floor muscles);
, during which hormonal changes occur in the body and the level of estrogen decreases;
certain diseases that damage the nerve pathways from the bladder to the brain, such as:
recurrent urinary tract infections (UTIs);
incorrect combination of drugs;
hip dysfunction;
unsuccessful surgery on the anterior hips;
inflammatory processes affecting organs and the urinary system itself.

In addition, the causes of such an unpleasant phenomenon as urinary incontinence can be excess weight, a certain degree of obesity, since there is additional pressure on the abdominal muscles and pelvic floor, provoking involuntary discharge.

None of the factors mentioned lead directly to incontinence, but are considered only supporting factors.

Diagnostics

To make a correct diagnosis, a urologist is needed; she prescribes a comprehensive examination:

collecting data on the course of the disease, on the nature and frequency of urine discharge, intensity and volume, number of births, whether there have been surgical interventions and whether the person suffers from diseases;
vaginal (internal) examination - at this stage the doctor takes a smear for laboratory testing of the environment of the vagina and cervix;
They do an ultrasound of the ureter, bladder, and kidneys. This is necessary for the doctor to determine the presence and absence of inflammation.

In addition to this, a general test is carried out to detect infections (hematuria and glycosuria).

It is important to emphasize that older people often suffer from asymptomatic bacteriuria, which does not cause incontinence and does not require treatment, except in patients whose leakage has recently appeared or is accompanied by high fever or burning when urinating.

Pelvic check

Women need a pelvic examination. The following reasons:

Atrophic vaginitis causes or worsens the course of urinary incontinence.
During the test, it is necessary to assess the ability to contract the muscles of the pelvic floor and, according to this, plan treatment.
Many older women do not take constant gynecological monitoring seriously. A pelvic smear test (Pap smear) can rule out the presence of cervical tumors.
As part of the check, provocative tests are performed to exclude urine leakage during exertion, including coughing and the Valsalva maneuver. If there is, it is necessary to achieve vaginal prolapse during testing with a finger or with the help of a pessary (a device that is inserted into the vagina to support the uterus, bladder and rectum) to exclude hidden urinary incontinence due to stress.

Assessment of residual urine in the bladder

Assessing the residual urine in the bladder after a sufficient voiding provides information about the effectiveness of voiding and the risk of infection.

Although testing can be done using a catheter, ultrasound is the preferred method.

It should be remembered that problems such as or can make it difficult to conduct an ultrasound examination.

Imaging check

There is no specific imaging test as part of the evaluation of a patient with urinary incontinence. The choice of a specific diagnostic procedure depends on the clinical condition and treatment options.

Ultrasound examinations of the kidneys and urinary tract provide information about the volume of the bladder, the amount of residual urine after emptying the bladder, stones or tumors of the urinary system.

Treatment of urinary incontinence in older women

Treatment can help more than 80% of people with the problem.

Exercise and behavioral therapy (one of the leading areas of modern psychotherapy) are the most successful.

Also, urinary incontinence in women after 70 is often treated with medications.

Medications

Urotol, 2 mg tablets with the active ingredient Tolterodine;
Enablex with the active ingredient Darifenacin* (Darifenacin*);
Fesoterodine(Fesoterodine fumarate).

Homeopathic medicines for urinary incontinence:

Causticum;
Pareira;
Sepia;
Zincum.

Here are some of the most common homeopathic remedies used for stress incontinence.

Attention! According to a recent study, the drugs only help about 20-30% of women who take them and often have significant side effects. Therefore, before taking pills, you need to discuss everything with your doctors.

Kegel exercises

To strengthen your pelvic floor muscles, squeeze and hold for 10 seconds. vaginal muscles, then relax them.

To find and feel the muscles, you need to imagine that you are trying to stop the flow of urine so as not to wet yourself, without particularly straining the buttocks or abdominal cavity.

Keep your muscles tense for 10 seconds, then relax for 10-15 seconds, and again. Do this exercise 2 times a day (day and evening) for 20 approaches.

Treatment of urinary incontinence in women with folk remedies

Recipe #1:

mix St. John's wort, knotweed, valerian root and hop cones in equal proportions - 2 tbsp.
Next, the collection is steamed in a glass with boiled water, left for half an hour and taken before meals.

Recipe #2:

For involuntary and uncontrollable incontinence, the following can be used from the arsenal of folk remedies:

take St. John's wort, coltsfoot, centaury in equal parts - 1 tbsp. l.
Next, you need to brew the herbs in a glass of boiling water and leave for 30 minutes. and take twice a day.

Other recipes for treating urinary incontinence in older women:

Sage: 50 gr. sage is steamed in a thermos, pour 1 liter. boiling water, left for 2 hours - take half a glass 3 times a day.
Bird cherry bark, collected during its flowering period, crushed - 2 tbsp. l. steamed in 300 ml. boiling water, boil in a water bath for 10-15 minutes, infuse and take throughout the day as tea.
Blueberries with blackberries: add 2 tbsp to 0.5 liters of water. l. blueberries and blackberries, boil for 20 minutes. over low heat, leave for an hour and take as tea.
Lingonberry recipe: mix 2 tbsp. l. leaves and berries of lingonberries and St. John's wort in an iron container, pour boiling water over the broth and put on low heat for 8-10 minutes, then let the broth sit for half an hour and take half a glass 3 times a day.
Yarrow: 1 tbsp. l. Steam yarrow leaves in boiling water, leave for half an hour and drink 100 ml. three times a day before meals. You can also use St. John's wort - the recipe is the same, and to enhance the positive effect of medicinal plants, you can take them in equal parts for collection.
Effective infusion of dill seeds: it helps solve the problem of incontinence quickly and effectively. Just brew 2 tbsp. l. in 300 ml. boiling water, let it brew and drink once a day, preferably in the morning.

In addition to treatment with folk remedies, all women should exclude strong tea, coffee and caffeine-containing products from their diet.

Acupuncture

Acupuncture may help, depending on what is causing the incontinence. In one American study, women received 4 weekly bladder acupuncture treatments and experienced significant improvement in symptoms.

Forecast

The prognosis is favorable - incontinence can be cured, the main thing is to consult a doctor in a timely manner, undergo a full and comprehensive examination and follow all the recommendations of doctors without self-medicating. Even with all the effectiveness of folk recipes.

If the condition is left untreated, patients may suffer from symptoms, recurrent urinary tract infections, and social isolation.

Interesting

In older people, urological pathologies are among the most common disorders and are accompanied by a number of characteristic features. Moreover, such a phenomenon causes a lot of trouble for the person suffering from it, both from a personal, medical, and social point of view. According to statistics, urinary incontinence occurs in approximately 5-15% of elderly people living at home, and in approximately every fifth patient belonging to the older age group hospitalized in medical institutions. But among residents of nursing homes, the prevalence of the disease is already approximately 70%. Moreover, urinary incontinence occurs twice as often in older women as in men.

Urinary incontinence in older people causes a significant deterioration in their quality of life and certain life and situational difficulties. Quite often, this phenomenon becomes a prerequisite for avoiding society, developing an inferiority complex and feelings of guilt in a person, and also provokes depressive states.

Types of urinary incontinence in older people

In medical practice, there are several types of urinary incontinence in older people. Among them:

Stress incontinence is the uncontrollable leakage of urine, which is provoked by physical exertion, occurs as a result of lifting heavy objects, while laughing or coughing. Its main cause is age-related changes in the body and, in particular, increased weakness of the pelvic muscles;
Urge incontinence is a condition associated with an irresistible urge to urinate, and which is a consequence of exposure to external irritants. For example, the activity of the bladder reflexively increases when washing dishes, if water is flowing nearby in a fountain, as well as in the cold;
Transient incontinence is a phenomenon that occurs against the background of infectious and inflammatory diseases affecting the genitourinary system (for example, it can result from cystitis or inflammation of the vagina);
Overflow incontinence is a fairly rare occurrence. Moreover, this type of urinary incontinence is much more common in older men than in women. It is caused by various types of prostate diseases, among which a special place is occupied by prostate hyperplasia, oncological lesions, and urethral stricture (narrowing of the urethra). Treatment of urinary incontinence in the elderly in this case is most often carried out using surgical methods;
Mixed type is a condition characterized by the presence of several forms of incontinence in a person at the same time. As a rule, it requires an integrated approach to treatment.

Causes of urinary incontinence in older people

Urinary incontinence in representatives of the older age group in most cases is a consequence of certain physiological changes that accompany the aging process of the body (for example, with age, all people experience a decrease in bladder volume). In addition, problems with urinary control can occur for a number of other reasons. Moreover, quite often urinary incontinence in elderly people is temporary, and after eliminating the cause that caused the failure of the regulatory mechanism, the ability to restrain the urge to urinate is completely restored.

Factors that provoke urinary incontinence include:

Disorders of integrative activity of the brain (or, in other words, confusion, when the patient ceases to realize that he wants to go to the toilet);
Infectious processes affecting the urinary tract;
Violation of the integrity of the mucous membranes in the urinary and genital tracts (usually observed in postmenopausal women);
Taking certain medications;
The process of swelling subsiding;
Increased urine production (polyuria), which is accompanied by the fact that a person feels the urge to urinate and is fully aware of the need to go to the toilet, but simply does not have time to go there;
Restriction of a person’s mobility (in such cases, to avoid urinary incontinence in older people, a urinal is used);
A complication of constipation in the form of fecal blockage (usually typical for bedridden and sedentary patients, and is also observed in people suffering from mental disorders).

Features of urinary incontinence in older women

Urinary incontinence occurs in approximately 2/3 of older women. At the same time, 30-40% of cases are due to stress incontinence, 15-20% are due to urgent incontinence, and another 45% are mixed forms of pathology. Other types of urinary incontinence in older women average from 2 to 15%.

The main reasons why such an unpleasant phenomenon occurs in the fair half of humanity include:

Changes in hormonal balance, which is accompanied by a decrease in the amount of female sex hormones, as well as atrophic changes that contribute to a decrease in overall muscle tone in the pelvic area;
Increased tone of the bladder muscles due to bladder hypersensitivity, Parkinson's disease, strokes, stress or damage to the nervous system;
Congenital malformations and inferiority of pelvic floor tissues;
Surgical operations performed on the female genital organs;
Inflammatory diseases of the female reproductive system.

Features of urinary incontinence in older men

This is one of the serious causes of most complexes and mental disorders. As a rule, urinary incontinence in older men is a consequence of weakening of the sphincters that retain urine, as well as fatty degeneration of the walls of the bladder. Another prerequisite for the development of pathology is the fact that as the body ages, the nerve impulses that force a person to wake up and empty the bladder are significantly weakened. In some cases, the cause of purely male incontinence is prostate adenoma. It contributes to dysfunction of urination, which provokes overflow of the bladder and subsequent involuntary release of urine at the most inopportune moment.

During the daytime, urinary incontinence can be caused by increased muscle tension, sharp and irritating sounds, coughing, etc. Diseases such as multiple sclerosis and Parkinson's disease aggravate the situation.

Treatment of urinary incontinence in older people

The treatment regimen depends on what causes the disease. Treatment of urinary incontinence in older people is based on:

Use of medications;
Support of the patient by family and friends;
Reducing the amount of fluid consumed before bedtime;
Performing procedures that are aimed at increasing the reaction of the sphincters that retain urine (for example, cold rubdowns in the morning);
Maintaining muscle tone (patients are recommended to walk and do as much physical activity as possible).

As you age, your chances of developing problems with the urinary system increase. One of the most common ailments is considered to be urinary incontinence in older people, which is often recorded in women and men whose age exceeds 60 years. This disorder manifests itself in the form of involuntary loss of urine during daily activities (for example, when lifting heavy objects, sneezing, coughing, etc.), which brings serious inconvenience to men and women and makes them want to cure the disease as soon as possible.

About the problem

Urinary incontinence is a characteristic sign of old age of the body and its systems, deviations and disorders of which become the cause of the formation of the described phenomenon. At the same time, in older people living in different conditions, the incidence of the disease is uneven. The disorder is detected:

in 5-15% of older people living at home;
in 20-30% of elderly patients who were hospitalized;
in 70% of nursing home residents.

Causes

In the majority of cases, urinary incontinence (both daytime and nighttime) is caused by various pathological processes occurring in the body. First of all, these include cystitis and urosepsis. Other causes include the formation of bedsores and medical procedures (for example, too frequent insertion of a catheter into the bladder). In addition, a similar condition often appears after a mini-stroke.

But doctors believe that the main cause of this disorder is weakening of the bladder sphincters, which serve to retain urine. At the same time, women are more susceptible to the formation of such a deviation. This is due to changes in hormonal levels during menopause and inhibition of metabolism.

Symptoms

Patients suffering from urinary incontinence note that a frequent accompaniment of the disease is the sensation of a foreign body in the vagina or urethra, an increased urge to urinate and a feeling of incomplete emptying. The last symptom is due to the fact that patients really cannot empty the bladder for various reasons, including a significant deterioration in its tone.

Diagnostics

Before prescribing treatment for enuresis, doctors determine the cause of urinary incontinence in the patient. For this, a set of diagnostic procedures is used, and this list includes:

consultation with a gynecologist (for women);
ultrasound examination of the urinary system (primarily the kidneys and bladder);
uroflowmetry, cystometry and profilometry, as well as other methods of monitoring urodynamics;
fibrocystoscopy (a method of examining a patient using a soft cystoscope);
compiling a urinary diary (the number of trips to the toilet per day is recorded in it, indicating the volume of fluid excreted).

Treatment options

Depending on the patient’s complaints, as well as the causes of the disease and the degree of its development, different treatment options are prescribed, which include medication, surgery and other methods. The selection of the required method is carried out by the attending physician, taking into account the results of the diagnosis. At the same time, the greatest effectiveness was noted when using complexes of therapeutic measures.

Medication

Treatment with medications is aimed at reducing bladder contractions. For this purpose, antidepressants and antispasmodics are used (including Spazmex, Tolterodine and Pantogam), the use of which by elderly people should be under the supervision of a doctor. In cases where incontinence is stressful, adrenergic agonists are used to increase the tone of the sphincters and urethra.

In women during menopause, hormone replacement therapy is highly effective, as is the use of local ointments and gels aimed at eliminating discomfort and itching.

Surgical

Conservative methods are not highly effective in all cases. This determines the periodic need for surgical intervention. First of all, a method of surgical treatment is necessary in cases where the patient is diagnosed with stress urinary incontinence. However, its use is also possible when an urgent form of the disease is detected. Among the operations performed during surgery, there is complete removal of the bladder, which is accompanied by implantation of an artificial sphincter or removal of the prostate gland. The most modern method is the use of a laser.

other methods

Other methods of treating urinary incontinence in older people include vitamin therapy and physiotherapy, as well as various traditional medicines. Among the latter, decoctions of sage and St. John's wort, lingonberry leaves with rose hips, as well as yarrow inflorescences and other herbs have especially shown their effectiveness. During physical therapy, it is necessary to do special exercises necessary to strengthen the muscles of the pelvic floor, legs, and abs. In order to avoid skin diseases caused by urine leakage, it is recommended to use urological pads.

Prevention

There are simple rules that should be followed to avoid premature development of the described disorder. First of all, it is necessary to maintain a drinking regime, consuming a sufficient amount of liquid throughout the day (do not limit yourself to drinking if you want, but also do not drink too much). Empty your bladder as soon as possible when you feel the urge to urinate.

Normalization of lifestyle

The main role during prevention is played by the lifestyle that a person adheres to. First of all, you should give up bad habits (smoking, excessive alcohol consumption). If you are overweight, you need to bring your body weight back to normal values. If any diseases related to the urinary system appear, you must immediately consult a doctor and carry out timely treatment (you cannot take pills on your own without a doctor’s advice). In addition, you should undergo periodic preventive medical examinations.

Detrusor training with drinking regimen

In some cases, the cause of urinary incontinence in older people is a weakening of the bladder detrusor (the muscle necessary to remove urine from the human body). Experts recommend training the described organ, and one of the ways is a special drinking regimen. The attending physician can help in compiling it, since he is able to do this taking into account the individual characteristics of the patient’s body.

Kegel exercise

During physical therapy using special exercises for urinary incontinence in older people (especially women), special attention is paid to the Kegel technique. A set of exercises is necessary to tone and strengthen the pelvic floor muscles. In everyday activities, the muscles of this category are practically not used, and therefore over time (or after childbirth) their elasticity and strength deteriorate significantly.

Dr. Arnold Kegel developed a system of exercises for women suffering from urinary incontinence due to weakness of the pelvic floor muscles back in the mid-20th century. The main attention was paid to the muscles that support the internal organs (uterus, bladder and rectum). The implementation of this complex ensures the elimination of their prolapse, which helps to get rid of urinary incontinence. Particular attention is paid to strengthening the vaginal and pubococcygeus muscles. At the same time, the blood supply to the pelvic organs improves.

Most older women are familiar with the characteristic symptoms of incontinence - urination that cannot be controlled by willpower. About 80% of patients who have entered menopause suffer from urinary disorders. Not all representatives of the fair sex seek help from a doctor, aggravating the situation and provoking the development of complications.

Classification of urinary incontinence:

False. This is involuntary urination caused by congenital or acquired defects of the urethra, bladder or ureter (for example, total urethral epispadias, the result of trauma - urinary fistula or ectopic ureteral orifice).
True (not related to the presence of gross defects).

Causes and factors provoking development

Urinary incontinence in old age is a frequently diagnosed female ailment. The causes of senile urinary incontinence lie not only in age-related changes in the body. There are several types of urination disorders, each of which has a specific basis:

Stress incontinence. Symptoms of this pathology can be noticed during physical activity, as well as when sneezing and laughing. In older people, the problem occurs in 30–40% of cases;
Imperative or urgent incontinence. Manifestations of this type of disease are familiar to 15–20% of people. The disorder is a consequence of increased bladder tone. Pathology is negatively affected by external irritating factors, for example, the sounds of pouring water, cold air temperature, drinking strong drinks, etc.;
Involuntary loss of urine of a temporary nature (transient).

If an older person experiences symptoms of such a disorder from time to time, it is advisable to get tested. This is necessary to identify an infectious and inflammatory lesion affecting the bladder or urethra - urethra. In older women, urinary urgency can also be associated with inflammation of the vagina and is usually accompanied by a burning sensation.

The consequence of past diseases of the genitourinary system can be enuresis - urinary incontinence, which manifests itself during sleep. Severe emotional shocks and some pathologies of the central nervous system also lead to a disorder of excretory function: Parkinson's disease, stroke.

Women who have entered menopause may experience the disease due to a decrease in the amount of estrogens - female sex hormones produced by the ovaries. Hormonal imbalance provokes atrophic changes in the cervix and urethral tissue.

Involuntary release of urine may be a consequence of a mechanical obstruction to its normal outflow. Tumors and stones localized in the bladder or urethra can cause an imbalance in urinary function

Some habits and risk factors contribute to the development of the disease:

Regular consumption of carbonated and caffeinated drinks.
Insufficient amount of coarse fiber food in the diet and, as a result, frequent constipation.
Hormonal changes in the body associated with menopause.
Hereditary predisposition.
Participation in certain sports.
Chronic inflammatory process in the pelvis.
Smoking and accompanying cough.
Decreased overall muscle tone.
Gynecological operations.
Rapid, protracted or traumatic labor.
Upper respiratory tract diseases.

Therapeutic course

Incontinence is especially difficult to control in very old people. In old age, all body systems weaken, and the protective function of the immune system decreases. Aging does not bypass the bladder either: the tone of its muscles weakens, and the walls of the organ thicken, losing their ability to stretch.

For treatment of age-related urinary incontinence in women to be effective, it is necessary to visit a doctor and undergo the necessary tests

Hormonal deficiency leads to a decrease in the tone of the bladder, so the organ loses its ability to hold a normal amount of urine. Urinary disorders in older women can occur due to prolapse and sagging of the urethra, since a lack of female sex hormones can also affect the urethra. To eliminate a delicate problem, the doctor selects special medications that help restore estrogen levels.

Relaxing agents and laser treatment techniques, which do not require hospitalization or a rehabilitation period, help to cope with the pathology. Laser correction is carried out within half an hour, helps strengthen the collagen of the vaginal tissue and quickly eliminate the symptoms of the disease.

Treatment of chronic diseases requires regular use of pills, which often cause symptoms of incontinence. This side effect is observed with antihistamines, diuretics and sedatives. Severe urinary dysfunction may disappear after discontinuation of inappropriate medications.
If pathogenic microflora contributes to the development of incontinence, antibiotic therapy is indicated.

Set of exercises

There are special exercises designed to solve a sensitive problem. We should not forget that gymnastics must be done regularly, otherwise the long-awaited relief may not come.

Female urinary incontinence is corrected by alternately contracting and relaxing the muscles that support normal urination. This technique is called Kegel gymnastics. By performing the exercises daily, the first results can be seen within a month. The duration of the full course is about 6 months.

Herbal treatment

Many women, faced with the first symptoms of the disease, try to treat incontinence on their own. Traditional medicine recipes complement physiotherapy and drug treatment well, but it is not recommended to use them without the consent of the attending physician and until the causes of the pathology are clarified.

A decoction of lingonberry leaves and St. John's wort helps to eliminate the urinary disorder that occurs during menopause. To prepare it you will need 2 tbsp. l. berries and lingonberry leaves and 2 tbsp. l. dried St. John's wort. The resulting mixture is poured with 3 glasses of water and boiled for 10 minutes. The herbal decoction is filtered and drunk 3 times a day before meals.

Lingonberry leaves are rich in phytoncides - active substances that have a detrimental effect on microorganisms that cause bladder diseases

Surgical methods

In some cases, medications do not bring the expected effect and the woman’s quality of life continues to decline. If this happens, it is necessary to pay attention to other methods of treating the disease, for example, modern surgical methods (fixation of the pelvic floor using synthetic materials, elimination of anatomical defects, etc.).

Relaxation of the bladder sphincter, resulting from the formation of stones, cannot be treated conservatively. The tablets will not restore normal excretory function until the tumors are removed.

How to prevent illness and prevent complications from developing

To prevent the symptoms of pathology from affecting the normal rhythm of life, older women should carefully monitor the condition of the body. Preventive recommendations will help you avoid problems with urinary function:

The bladder should be emptied completely and promptly, even if there is no urgent need to go to the restroom.
Products containing large amounts of sugar do not have the best effect on the functioning of the excretory system. Tomatoes, citrus fruits and milk have a similar effect.

Alcohol has an irritating effect on the bladder, so drinks containing alcohol should be excluded from the menu

Heavy lifting and strenuous physical labor should be avoided.
You cannot limit the amount of fluid you drink. Some women drink very little water, hoping that this measure will help avoid frequent urge to go to the toilet. However, dehydration will have the opposite effect - the urine will become concentrated, which means increased irritation of the bladder. The likelihood of developing a bacterial infection will also increase. If incontinence symptoms occur primarily during sleep (enuresis), you can reduce the amount of fluid you drink at night.
Hygiene products (soap, toilet paper, bath fillers) should not be colored or strongly scented.
The pressure exerted on the urinary system is often associated with the acquisition of excess pounds by a woman. Having lost excess weight, patients often report significant relief.

Summary

Any type of urinary incontinence requires proper treatment. The causes of the pathology are varied, so you cannot choose a therapeutic course on your own. Only a specialist can prescribe medications or recommend surgery after collecting a complete history of the disease.