Urinary problems in the elderly

Old people suffer from many age related problems at the time in life when they should be most comfortable. But worst of all are the urinary problems. Old men or women, who suffer from urinary problems, find them uncomfortable, inconvenient, and also embarrassing. Elderly people are more prone to develop urinary troubles because of many reasons. Loss of tone of bladder sphincter, loss of tone of bladder muscle, decreased fluid intake, prolonged recumbency, malignancy, and many neurological problems. “Dysurea”, means a burning or painful sensation while voiding. “Frequency” as the word literally means is the need to void at frequent intervals. “Hesitancy” is the difficulty in urination when a smooth flow of urine is not present. “Urgency” is an exaggerated sense of need to void and the sufferer finds it difficult to hold back urine. While, “incontinence” is the most embarrassing state where the affected person cannot hold back urine and it comes out spontaneously, all or little. Many of these evils are present more or less together in varying quantities, depending on the cause and its severity. Inflammation of the urinary bladder i.e. cystitis can create all the above mentioned troubles in both elderly men and women. It may be because of poor intake of water and liquids, kidney failure, diabetes mellitus, tumors of the urinary bladder or adjacent organs like rectum or prostate, infections due to urinary catheters. Along with the urinary problems these patients also have the complaints of vague pain in the lower abdomen, perineal pain, malaise, nausea and fever. Apart from the inconvenience, urinary infections if persistent can lead to infections of the kidney and kidney failure. Psychosomatic cystitis is a very vague condition in middle aged and elderly women. In this there is vague perineal and lower abdominal pain. There is frequency of urination, only in the day. This could be related to the psychological and hormonal changes occurring around menopause. Weakness of the detrusor muscle of urinary bladder can cause infection of the bladder and also incontinence. This occurs in about 70% of elders suffering from incontinence. Causes can be many ranging from muscular weakness, stroke, Alzheimer’s disease, neoplasms, prostatic enlargement e.t.c. Enlargement of the prostate is a very common condition in men in later years of life. This causes compression of the bladder in varying amounts. There is incomplete evacuation of the bladder, residual urine remaining in the bladder invariably gets infected causing cystitis. The poor man suffers from the entire spectrum of urinary troubles i.e. frequency, urgency, hesitancy and incontinence. In severe cases there is retention of the urine, requiring urgent surgical intervention. Even after surgery the affected person does not get rid of these troubles. The sphincter controlling voiding of urine may get damaged causing incontinence, i.e. the urine would come out spontaneously during any effort. Urethral stricture tends to develop after surgery of prostate, which causes difficulty in urination and also retention. Dilation of the urethra is needed once in one or two years for the urethral stricture. Stress incontinence is a common condition affecting post menopausal women. This is because of deprivation of estrogen. Difficult child birth, uterine prolapsed, e.t.c. are common causes for stress incontinence. Many neurological problems like stroke, diseases of the lower spinal chord also produce urinary problems in the elderly people mainly retention or hesitancy or incontinence. Tumors, neuropathy due to diabetes can also cause these problems. Drugs especially diuretics like Frusemide which is given to mobilize excess fluid in the body as in systemic diseases cause not only polyurea but also urgency and incontinence in the person. Unfortunately it is the elderly who often need this drug more for treating cardiac or renal failure, making them suffer. “Nocturnal enuresis” or, “bed wetting” is a well known condition in small children but can be present in elderly also. Due to any of the reasons above, an elderly gentleman or lady may find it difficult to hold back urine and wet the bed in night. If one is in the habit of drinking plenty of water always, he would be less prone to develop urinary infections in old age, thus preventing one cause of urinary troubles. Keeping diabetes well controlled, remaining physically active, keeping away from alcohol, avoiding holding urine for long, are some other measures which help in protecting one against urinary troubles in old age. Perineal exercises done regularly help to strengthen the pelvic muscles as well as the bladder muscles and can minimize urinary troubles in old age. If at all one develops any of these symptoms it is best to consult a doctor, because a remediable condition if delayed to be treated can become irreversible and even dangerous. In case of a person suffering from stress incontinence or nocturnal enuresis, he or she would need a fixed time table for going to the toilette. Like toddlers,, they need to go to the toilette every one to two hours irrespective of the desire for urination. Thus the bladder is evacuated at regular intervals, thus avoiding the inconvenience and embarrassment. It is imperative for the family members to take good care of their elders suffering from urinary problems. They need good nursing care and a sympathetic attitude. In no way should one ridicule them or get angry, because the problems they are suffering from are beyond their control. The author is a specialist in Internal Medicine E-mail: rachna212002@yahoo.co.uk