Elderly people suffer from many health-related problems in the later phase of their lives. But worst of all is urinary problems. Elderly men and women who suffer from urinary problems find it uncomfortable, inconvenient, and also embarrassing. Elderly people develop urinary troubles because of one or more many reasons, including loss of tone of the bladder sphincter or bladder muscle, decreased fluid intake, prolonged recumbency, malignancy, and many neurological problems. Burning during urination, frequency, hesitancy, urgency during urination, urinary incontinence, are common problems present in the elderly. Inflammation of the urinary bladder i.e. cystitis can create all the above-mentioned troubles. It may be because of poor intake of fluids, kidney failure, diabetes mellitus, tumors of the urinary bladder or adjacent organs like the rectum or prostate, and infections due to urinary catheters. These individuals can also have complaints of vague, lower abdominal pain, perineal pain, malaise, nausea, and fever. Persistent or recurrent urinary infections 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, along with frequency of urination, only in the daytime. This could be due to post-menopausal psychological and hormonal changes. Weakness of the detrusor muscle of the urinary bladder can cause infection of the bladder and also incontinence. Enlargement of the prostate is a very common condition in men in later years of life. This causes compression of the bladder, resulting in incomplete evacuation. Residual urine in the bladder invariably gets infected, causing cystitis. The affected man suffers from the entire spectrum of urinary troubles i.e. frequency, urgency, hesitancy and incontinence. Retention occurs in severe cases requiring urgent surgical intervention. The bladder sphincter, controlling voiding of urine, may get damaged causing incontinence. Urethral limit tends to develop post-prostate surgery, 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, which occurs due to reduced oestrogen levels. Difficult childbirth, uterine prolapse, et cetera, are common causes of stress incontinence. Neurological problems like stroke, and lower spinal cord diseases, also produce urinary problems in the elderly, mainly retention or hesitancy or incontinence. Tumours, and autonomic neuropathy, can also cause these problems. Drugs, especially diuretics, given to mobilise excess fluid in the body cause polyuria, urgency, and incontinence in the person. The elderly often need these drugs to treat cardiac or renal failure. Bedwetting can be present in the elderly. Due to any of the reasons above, an elderly person 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, they would be less prone to develop urinary infections. Keeping diabetes well controlled, remaining physically active, and avoiding holding urine for long, are some other measures that 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 minimise 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 treatment is delayed, can become irreversible. In case of a person suffering from stress incontinence or nocturnal enuresis, they would need a fixed timetable to visit the toilet. They should go to the toilet every one to two hours irrespective of the desire to urinate. Thus, the bladder is trained to evacuate at regular intervals, which prevents the inconvenience and embarrassment of incontinence. 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. Dr Rachna Pande is a specialist in internal medicine.
