A nurse practitioner (NP) is talking with a 70-year-old patient who asks if she could discuss a problem that she is embarrassed to talk about with her physician. She states she has been having increasing problems with incontinence. Every time she coughs or sneezes, she notices a loss of urine. She has not had any fever or chills or pain with urination. She asks the NP if this is just a sign of getting older?
Discuss the etiology associated with incontinence in the aging adult.
Post your initial response by Wednesday at midnight. Respond to one student by Sunday at midnight. Both responses must be a minimum of 150 words, scholarly written, APA formatted, and referenced. A minimum of 2 references are required (other than your text). Refer to grading rubric for online discussion.
Urinary Incontinence in Frail Older Adults, Enberg and Li (2017) stated “in the frail elderly population, urinary incontinence is generally caused by a combination of factors affecting the lower urinary tract” (p. 119). Enberg and Li (2017) documented the co-existence of frailty and UI and described them as “geriatric syndromes” seen in individuals 65 years of age and older. Normal LUT function was documented as being adversely affected by frailty, Enberg and Li (2017) further stated frailty adversely affects “many functional requirements needed to maintain continence” (p. 220). Common causes of LUT, which subsequently contribute to urinary incontinence, that are unrelated to age-induced changes are medications, medical illness, neurologic/psychiatric disorders, functional impairment, disorder of the LUT or surrounding structures, and environmental issues (Enberg and Li, 2017, p. 121). Module 7Subscribe Steven Bartos posted Mar 3, 2021 4:28 PM Contains unread posts Urinary incontinence (UI) is a loss of bladder control that is common in the aging adult. The three most common types of UI include urgency incontinence, stress incontinence, and mixed incontinence. Urgency incontinence is a loss of urine related to an increased need to urinate. Stress incontinence is a loss of urine as a result of coughing, sneezing, lifting, or laughing. Mixed incontinence is a combination of the two (Vaughn & Markland, 2020).Research has found that stress incontinence is mostly related to the integrity of the urethra and the maximum urethral closure pressure. It is also related to the support of the bladder muscles and the supporting connective tissue laxity. Mixed incontinence doesn’t have a clear pathophysiology, as it is difficult to distinguish between urine loss from urgency versus stress (Minassian et al., 2017).ReferencesVaughn, C.P., & Markland, A.D. (2020). Urinary incontinency in women. Annals of Internal Medicine, 172(3), ITC17 – ITC32. https://dx.doi.org/10.7326/AITC202002040less1 UnreadUnread4 ViewsViews 4 1 1 RepliesReplies 1 View profile card for Eleany Yasein Last post March 7 at 11:40 AM by Eleany Yasein Minassian, V.A., Bazi, T., & Stewart, W.F. (2017). Clinical epidemiological insights into urinary incontinency. International Urogynecology Journal, 28(5), 687 – 969. https://dx.doi.org/10.1007/s00192-017-3314-7 It seems that in the example of the 70 year old female, she may be having an experience of stress or mixed incontinence. Her urethra or bladder may be compromised by the normal aging process related to urinary urgency, and sneezing or coughing may be causing incontinence as a result of the stress to her system. The etiology of urgency incontinence is still being understood through research; however, most individuals have idiopathic urgency UI or overactive bladder syndrome. Several theories have been proposed, such as neurogenic, epithelial, and myogenic. Neurogenic theory describes UI as a loss of central nervous system control over the continence stemming from the micturition center of the brain, which normally would suppress the urge to urinate when a full bladder is present. As a result, involuntary overreactive contractions of the bladder muscle, known as detrusor hyperreflexia, causes the UI. Examples of disorders that would cause this CNS malfunction include stroke, traumatic brain injury, dementia, and brain tumors. The epithelial hypersensitivity theory suggests that chemo-sensitizing agents leads to bladder instability. The myogenic theory proposes that the pelvic floor might fail to support urethra continence as a result of exhaustion, birth injury, genetic or environmental factors (Minassian et al., 2017). Bladder IncontinenceSubscribe Jazmin Jerez-Rivera posted Mar 2, 2021 11:11 AM Contains unread posts Incontinence is quite common in the elderly population and many feel it is a normal part of aging. However, many are reluctant to bring it up and symptoms can progress over time. Research by Shaw & Wagg suggests “Physiological, pathological and functional changes can result in a loss of continence” (2017, p. 1). Muscles in the bladder contract during urination allowing flow through the urethra (NIH, 2017). Sphincter muscles found in the urethra then relax to pass urine from the body. Bladder incontinence can be the result of weak bladder muscles, weak pelvic floor muscles, nerve damage that controls the bladder, pelvic prolapse and even some diseases (NIH, 2017).ReferencesNational Institute of Health. (2017) Urinary Incontinence in Older Adults. Retrieved from https://www.nia.nih.gov/health/urinary-incontinence-older-adultsless1 UnreadUnread4 ViewsViews 4 1 1 RepliesReplies 1 View profile card for Dennies Jones Last post March 6 at 6:54 PM by Dennies Jones Shaw, C., & Wagg, A. (2017). Urinary incontinence in older adults. Medicine, 45(1), 23-27 Huether, S. E., McCance, K. L., Brashers, V. L. (2020). Understanding Pathophysiology (7 Ed.). Elsevier. The patient seems to display symptoms of stress incontinence. This type of incontinence occurs when there is increased pressure in the abdomen usually while laughing, coughing, or sneezing (Huether et. al. 2020). Other types of incontinence include urge incontinence which is the strong desire to void. Overflow incontinence is loss of urine due to an overdistended bladder (Huether et. al., 2020). Mixed incontinence is a pattern of both stress and urge incontinence. Functional incontinence can be caused by physical impairment and immobility or cognitive impairment (Shaw & Wagg, 2017). Module 7, ModuleSubscribe Eleany Yasein posted Mar 3, 2021 5:41 PM Contains unread posts Urinary incontinence is a major problem seen in elderly population (above age 65), it is an involuntary leakage of urine (McDaniel, Ratnani, Fatima, Abid, & Surani, 2020). Urinary incontinence is caused due to physiological, pathological and functional factors (Shaw & Wagg, 2017). Age-related changes in the lower urinary tract can be associated with urinary incontinence. Older adults have decreased bladder capacity, sensation of filling, and urinary flow rate. They have increased urinary frequency, prevalence of post void, residual volumes and outflow tract obstruction in men. Furthermore, some medications such as diuretics, lithium, opioids, and calcium channel blockers has been associated with urinary incontinence. Furthermore, changes in the brain has been linked to different geriatric syndromes including decline in continence. Lastly, some comorbidities that are associated with urinary incontinence include hypertension, diabetes, congestive heart failure, arthritis, depression and anxiety (Shaw & Wagg, 2017). McDaniel, C., Ratnani, I., Fatima, S., Abid, H. M., & Surani, S. (2020, July 12). Urinary Incontinence in Older Adults Takes Collaborative Nursing Efforts to Improve. Cureus, 12(7), 9161. doi: 10.7759/cureus.9161more1 UnreadUnread5 ViewsViews 5 1 1 RepliesReplies 1 View profile card for Candice Russell Last post March 6 at 5:46 PM by Candice Russell Shaw, C., & Wagg, A. (2017, January). Urinary incontinence in older adults. Medicine in Older Adults, 45(1), 23-27. Retrieved from https://doi.org/10.1016/j.mpmed.2016.10.001 References Urinary incontinence can lead to skin breakdown including, pressure ulcers, urinary tract infections that can lead to sepsis, and falls (McDaniel et al., 2020). Moreover, it can lead to emotional problems that can impair quality of life. Evaluations, implementing interventions and management is needed. Also, educating evidence-based practices to healthcare providers is important (McDaniel et al., 2020). IncontinenceSubscribe Tallona Boddy posted Mar 1, 2021 11:38 AM Contains unread posts The 70 year-old female patient speaking with her NP, appears to be suffering from stress incontinence. Stress incontinence is defined as the leakage of urine when pressure is placed on the bladder and leakage of urine occurs (Mayo Clinic, 2020a). The other form of incontinence is overactive bladder, which results in a sudden and urgent need to void and at times can be uncontrolled, resulting in urine leakage (Mayo Clinic, 2020b). Overactive bladder is caused by the involuntary spasm of the muscle of the bladder, even when it is not full (Mayo Clinic 2020b). The spasm contractions of the bladder then create an urgency for the individual to empty their bladder. Some of the risk factors for developing overactive bladder include age, incomplete emptying of the bladder, decline in cognitive function, excessive intake of alcohol or caffeine, neurological conditions, diabetes and abnormalities in the bladder (Mayo Clinic, 2020b). Mayo Clinic. (2020a, March 19). Stress incontinence. https://www.mayoclinic.org/diseases-conditions/stress-incontinence/symptoms-causes/syc-20355727less1 UnreadUnread5 ViewsViews 5 1 2 RepliesReplies 2 View profile card for Melissa Morgan Last post March 6 at 2:26 PM by Melissa Morgan Mayo Clinic. (2020b, March 20). Overactive bladder. https://www.mayoclinic.org/diseases-conditions/overactive-bladder/symptoms-causes/syc-20355715 References The cause of stress incontinence is due to the weakening of the patient’s pelvic floor muscles and/or the weakening of the urinary sphincter (Mayo Clinic, 2020a). The pelvic floor muscles and urinary sphincter are the mechanisms our bodies use to seal the bladder closed when not voiding. If these are weak, urine can leak out, especially if pressure is placed on them such as sneezing and coughing. Factors that contribute to the weakening of these mechanisms include, childbirth, prostate surgery, obesity, frequent coughing, and generalized weakness from other illnesses or aging (Mayo Clinic, 2020a). Dennies JonesSubscribe Dennies Jones posted Mar 3, 2021 4:41 PM Contains unread posts Female patient was embarrassed to discussed her on going urinary incontinence (UI) problem. She thought urinary incontinence is a sign of aging. Harding et al. (2020) explained that “UI is an involuntary leakage of urine. Although incontinence is more prevalent among older adults, it is not a natural consequence of aging. UI has traditionally been viewed as a social or hygienic problem” (P. 56384). Matos et al. (2019) states that “UI is among the geriatric syndromes, which is considered the most recurrent pathology and also extremely important in the geriatric setting, as it generates consequences that affect psychological and social aspects, modifying quality of life (QOL), reducing self-esteem and limiting the individual’s autonomy” (p. 568). According to Huether et al. (2020), Stress incontinence is the involuntary loss of urine during coughing and laughing and sneezing, or other physical activity that increased abdominal pressure. Stress incontinence is common in women over 60 years of age. Jolping et al. (2020) stated that patient engagement, an original shared-decision aid (SDA) was used to educate women about incontinence types, risk factors, bladder irritants, lifestyle changes, and daily Kegel exercises. Jopling, A. G. (2020). Effective Screening for Female Urinary Incontinence at the Well-Woman Examination. Urologic Nursing, 40(3), 139–148. https://doi-org.wilkes.idm.oclc.org/10.7257/1053-816X.2020.40.3.139Mirelle Aires Botelho De Matos, Bruna Letícia Alves Barbosa, Mara Cecília Costa, Francisca Cecília Viana Rocha, Camila Aparecida Pinheiro Landim Almeida, & Fernanda Cláudia Miranda Amorim. (2019). The Urinary Incontinence Repercussions Towards the Elderly’s Life Quality. Revista de Pesquisa: Cuidado e Fundamental, 11(3), 567–575. https://doi-org.wilkes.idm.oclc.org/10.9789/2175-5361.2019.v11i3.567-575less1 UnreadUnread5 ViewsViews 5 1 1 RepliesReplies 1 View profile card for Joanne Hogan Last post March 5 at 11:00 PM by Joanne Hogan Harding, Mariann M.,Kwong, Jeffrey,Roberts, Dottie,Hagler, Debra,Reinisch, Courtney. Lewis’s Medical-Surgical Nursing E-Book (Kindle Locations 56384-56385). Elsevier Health Sciences. Kindle Edition. References: Discussion 7Subscribe Sheryl Dixon posted Mar 3, 2021 10:44 PM Contains unread posts Urinary incontinence (UI) means a person leaks urine by accident. While it may happen to anyone, urinary incontinence is more common in older people, especially women. Incontinence can often be cured or controlled. The body stores urine in the bladder. During urination, muscles in the bladder tighten to move urine into a tube called the urethra. At the same time, the muscles around the urethra relax and let the urine pass out of the body. When the muscles in and around the bladder don’t work the way they should, urine can leak. Incontinence typically occurs if the muscles relax without warning (NIH,2017).Among the elderly postmenopausal women, the pelvic muscles show loss of volume and tone. The ligamentous and connective tissue support for the pelvic organs gradually fail because of ageing. The weakened pelvic floor increases the risk of pelvic organ prolapse causing cystocele, rectocele and uterine prolapse. Stage 3-4 prolapse of pelvic organs can cause UI. A weakened pelvic floor also allows a hypermobile urethra to slide downwards during sudden increase in intra abdominal pressure. NIH, (2017). Urinary Incontinence in Older Adults. Retrieved from https://www.nia.nih.gov/health/urinary-incontinence-older-adultsless1 UnreadUnread6 ViewsViews 6 1 1 RepliesReplies 1 View profile card for Jennifer Bryant Last post March 5 at 11:43 AM by Jennifer Bryant Si Ching, Lim (2017) Managing the Elderly with Urinary Incontinence and Dementia. Int Arch Urol Complic 3:027. doi.org/10.23937/2469-5742/1510027 References Among the elderly men, it is estimated that histological evidence of Benign Prostatic Hyperplasia (BPH) is present in 90% of men by age 80. Although BPH is synonymous with ageing, it does not correlate directly with prostatic enlargement. Lower Urinary Tract Symptoms (LUTS) which consist of voiding and storage symptoms are common among the elderly men and increase in severity with age. Prostatic enlargement causes bladder outlet obstruction with voiding and storage symptoms. The association between LUTS and BPH in elderly men are temporal in onset but are not causally related. The differential diagnoses of LUTS in elderly men include urological and functional causes such as neurological disorders, Diabetes Mellitus, urethral stricture, etc. (Si Chim,2017). Urinary incontinence increases with rising age. Ageing is associated with changes in the lower urinary tract which predispose an elderly to UI. As we age, bladder capacity and contractility reduce, with reduced ability to defer voiding once the urge to do so arises. The post-void residual urine volume increases with age. During the storage phase, detrusor shows increased uninhibited contractility. Module VII Discussion Post – The Renal and Urologic Systems Subscribed Gisselle Mustiga posted Mar 2, 2021 4:43 PM Urinary incontinence refers to loss of bladder control leading to involuntary leakage of urine. The condition is quite common in women more than men. It is experienced by 1 in 3 older women globally; hence this 70 year old woman patient experiencing this. UI has a prevalence of between 10% and 34% among the elderly (Neki, 2016). Notably, the condition is under reported due to hesitation or shame. UI is associated with rashes, skin irritation and urinary tract infections. The main signs and symptoms of the condition are urine leakages and frequent loss of small to moderate amounts of urine (Huether et al. 2020). Some of the major type of urinary incontinence included mixed incontinence where the patient experiences more than one type of the condition, overflow incontinence characterized by constant and continuous flow of urine, stress incontinence in which leakages results from pressure in the bladder, urge incontinence and functional incontinence.ReferencesMayo Clinic, (2021). Urinary Incontinence: Overview. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/urinary-incontinence/symptoms-causes/syc-20352808 less0 Tallona Boddy Neki, N. (2016). Urinary Incontinence in Elderly. Journal of Krishna Institute of Medical Sciences University 5(1):5-13. https://www.researchgate.net/publication/292194746_Urinary_Incontinence_in_Elderly Huether, S. E., McCance, K. L. & Brashers, V. L. (2020). Understanding Pathophysiology 7th ed. Elsevier Mosby.
Urinary incontinence (UI), as defined by Giraldo-Rodriguez et al., (2019), is the involuntary leakage of urine. There are several factors that correlate with urinary incontinence and these include an increase in age, ethnicity, educational level, increase in body mass index, over active bladder syndrome, vaginal birth in women, and prostate surgery in men (Giraldo-Rodriguez et al., 2019). Davis et al., (2020), attributes age related changes to the genitourinary system such as decreased bladder capacity, increased involuntary bladder muscle contractions, prostate enlargement, decreased estrogen levels, and increased night time urine production as major causes of increase prevalence of UI among older adults. Additionally, certain medications and cognitive decline in the elderly are also factors increasing the prevalence of UI in the elderly (Davis et al., 2020). As age increases, the bladder’s capacity to contract decreases which also affects an individual’s ability to hold their urine. Decreased contractability also impacts the ability to completely empty the bladder which increases post void residual (Giraldo-Rodriguez et al., 2019). Moreover, any kind of age-related physical condition or illness which limits mobility also increases risk of UI and some examples include arthritis and Alzheimer’s (Davis et al., 2020). ReferencesDavis, N. J., Wyman, J. F., Gubitosa, S., & Pretty, L. (2020). Urinary incontinence in older Epidemiology, progression, and predictive factors of urinary incontinence in older community‐dwelling mexican adults: Longitudinal data from the mexican health and aging study. Neurourology and Urodynamics, 38(7), 1932- 1943. https://doi.org/10.1002/nau.24096Shlain, I., Lavy, Y., Arbel, R., Shveiky, D., Woloski Wruble, A., & Liebergall‐Wischnitzer, M. Daigle, S. G., Redden, D. T., & Markland, A. D. (2016). Vitamin D and incident urinary incontinence in older adults. European Journal of Clinical Nutrition, 70(9), 987-989. https://doi.org/10.1038/ejcn.2016.20less2 UnreadUnread6 ViewsViews
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Vaughan, C. P., Tangpricha, V., Motahar-Ford, N., Goode, P. S., Burgio, K. L., Allman, R. M.,
(2018). Urinary incontinence type, symptoms, and quality of life: A comparison between grand multipara and non‐grand multipara women aged ≥50 years. Japan Journal of Nursing Science : JJNS, 15(4), 309-317. https://doi.org/10.1111/jjns.12200
Giraldo‐Rodríguez, L., Agudelo‐Botero, M., Mino‐León, D., & Álvarez‐Cisneros, T. (2019).
adults. The American Journal of Nursing, 120(1), 57-62. https://doi.org/10.1097/01.NAJ.0000652124.58511.24
Urinary incontinence can negatively affect the quality of life in the older adult and may lead to social isolation, falls and depression (Vaughan et al., 2016). It is important to note that there are several types of urinary incontinence which include, stress, urgency and overflow incontinence (Shlain et al., 2018). Stress UI is defined as leakage of urine that occurs on exertion or while sneezing or coughing, urgency incontinence is when leakage of urine occurs after a person has the sudden urge to urinate but is not able to hold the urine long enough to make it to the bathroom (Shlain et al., 2018). Overflow incontinence refers to urinary leakage as a result of overfill or distended bladder which usually happens due to bladder outlet obstruction as it is found in men with enlarged prostate (Davis et al., 2020).
Lastly, the final type of incontinence is the Functional incontinence. This means that there is an involuntary loss of urine attributable to dementia or immobility, and patients are forced to pampers all the time because of this. Aoki, Y., Brown, H. W., Brubaker, L., Cornu, J. N., Daly, J. O., & Cartwright, R. (2017). Urinary incontinence in women. Nature reviews. Disease primers, 3, 17042. https://doi.org/10.1038/nrdp.2017.42 Huether, S. E., McCance, K.L. & Brashers, V.L. (2020). Understanding Pathophysiology 7th ed. Elsevier Mosbyless0 UnreadUnread
Demaagd, G. A., & Davenport, T. C. (2012). Management of urinary incontinence. P & T : a peer-reviewed journal for formulary management, 37(6), 345–361H.
Our abdominal cavity, pelvic cavity and retroperitoneal cavity hold our organs exactly where they need to be using ligaments and muscles. Over time gravity, and wear and tear, as well as surgeries that have disrupted the strength of the abdominal muscles. Over time this may cause the bladder to sit as high as it once did, thereby causing a disruption in the usual flow and production of things.
There are four different types of Incontinence in the human population. The most common type often found in older adults is the urge incontinence, which is the involuntary loss of urine associated with the abrupt and strong desire to void. This is associated with involuntary contractions of bladder wall and does not indicate a neurological disorder, even though it may be present with one, it is not, however used as a symptom for one (Demaagd, 2012). The second type of incontinence, and the most common one in women above the age of sixty years old as well as men who have had prostate surgery is; stress incontinence. Stress incontinence is the involuntary loss of urine during coughing, sneezing, laughing, or other physical activity associated with increased abdominal pressure. This can be very distressful for others as the moment usually comes unexpectedly (Aoki, et.al. 2017). The third type of incontinence is called Overflow incontinence, and I have seen this in my practice. This is the involuntary loss of urine with overdistention of bladder, associated with neurologic lesions below S1, polyneuropathies, and urethral obstruction, as in the case of an enlarged prostate. In this case, the patient will report that they are voiding however their bladders are still distended and are full, and it is the fullness that causes the overflow because the urine has nowhere else to go to. Then there is a Mixed incontinence type which is common in older women and this is a combination of both stress and urge incontinence.
According to Qaseem, Dallas, Forciea, Starkey, Denberg, and Shekelle (2014), aged 75 years and older. Other studies show up to 75% of women greater than treatable condition (Jopling & Meier, 2020). This estimate may be low as there Associated with anxiety, depression, sexual dysfunction, sleep disturbances.incontinence also carries a high cost for treatment and can lead to nursingsymptoms of urinary incontinence and include shame, the belief that the reporting of the problem, providers often fail to screen and understand treatment Risk factors for urinary incontinence in women include obesity, pregnancy,hysterectomy, menopause, cognitive and or functional decline of aging for both screening and treating urinary incontinence. Screening for incontinence to overall improved quality of life, as well as reduced medical spending for this the well woman exam. Urologic Nursing, 40 (3). (2014). Incontinence in Women: A Clinical Practice Guideline for the from https://doi.org/10.7326/M13-2410/.less0 UnreadUnread
American College of Physicians. Annals of Internal Medicine. Retrieved
Qaseem, A., Dallas, P., Forciea, M., Starkey, M., Denberg, T., and Shekelle, P.
Jopling, A., & Meier, N. (2020). Effective screening for urinary incontinence at
during the annual well woman exam is the first step in treatment which can lead
This condition is caused by physical, psychological, environmental and neurological factors. Some of the recognized neurological causes include herpes, stroke, Alzheimer’s disease, Parkinson disease, spinal injuries, diabetes and focal neuropathy. These conditions interfere with the nerve signals that control the bladder activities. Also, temporary urinary incontinence can be caused by drinks such as alcohol, chocolate, caffeine, and carbonated drinks which stimulate the bladder and increase the volume of urine (Mayo Clinic, 2021). Moreover, treatable medical conditions such as constipation and urinary tract infections can also cause this condition. UTI irritates the bladder thus bringing the feeling and urge of urinating. Furthermore, UI can be caused by underlying physical problems including menopause, enlarged prostate, prostate cancer, obstruction, childbirth and pregnancy. It should be noted that the primary risk factors include gender, age, smoking, family history and obesity.
The patient could be experiencing stress incontinence where involuntary loss of urine during cough, sneezing or laughing occurs (Huether, McCance & Brashers, 2020). Incontinence can be caused by lower urinary tract obstruction (LUT). This obstruction could be as a result of urethral stricture, pelvic prolapse, and tumor compression (Huether, McCance & Brashers, 2020). Older women frequently have overactive bladder syndrome (OAB), which is idiopathic and results in “involuntary contractions of the detrusor muscle resulting in urge incontinence” (Huether, McCance & Brashers, 2020, p. 731). These symptoms are usually more common in people age 65 and older, and are a continual source of embarrassment, discouragement, depression, and can cause skin breakdown (Huether, McCance & Brashers, 2020).ReferencesGovender, Y., Gabriel, I., Minassian, V., & Fichorova, R. (2019). The Current Evidence on the Association Between the Urinary Microbiome and Urinary Incontinence in Women. Frontiers in cellular and infection microbiology, 9, 133. https://doi.org/10.3389/fcimb.2019.00133 less1 UnreadUnread2 ViewsViews
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Huether, S., McCance, K., and Brashers, V. (2020). Understanding Pathophysiology (7th ed.). Elsevier
Aoki, Y., Brown, H. W., Brubaker, L., Cornu, J. N., Daly, J. O., & Cartwright, R. (2017). Urinary incontinence in women. Nature reviews. Disease primers, 3, 17042. https://doi.org/10.1038/nrdp.2017.42
The patient should have a full physical examination, urinalysis (if warranted), detailed history that focuses on whether the patient had a vaginal birth, surgery for pelvic organ prolapse, hysterectomy, and medications. Urodynamic tests, renal imaging, and labs that measure serum creatinine can help diagnose the cause of incontinence. Treatment includes medications, behavioral therapy, diet modification, and neuromodulation if other therapies have failed (Huether, McCance & Brashers, 2020). Urinary incontinence can be the result of several different urinary tract disorders, which makes diagnosing it difficult (Govender, Gabriel, Minassian & Fichorova, 2019). Normal urinary microbes help to maintain a healthy bladder milieu: “cumulative evidence suggests that certain Lactobacillus species may play a role in maintaining a healthy bladder milieu. Higher bacterial diversity in the absence of Lactobacillus dominance was associated with urgency UI and resistance to anticholinergic treatment for this condition” (Govender, Gabriel, Minassian & Fichorova, 2019). The hammock hypothesis is an interesting explanation of stress urinary incontinence. It states that damages to the pelvis and tissues result in decreased anatomical support of the bladder neck and the urethra (Aoki, et al., 2017). This results in leakage, a feeling of not being able to hold urine, and frequently having to empty the bladder.
Urinary incontinence is the involuntary loss of urine and tends to be more frequent among women than men (Aoki et al., 2017). There also tends to be slight differences in the causes of incontinence between men and women. Incontinence in men often results from enlargement of the prostate or damage from surgery or radiation used to treat prostate cancer. In women, incontinence is often a result of dysfunction of the bladder or pelvic floor muscles, which can occur after pregnancy, childbirth, or during menopause (Aoki et al., 2017). As a result, incontinence is often more common as people age, but it is not a normal part of aging for people. In a study by Suskind et al., it was found that higher body mass index (BMI) and higher amounts of body fat were found to be markers for both stress urinary incontinence and urgency urinary incontinence in women (2017). It has been found that stress urinary incontinence in women with higher BMIs may in part result from an increase in abdominal pressure, which can result in intravesical pressure and urethral sphincter mobility (Suskind et al., 2017). Urgency urinary incontinence in older women who are overweight may be due to the effects of oxidative stress over time, which can result in ischemia of the bladder and detrusor muscle instability (Suskind et al., 2017). Conversely, older adults with lower than average BMIs may have an increased risk of incontinence. This may occur if the weight loss that they undergo is that of lean muscle mass opposed to fatty tissue. When this loss of lean muscle mass occurs, older adults may become frail, which may interfere with normal toileting habits. Lower muscle mass and strength in extremities may be associated with lower strength of the pelvic muscle floor as well as its function, which can result in the leaking of urine (Suskind et al., 2017). So, while urinary incontinence may be more prevalent in older adults, it is not a normal process of aging and it often results from certain conditions which can develop or evolve over the lifespan, resulting in more incontinence in older adults. Aoki, Y., Brown, H. W., Brubaker, L., Cornu, J. N., Daly, J. O., & Cartwright, R. (2017). Urinary incontinence in women. Nature reviews. Disease primers, 3, 17042. https://doi.org/10.1038/nrdp.2017.42 less1 UnreadUnread7 ViewsViews
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Last post March 4 at 9:49 AM by Jazmin Jerez-Rivera
Suskind, A. M., Cawthon, P. M., Nakagawa, S., Subak, L. L., Reinders, I., Satterfield, S., Cummings, S., Cauley, J. A., Harris, T., Huang, A. J., & Health ABC Study (2017). Urinary Incontinence in Older Women: The Role of Body Composition and Muscle Strength: From the Health, Aging, and Body Composition Study. Journal of the American Geriatrics Society, 65(1), 42–50. https://doi.org/10.1111/jgs.14545
Urinary incontinence (UI) as defined by the National institute of aging is basically when a person leaks urine by accident and guided literature suggests this is prevalent in the older population especially women. UI is one of the most common geriatric syndromes and affects overall health, quality of life, and economical burden in patients. (Sohn et al., 2018). Although urinary incontinence can occur in the younger age population, it is not often seen unless the etiology is associated with pathological and medically induced etiologies such as strokes or cancer. The prevalence of urinary incontinence is estimated to be 5-10% among the general elderly population, 10-20% among those receiving home care, and at least 50% among those individuals living in long-term care institutions (Southall et al., 2017). Most studies indicate that women have a higher prevalence of urinary incontinence than men, due to differences in the structure of the male and female urinary tracts. The causes of urinary incontinence among women include childbirth, menopause, obesity, presence of lower urinary tract symptoms and decreased mobility. It is common for men to experience urinary incontinence following a prostatectomy, as suggested by the prevalence rate for men spiking from 5% to over 60% following this surgery. (Southall et al., 2017). Our patient is a 70 y/o female who experiences urinary incontinence with coughing or sneezing has been embarrassed talking to her physician about this and this is a common theme seen with patient’s incontinence. Patients with UI experience elements of stigma, including embarrassment and shame. (Devendorf et al., 2020). Patients are often reluctant discussing UI as bodily fluids expulsion is typically a private affair and the vulnerability associated with the lack of control over one’s bodily function is one that can render reduction in self-esteem. Several studies have also shown that this can lead to self-isolation as well as depression given the particular age population that this medical condition is related to.The etiology of UI is vast however several common factors come into play in the most prevalence group; elderly population. Incontinence can happen for many reasons however for the purpose of this case study we will focus on etiology of UI as related to our patient who experiences these symptoms with coughing or sneezing. This component of UI is called stress incontinence. Factors of incontinence can be associated with major neurological damage or can be functional or iatrogenic however in the case of stress incontinence, the notable factors of causes are usually the result of the age related changes that can lead to the weakening of or damage to the muscles used to prevent urination, such as the pelvic floor muscles and the urethral sphincter. When pelvic organs are out of place, the bladder and urethra are not able to work normally, which may cause urine to leak. Many individuals go to great lengths to deny and hide urinary incontinence, which can pose physical and psychosocial impediments to the enjoyment of life.The etiology of urinary incontinence in the elderly population can often be multifactorial and this is where adequate history taking as well as physical exam will play a major role in diagnosing as well as treatment associated with the type of urgency. Treatment of stress incontinence will include kegel exercises, bladder training, vaginal estrogen cream and medications that increase urethral sphincter contraction amidst others (Huether et al., 2020). ReferencesDevendorf, A. R., Bradley, S. E., Barks, L., Klanchar, A., Orozco, T., & Cowan, L. (2020).Stigma among veterans with urinary and fecal incontinence. Stigma and Health. Advanceonline publication. https://doi.org/10.1037/sah0000260Pathophysiology (7th ed.). Elsevier.Sohn, K., Lee, C. K., Shin, J., & Lee, J. (2018). Association between female urinary incontinenceand geriatric health problems: Results from korean longitudinal study of ageing(2006). Korean Journal of Family Medicine, 39(1), 10-14. https://doi.org/10.4082/kjfm.2018.39.1.10https://www.acog.org/womens-health/faqs/urinary-incontinence less0 UnreadUnread
J. W. (2017). Assessing the stigma content of urinary incontinence intervention outcome
Southall, K., Tuazon, J. R., Djokhdem, A. H., van den Heuvel, Eleanor A, Wittich, W., & Jutai,
Huether, S., McCance, K., and Brashers, V. (2020). Understanding
Urinary incontinence can carry added factors along with the main diagnosis such as loneliness, isolation and depression and should not be the only focus of the initial encounter with the patient. Health practitioners should approach incontinence with methods of evaluation that address the physical and mental health indicators, as well as the impact on the quality of life of the patient. But firstly getting the patient to discuss the problem is the first priority and then treatment should be personalized based on the individual patient preferences and goal of therapy.
Much like the discussion prompts urinary incontinence (UI) can be an embarrassing condition which many who suffer from do not feel comfortable discussing with their providers. For this reason, the number of patients who have UI is unknown (American Urology Association, 2021). However, it is reported to be more common among women over the age of 50 (Ellis, 2020). There are four forms of UI, stress urinary incontinence (SUI), overactive bladder (OAB), mixed incontinence (SUI and OAB) and overflow incontinence (American Urology Association, 2021). Urinary incontinence is not a normal part of aging and is not a disease, but it is a symptom of many different medical problems or can be caused by everyday problems or habits. The Mayo Clinic, (2019) refers to other types of urinary incontinence; stress, urge, overflow, functional, and mixed incontinence. Further breaking it down into temporary and persistent incontinence.Underlying physical problems which could cause UI include pregnancy which places additional pressure on the bladder as the fetus grows, childbirth which can weaken the pelvic floor muscles. These muscles can also be affected with any women’s reproductive surgeries such as a hysterectomy. Aging patients lose capacity of their bladder and have involuntary bladder contractions causing frequent urination. The hormone estrogen helps keeping the lining of the bladder healthy, which is lost when a patient experiences menopause. An Enlarged prostate, Prostate cancer or obstruction from tumors or urinary stones can cause an incontinence as well. Lastly another cause of persistent UI may include types of neurological disorders such as Multiple sclerosis, Parkinson’s disease, stroke, or spinal cord injury (Mayo Clinic, 2019). ReferencesEllis, M. (2020). Why Am I Experiencing Urinary Incontinence? Healthline. Retrieved March 2, 2021 from: https://www.healthline.com/health/urinary-incontinenceless0 UnreadUnread
Treatments for UI will depend on the causative nature of the problem. For things such as pregnancy, menopause, surgery, or other function pelvic floor changes you may be instructed to do exercises to increase the pelvic floor muscles. For causes related to daily habits you may be instructed to limit fluid intake or avoid certain food/drinks and take scheduled bathroom breaks to ensure you are emptying your bladder fully on a regular basis. It is also important to maintain a healthy weight and et plenty of exercise to decrease or prevent urinary incontinence (Ellis, 2020).
Risk factors of UI include; gender, age, body habitus, smoking, family history, other disease such as diabetes or neurological disease. Temporary UI can be caused from urinary tract infections which can irritate the bladder causing strong urges to urinate. Also, Constipation which places pressure on the nerves around the bladder increasing the activity and urinary frequency. Other daily habit factors which can cause UI include increasing the volume of the bladder by consuming items which act as a diuretic such as caffeine, alcohol, some blood pressure medications, or large doses of vitamin C (Mayo Clinic, 2019).
Module 7Urge incontinence is the most common type of incontinence in older adults and is caused by enlarged prostate or atrophy in the bladder which are both common with increased age (Vogel, 2001). Overflow incontinence occurs when urine leaks from the bladder without warning and can be often confused with stress incontinence due to its similar presentation (Vogel, 2001). Stress incontinence is more common in women and what is what most people think of when they hear the term overactive bladder syndrome (Vogel, 2001). This usually occurs during laughing or coughing and is related to a weakened sphincter muscle (Vogel, 2001). The patient in the case study appears to be suffering from stress incontinence. Huether, S. E., McCance, K. L., & Brashers, V. L. (2020). Understanding pathophysiology (7th ed.). Elsevier.Vogel, S. L., MD. (2001). Urinary incontinence in the elderly. The Ochsner Journal, 3(4), 214–218. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3116748/
Radzimińska, A., Weber-Rajek, M., Strączyńska, A., Podhorecka, M., Kozakiewicz, M., Kędziora-Kornatowska, K., & Goch, A. (2018). The impact of pelvic floor muscle training on the myostatin concentration and severity of urinary incontinence in elderly women with stress urinary incontinence – a pilot study. Clinical Interventions in Aging, Volume 13, 1893–1898. https://doi.org/10.2147/cia.s177730
Treatment of urinary incontinence in aging adults can include pelvic floor exercises, addition of bladder relaxers into the medication regimen, or surgical interventions (Wyndaele & Hashim, 2017). Sometimes straight catherization can assist if overflow incontinence is the main issue (Wyndaele & Hashim, 2017). Bladder training, constipation management, and management of fluid intake can also assist in treatment (Huether et al., 2020). In order to properly diagnose, a physical and pelvic exam should be performed as well as a urine analysis and basic lab panels (Wyndaele & Hashim, 2017).
Urinary incontinence affects nearly 300 million women and 120 million men worldwide (Radziminska et al., 2018). While there are a few causes of urinary incontinence in aging adults, the most prevalent is overactive bladder syndrome (OAB) (Huether et al., 2020). This syndrome can often get worse with age and can be caused by a decline in muscle strength as well as muscle mass (Radziminska et al., 2018). In women, low estrogen levels and history of vaginal births or pelvic surgery can be contributing factors to low muscle mass and poor strength (Huether et al., 2020). Contributing factors in men include enlarged prostate and history of pelvic surgery (Wyndaele & Hashim, 2017). Diuretics, anticholinergics, antidepressants, and alpha or beta agonists can also contribute to the development of OAB (Huether et al., 2020). Other factors of decreased pelvic muscle mass and strength with age include decrease in physical activity, lower caloric intake, stress, and neuron death (Radziminska et al., 2018).