Urinary complaints

As one ages (>65 years), it is unfortunately a fact that urinary complaints will become more general.  It is interesting to know that the older person’s bladder capacity reduces over time and thus to store large volumes of urine becomes physiologically impossible.  This leads to more frequent bathroom visits and discomfort at night when waking to use the bathroom.  In some cases, this can discourage many people to take in enough liquid and this can in turn lead to dehydration and concentration of urine.

It has been found that the older person also has a higher prevalence of asymptomatic bacteriuria, in other words, organisms grow in the urinary system without symptoms like dysuria (pain / burning sensations when urinating), frequency (more frequent need to urinate), incontinence (involuntary urination or leakage of urine) or blood in the urine.   It is debated whether treatment is then needed without actual symptoms presenting.  With antibiotic-resistance increasing, it is not wise to demand antibiotics if there is no clinical indication present.  It is sometimes difficult to diagnose a urinary tract infection in those already suffering from incontinence and similar symptoms. In case of a sudden change in the mental state (confusion or disorientation), also known as delirium, a urinary tract infection must be ruled out for an older person, this is sometimes the only symptom that emerges.

Urinary symptoms are difficult to evaluate in those with cognitive impairment for example persons with dementia or those that are cared for in adult nappies.  If a urinary tract infection causes symptoms, it is important to treat the infection with the correct antibiotics.  This implies that urine must be collected and sent to a laboratory to determine which organism causes the infection and which antibiotic is suitable for the specific organism. For good urinary tract health, it is important to drink enough water, to rectify functional bladder problems (bladder outlet obstruction, prostate enlargement, weak pelvic floor), products containing cranberries have been found to keep the urinary tract healthy.

Visit your urologist if you have problems / complaints, and all men should have a prostate examination as well as a PSA (Prostate Specific Antigen) test to monitor the prostate’s health annually. With an ageing population, incontinence is increasing.  Incontinence is more common in women than in men. 

Various types of incontinence:

• Stress incontinence refers to leakage of urine if there is a rise in intra-abdominal pressure as what happens when you cough, laugh, sneeze or with activities requiring effort.  This type of incontinence is more common in younger women although it can occur at any age.  A weak pelvic floor is in question that causes the bladder to drop out.
• Urge incontinence happens because of the bladder muscle (detrusor) that contracts involuntarily when the bladder fills up and then the urge to urinate comes suddenly and is difficult to control.  This can be because of an underlying medical condition like spinal cord injury or bladder abnormalities. Mixed stress and urge incontinence also occur and will lead to a combination of the symptoms.
• Overflow incontinence presents with ongoing leakage of urine or so-called dribbling.  This can be because of the detrusor that is under-active or there might be a bladder outlet obstruction.
• Functional incontinence can occur in those people where bladder storage and emptying are intact, but the person is not physically capable of getting themselves to the bathroom in time.  This can occur with patients with dementia, persons that cannot mobilise because of a hip or knee problem or in some cases where medication that was administered has a sedating effect and thus makes planning to visit the bathroom in time difficult. Incontinence in men after a prostate procedure is also a reality.

In many cases, continence will return after a while.  It is explained in literature that continence will return for most men (93%) 24 months after surgery.  Some risk factors determine the possibility of normal bladder function after prostate surgery like the person’s bladder function before the surgery, age, the length of the urethra, previous radiation, and obesity. There are many products on the market that can assist with bladder control and personal protection products (adult nappies, special underwear and absorbent pads for men and women) that can make life easier.

Urinary tract health, or rather the lack thereof, can have detrimental effects on the quality of life of the older person.  Support is also available, rather look for help / assistance than staying away because of shame, your life might just get better!

Dr. Janet Strauss is a Medical Doctor and the Head Operational Officer at Medwell SA – Home Health Care Specialists.  Medwell SA also provide Primary Health Care at various Retirement Villages across South Africa.

For more information visit www.medwell.co.za or send an enquiry to info@medwell.co.za