How Effective Is Biofeedback for Incontinence?

Urinary incontinence in the elderly means that the urine in the bladder cannot flow out without control. Urinary incontinence can occur in patients of all age groups, but elderly patients are more common. Because urinary incontinence is more common in the elderly, people mistakenly believe that urinary incontinence is an inevitable natural consequence of aging. In fact, there are many causes of urinary incontinence in the elderly, and various causes should be found and reasonable treatment methods taken.

Basic Information

English name: Urinary Incontinence
Visiting department: Urology, Obstetrics and Gynecology, Neurology
Multiple groups: Seniors

Common causes: Central nervous system disease, surgery, urinary retention, unstable bladder, birth injury, postmenopausal
Common symptoms: Involuntary outflow of urine, including overflow, stress, urgency, and functional urinary incontinence

Causes of Urinary Incontinence

Central nervous system disorders

Such as cerebrovascular accident, brain atrophy, cerebral spinal cord tumors, lateral sclerosis and other neurogenic bladder.

2. Surgery

Such as prostatectomy, bladder neck surgery, radical rectal cancer surgery, cervical cancer radical surgery, abdominal aortic aneurysm surgery, etc., damage the bladder and sphincter's motor or sensory nerves.

3. Urinary retention

Urinary retention caused by benign prostatic hyperplasia, bladder neck contracture, and urethral stricture.

4. unstable bladder

Bladder tumors, stones, inflammation, foreign bodies, etc. cause unstable bladder.

5. Women after menopause

Estrogen deficiency causes hypotonia in the urethral wall and pelvic floor.

6. Birth injury

Uterine prolapse, bladder bulge, etc. cause weakened sphincter function.

Clinical manifestations of urinary incontinence

Urgency incontinence

This type of urinary incontinence includes bladder instability, detrusor hyperreflexia, bladder spasm, and neurogenic bladder (unsuppressed bladder). Urinary incontinence is associated with uncontrolled detrusor contractions.

2. Stress urinary incontinence

Involuntary urine outflow occurs after the abdominal pressure rises sharply when the body works such as coughing, sneezing, bumping or pushing heavy objects. Without detrusor contraction, urinary incontinence occurs when the bladder pressure rises above the urethral resistance, stress The deficiency of sexual urinary incontinence is in the bladder outflow tract (sphincter insufficiency), resulting in insufficient urethral resistance to prevent urine leakage.

3. Overflow urinary incontinence

When long-term filling bladder pressure exceeds urethral resistance, overflow urinary incontinence occurs. The cause can be functional or mechanical obstruction of the tension-free (non-contractible) bladder or bladder outflow tract. The tension-free bladder is often caused by spinal cord trauma or diabetes. Obstruction of the bladder outflow tract in elderly patients is often caused by fecal incarceration. About 50% of patients with constipation have urinary incontinence. Other causes of outflow tract obstruction include prostatic hyperplasia, prostate cancer and bladder sphincter disorders, and individual cases are mental urine retention.

4. Functional urinary incontinence

The patient can feel the bladder filling, but can't help or intentionally urinate because of physical movement, mental state and environment.

Urinary incontinence test

Laboratory tests include urine routine, urine culture, urea nitrogen, creatinine, serum potassium, sodium, chlorine, and blood glucose. If urination records indicate that the patient has polyuria, blood glucose, blood calcium, and albumin should be checked. With microscopic hematuria, urinary tuberculosis, inflammation, and tumors should be excluded.

Urodynamic examination can confirm the diagnosis. There are two commonly used urodynamic tests: Urodynamic examination of detrusor overactivity; Urodynamic examination of stress urinary incontinence.

Diagnosis of urinary incontinence

Diagnosis is based on etiology, clinical manifestations, and laboratory tests.

Urinary incontinence treatment

The main principle of treatment is to minimize unnecessary bed rest to correct the incentive.

Vaginitis or urethritis, acute antibiotics for urinary tract infections. Stop or replace drugs that cause urinary incontinence to correct metabolic disorders. General measures include limiting fluid intake (especially at night), regular urination during the day, limiting intake of xanthine such as coffee or tea containing xanthine, paying attention to perineal hygiene and skin care to avoid pressure sores and local skin infections. In addition to drug therapy for the treatment of urinary incontinence, some patients are suitable for surgical treatment, such as prostatectomy, repair of stress urinary incontinence, etc., can get better results. Some patients can use behavioral therapy, biofeedback therapy, or physical therapy alone.

Urgency incontinence

The most commonly used drug for the uninhibited bladder (detrusor instability) is the anticholinergic brompromamine, which has a strong specificity for detrusor muscles, has fewer adverse reactions in the central nervous system, and lasts longer than atropine. Disabled in patients with glaucoma, used with caution in patients with coronary heart disease or prostate disease, and disabled in patients with outflow tract obstruction

2. Outflow tract insufficiency

For urinary incontinence caused by sphincter insufficiency, norephedrine is less irritating to the central nervous system, and the effect is better than ephedrine. Use with caution in patients with hypertension and coronary heart disease.

3. tension-free bladder

The most effective drug for the tension-free bladder is clobecholine. This drug has high specificity, has a small effect on the central nervous system, has a longer duration of action than acetylcholine, and has a better effect on the muscle tone decompensated bladder than neurogenicity. Tension-free bladder. Medication should rule out mechanical obstruction. The adverse reactions of clobecholine are mainly limited to the gastrointestinal tract, but it is contraindicated in patients with asthma, and used with caution in patients with coronary heart disease and bradycardia.

4. Imbalance of sphincter synergy

The most effective way to reduce the sphincter tension is to use alpha antagonists to reduce the sphincter synergy due to neurogenic, functional or drug-induced sphincter coordination disorders caused by clobecholine. Its adverse effects are slight with small doses, and orthostatic hypotension and reflex tachycardia are seen with large doses, but the degree of increase in reflex heart rate is also limited in the elderly. Prazosin is also an effective drug, which is more selective for sphincter muscles, and is more suitable for patients with hypertension and congestive heart failure.