disorders of urination
kidney and urinary tract disorders
Urinary Incontinence in Adults
Although incontinence is more common among older adults, it is not a normal part of aging. With aging, bladder capacity decreases, ability to delay urination declines, involuntary bladder contractions occur more often, and bladder contractions weaken. Thus, urination becomes more difficult to postpone and tends to be incomplete. The muscles, ligaments, and connective tissue of the pelvis weaken, contributing to incontinence. In postmenopausal women, decreasedestrogenlevels lead to atrophic urethritis and atrophic vaginitis and to decreasing the strength of the urethral sphincter. In men, prostate size increases, partially obstructing the urethra and leading to incomplete bladder emptying and strain on the bladder muscle. These changes occur in many normal, continent older adults and may facilitate incontinence but do not cause it. Incontinence greatly reduces quality of life, causing embarrassment, isolation, and depression. Incontinence is often a reason older adults require care in a long-term care facility. Urine irritates the skin, contributing to the formation of Pressure Sores in people who are bedbound or chairbound. Older adults with urge incontinence are at increased risk of falls and fractures as they rush to the toilet. The most effective medications for many kinds of incontinence have anticholinergic effects (see sidebar Anticholinergic: What Does It Mean? ). These effects, such as constipation, dry mouth, blurred vision, and sometimes even confusion, can be particularly troublesome in older adults. 