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Urinary incontinence in older women


The specialty of geriatrics includes many syndromes; one among such is urinary incontinence, observed in over 1 in 3 older women. This condition greatly diminishes the individual’s quality of life, associated with increased social isolation, falls, fractures, and admission to long-term care facilities.


Women with urinary incontinence often fail to report it. Physicians and other caregivers should ask about its possible existence while taking histories during encounters in all older women.


From a thorough history, a doctor must delineate the chronicity of the incontinence, and make a diagnosis of the type of incontinence:


1] stress occurring during increased abdominal/pelvic pressure, such as is seen in coughing or laughing;


2] urgency, where the woman senses incoming bladder stimuli, associated with reflex micturition; or


3] mixed type of urinary incontinence, in which loss of urine results from factors of both types 1] and 2].


Making a history-based diagnosis in a woman with urinary incontinence allows prescription of optimal therapy.

Evidence-based incontinence therapy includes pelvic floor muscle exercises, such as Kegel exercises improve urinary symptoms related to urge and stress incontinence.


Kegel Exercises

What are Kegel Exercises?

These pelvic muscle exercises often benefit both men and women with stress and urge incontinence. The exercises strengthen the pubococcygeus (PCG) muscle simply by tightening and relaxing it. A person can learn to identify these pelvic muscles by simply tensing the ring of muscles around the rectum while sitting or standing. The abdominal, thigh and buttock muscles should remain relaxed. Stopping and starting the flow of urine while voiding is another good way to identify these muscles.


The Exercises

Quick Kegels: Tighten the PCG muscle. Hold it for a count of five, and then relax.

Pull In: Pull up the entire pelvic floor as though trying to suck water. Hold for a count of five, while breathing normally. Relax for a count of five and repeat.

At first, do 10 of each of the exercises (one set) four times every day. Each week increase the number of times of exercise by five (15, 20, 25, etc.). Complete four sets each day. Be patient because it may take at least 3 months for results. Make the exercises a part of your daily life to help assure ongoing benefit.


When you have control of these muscles, use them to help prevent “accidents.” Tighten your pelvic muscles:

When you have the urge to urinate.

Before you get up from a chair.

Before you move to get out of bed.

Before and while lifting heavy objects.

When someone is going to tell you a funny story.

When you feel a sneeze or cough coming on.


See link below:

http://www.newporturogynecology.com/pdf/Timed_Voiding_Program.pdf

A study was conducted of women over age 65 living in a rest home: 25 with urinary voiding symptoms were treated with Kegel exercise training, while a control group of 25 with the same urinary symptoms was given standard care.


Before study treatment was initiated, interviews were conducted of treatment and control participants regarding:


1] Quality of Life Scale,


2] Mini-Mental Test,


3] Rankin Scale,


4] Daily urinary forms, and


5] Pad tests.


Bladder training and Kegel exercises were given to the treatment group for 6 to 8 weeks. A second evaluation on both groups was done at 8 weeks. The last evaluation was done 6 months later.


Urgency, frequency and nocturia were significantly reduced at 8 weeks and 6-month evaluations in the treatment group compared to the control group. The strength of pelvic floor muscles increased significantly by 8 weeks in the treated women


Conclusion: Behavioral therapy can be used easily as an effective treatment for urinary incontinence in elderly women living in a rest home.

 

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