Elderly urinary incontinence

　　Urinary incontinence can occur in patients of all age groups, but it is more common in the elderly. The main causes of elderly urinary incontinence include the following points:

　　1. Neurogenic bladder caused by central nervous system diseases such as cerebrovascular accidents, cerebral atrophy, brain and spinal cord tumors, and lateral sclerosis.

　　2. Surgery such as prostatectomy, bladder neck surgery, radical rectal cancer surgery, radical cervical cancer surgery, and abdominal aortic aneurysm surgery may damage the motor or sensory nerves of the bladder and sphincter muscles.

　　3. Urinary retention caused by benign prostatic hyperplasia, bladder neck stenosis, urethral stricture, and other conditions.

　　4. Unstable bladder Unstable bladder caused by bladder tumors, calculi, inflammation, foreign bodies, etc.

　　5. Estrogen deficiency after menopause in women leads to decreased tension of the urethral wall and pelvic floor muscles.

　　6. Weakening of sphincter function caused by uterine prolapse and bladder prolapse due to childbirth injury.

　　If elderly urinary incontinence patients do not receive timely treatment, it may lead to the following complications:

　　1. Difficulty in urination

　　This condition is mainly caused by overly tight suspension. Some patients may be related to detrusor muscle contractile force damage or bladder outlet obstruction before surgery. For early postoperative difficulties in urination, intermittent catheterization can be used. A small number of patients may develop urinary retention after surgery and require the removal of the sling. This can be done under local anesthesia by releasing or cutting the sling through the vagina, and the difficulty in urination can disappear immediately after surgery. The adhesions produced by the sling still have a therapeutic effect on stress urinary incontinence.

　　2. Bladder perforation

　　Bladder perforation is most likely to occur in patients who have undergone surgery in the past, and repeated cystoscopy during the operation is an essential step. If bladder perforation occurs during the operation, re-puncture and installation should be performed, and a catheter should be retained for 1-3 days. If bladder perforation is found after surgery, the sling should be removed, and a catheter should be left in place for a week, and the sling should be repositioned in a second stage.

　　3. Bleeding

　　Bleeding and postpubic hematoma are also easy to occur, most often due to puncture too close to the postpubic area or the presence of scar tissue. Once postpubic space bleeding occurs, the bladder can be filled for 2 hours, and pressure can be applied to the lower abdomen. A uterine gauze pad is packed into the vagina, and close observation is made. Most cases can be absorbed spontaneously.

　　In addition to difficulties in urination, bladder perforation, and bleeding complications, common symptoms include perineal eczema, ulcers, urinary tract infections, bacteriuria, even falls and fractures, and some patients may suffer from depression, etc.

　　Urinary incontinence is mainly manifested as an inability to control urination voluntarily, and the following are the clinical manifestations of different types of urinary incontinence:

　　1. Urgency urinary incontinence

　　This type of urinary incontinence includes causes such as bladder instability, detrusor reflex hyperactivity, bladder spasm, and neurogenic bladder (uninhibited bladder), and urinary incontinence is related to uncontrolled detrusor muscle contraction.

　　2. Stress urinary incontinence

　　Unintentional urine leakage occurs after a sudden increase in intra-abdominal pressure during activities such as coughing, sneezing, jarring, or lifting heavy objects. Urinary incontinence occurs when the bladder pressure rises above urethral resistance without detrusor muscle contraction. The defect in stress urinary incontinence is in the bladder outlet (sphincter dysfunction), causing insufficient urethral resistance to prevent urine leakage.

　　3. Overflow incontinence

　　Overflow incontinence occurs when the pressure of a chronically full bladder exceeds urethral resistance, and its causes can include a non-contractile (inability to contract) bladder or functional or mechanical obstruction of the bladder outlet. A non-contractile bladder is often caused by spinal cord injury or diabetes, while in elderly patients, obstruction of the bladder outlet is often due to fecal impaction, with about 50% of constipated patients experiencing incontinence. Other causes of outlet obstruction include benign prostatic hyperplasia, prostate cancer, and detrusor sphincter dyssynergia, with some cases belonging to psychogenic urinary retention.

　　4. Functional urinary incontinence

　　Patients can feel the bladder is full, but it is just due to reasons such as physical exercise, mental state, and environment, and can not help but urinate or urinate intentionally.

　　Urinary incontinence is relatively common in the elderly population. To prevent the occurrence of this disease, it is recommended that everyone pay attention to the following lifestyle issues:

　　1. Good attitude

　　Maintain an optimistic and magnanimous attitude, face success, failure, stress, and troubles in life and work with a positive and peaceful mindset, and learn to regulate one's mood and emotions.

　　2. Prevent urinary tract infection

　　Develop the habit of wiping hands with toilet paper from front to back after urination and defecation to avoid urinary tract infections. Before sexual intercourse, both partners should clean the external genitalia with warm water, and the female partner should empty her urine immediately after intercourse and clean the external genitalia. If urinary pain and frequency occur after intercourse, anti-urinary tract infection drugs can be taken for 3 to 5 days, which can quickly cure the inflammation in the early stage.

　　3. Regular sexual life

　　Research shows that women who continue to have regular sexual life after menopause can significantly delay the physiological degeneration of the ovary's estrogen synthesis function, reduce the incidence of stress urinary incontinence, and prevent other elderly diseases, thereby improving health levels.

　　4. Strengthen physical exercise

　　Strengthen physical exercise, actively treat various chronic diseases such as emphysema, asthma, bronchitis, obesity, and large abdominal tumors, which can cause increased abdominal pressure and lead to urinary incontinence. It is necessary to actively treat these chronic diseases, improve the overall nutritional status. At the same time, appropriate physical exercise and pelvic floor muscle exercises should be carried out. The simplest method is to do 45 to 100 times of anal and anal upward activities before getting out of bed in the morning and after going to bed at night, which can significantly improve the symptoms of urinary incontinence.

　　5. Rational diet

　　Diet should be light, and more fiber-rich foods should be eaten to prevent increased abdominal pressure due to constipation.

　　The laboratory tests that should be performed for this disease include urine routine, urine culture, blood urea nitrogen, creatinine, serum potassium, sodium, chlorine, blood glucose. If the urination record indicates that the patient has polyuria, blood glucose, blood calcium, and albumin tests should be performed. If frequent urination and urgency are accompanied by microscopic hematuria, attention should be paid to exclude urinary system tuberculosis. At the same time, urodynamic examination should be performed, as urodynamic examination can ensure the accuracy of the diagnosis. If the patient cannot be diagnosed after general examination, or if empirical conservative treatment fails, or if surgery is to be performed, urodynamic examination should be performed. For the elderly, urodynamic examination is safe and reliable.

　　In addition to regular medication, patients with this disease can also try the following dietary recipes, which are quite effective.

　　Recipe One

　　Boil Chinese herbang xiang (Zhi Zi) to make a decoction and drink it three times a day. Persistent drinking can cure this disease. Steam a pig bladder: wash and clean a pig bladder, fill it with an appropriate amount of rice (enough to eat in one serving), tie the mouth with a white thread, and steam it. Eat it without adding salt or any other seasonings to treat elderly urinary incontinence.

　　Recipe Two

　　Stewed Dog Meat with Black Beans. 200 grams of dog meat and 100 grams of black beans. Boil them together until tender, then eat the meat and drink the soup in one serving. Take one dose per day for adult urinary incontinence. Dangshen and Walnut Kernel Soup: 18 grams of dangshen and 15 grams of walnut kernel. Boil them in an appropriate amount of water until thickened, then drink the soup and eat the walnut kernel. This recipe tonifies the Qi and strengthens the kidney, and has a significant therapeutic effect on elderly kidney deficiency leading to urinary incontinence.

　　Recipe Three

　　Apply a paste of scallion, sulfur, and ginger externally. Use 6 inch-long scallion roots with roots, 15 grams of sulfur, and 2 slices of fresh ginger. Mash them together to form a paste, and apply it to the navel with a bandage before bedtime. Remove it the next morning. It is effective for treating pediatric urinary incontinence. For mild cases, it may cure in one application, while severe cases may require 3 to 4 applications to heal.

　　Recipe Four

　　15 grams of Longan meat, 12 grams of fried Chinese date seeds, and 10 grams of Euryale flos. Boil the mixture in an appropriate amount of water to make a decoction, and drink it as tea. It has the effects of nourishing blood and calming the mind, benefiting the kidney and consolidating essence, and can treat elderly heart Yin deficiency, heart and kidney disharmony leading to insomnia and urinary incontinence.

　　Recipe Five

　　Take 2 fresh eggs, 20 grams of Chinese wolfberry, and 4 dates. Boil them together in a pot with water. After the eggs are cooked, remove the shell, put them back in the pot and boil for a moment more, then eat the eggs and drink the soup. Take this once every other day, and after 3 doses, significant effects can be achieved.

　　The main principle of treatment for this disease is to minimize unnecessary bed rest to correct the cause, treat acute confusion, defecation, and use estrogen to treat vaginitis or urethritis. Use antibiotics for acute urinary tract infections, discontinue or replace drugs that cause urinary incontinence such as sedatives, tricyclic antidepressants, psychiatric depressants, diuretics, antihypertensive drugs, and anticholinergic drugs to correct metabolic disorders. General measures include limiting fluid intake (especially at night), scheduled urination during the day, limiting the intake of xanthine-containing substances such as coffee or tea, paying attention to perineal hygiene and skin care, avoiding bedsores and local skin infections, etc. In addition to drug therapy, some patients may benefit from surgical treatment, such as prostatectomy and repair surgery for stress urinary incontinence, which can achieve good results. Some patients can use behavioral therapy, biofeedback therapy, or simple physical therapy.