Incontinence

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Urinary incontinence, or the uncontrolled leaking of urine, is a relatively common problem among older adults, but it can affect people in other age groups as well. There are four basic types of urinary incontinence:

Incontinence is not necessarily a permanent problem. Pregnancy, delirium, infection, vaginal irritation, depression, and psychosis can all cause some form of incontinence. Certain medication can be responsible as well, among them diuretics such as furosemide; antidepressants such as amitriptyline and desipramine; antipsychotics such as thioridazine and haloperidol; sedatives such as diazepam and flurazepam; and flurazepam; and many blood pressure drugs, decongestants, antihistamines and others. Alcohol also can affect incontinence.

The most common cause of incontinence in elderly people is a condition called detrusor over activity, in which the detrusor muscle, which surrounds the bladder, contracts without warning, resulting in urge incontinence. Often, no underlying cause can be found for this problem. However, tumors, bladder stones, or some other obstruction of the urinary tract can be involved in some cases.

Routine urinalysis and a urine culture are usually performed to check for irritating infections or abnormal kidney function. An anatomical abnormality such as a fistula, urine retention, or a bladder neck that has shifted, can be detected by a cystogram, in which a fluid that is visible on x-ray is introduced into the bladder by means of a catheter, and x-ray photographs are taken both while you are at rest and while you are straining. Ultrasound may be useful. A procedure called cystometry may be used to look for nerve damage, drug reactions, inflammation and other problems. In this technique, carbon dioxide gas or water is put into the bladder and pressures are noted in the presence of different stimuli, such as certain drugs, straining, and so on.

Much less common than urinary incontinence is fecal incontinence. A variety of problems, including nerve damage; diarrhea; local surgery; pressure from an enlarged prostate, tumors, or fecal impaction; and anal tears from childbirth trauma can permit unintended loss of stool.

General Recommendation

a type of pelvic-floor exercise called Kegel exercises retrain and strengthen the muscles and sphincters of the pelvic floor. They are easy to perform, are not time-consuming, and can be done anywhere, as follows: Squeeze the muscles tightly around the front and back passages, as if trying to stop urination. Hold the contraction for two seconds, then release, wait a moment, and repeat. Ten contractions equal one set of exercises. Over time, you should gradually work up to holding each contraction for ten seconds. Often it takes several months to be able to do this, so be patient. You should try to do ten sets of exercises each day. Many people do them while watching television, talking on the phone, or even while stopped at red lights while driving.

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