How is urinary incontinence treated in the elderly?

The impact of urinary incontinence on the quality of life of women is high, accounting for more than 20% of adults, and more common in middle-aged and older women. Stress incontinence, also known as tension incontinence, refers to a sudden increase in abdominal pressure when coughing, sneezing, laughing or standing up, and the involuntary flow of urine due to loss of control. Stress incontinence is the most common type of urinary incontinence in women, and can occur in women of all ages, but is more common in middle-aged and older women who are obese. Relevant data show that: the incidence of the disease in China’s middle-aged and elderly women is about 50%. Common causes are: 1, the characteristics of women themselves and birth injuries: women’s urethra is relatively short, coupled with the pelvic muscles will be damaged to varying degrees during childbirth, the ability to support some of the organs in the pelvis is reduced, thus easily leading to stress incontinence. Clinical findings show that the prevalence of urinary incontinence is higher in women with normal deliveries than in those with caesarean sections. 2, obesity: middle-aged and older women have more abdominal fat accumulation and higher abdominal pressure, which can produce greater pressure on the bladder. 3, estrogen levels decline: after menopause, women’s estrogen levels decrease, so that the urethral mucosa becomes thinner and tension decreases. 4, mental factors: tension, stress and anxiety can cause hypersensitivity in the bladder muscle response, making it unable to inhibit bladder contraction and cause incontinence. 5, surgical injury: surgery of pelvic organs directly injures the pelvic floor muscle groups and nerves can lead to stress incontinence Mild: incontinence only under heavy stress (such as coughing, sneezing, lifting heavy objects). Moderate: Incontinence under mild stress such as walking, standing, or while shopping Severe: Incontinence occurs regardless of activity or position. Because the symptoms of urinary incontinence vary in severity, treatment varies. Non-surgical treatment can be used for mild to moderate stress incontinence, while surgical treatment is appropriate for severe stress incontinence. For mild to moderate patients can be used: 1, the pelvic floor muscle group rehabilitation training. Pelvic floor muscle exercise: lift the anal muscle exercise (i.e., contraction of the anus), each contraction lasts more than 10 seconds, each time at least 15 to 30 times, three times a day. Pubococcygeus muscle exercise is the repetitive exercise of actively interrupting urination in the process of urination and then continuing to urinate afterwards; this method helps the recovery of urethral sphincter function. Bladder function exercise: urinate at the prescribed time and gradually extend the time interval of urination in order to gradually increase the bladder capacity; control the sensory stimulation of the bladder with consciousness to re-establish cortical control of bladder function and reduce the frequency of urination to once every 3 to 4 hours. Pelvic biologic feedback therapy: Vaginal cones of different sizes are placed according to the size of the patient’s vagina, and the patient is allowed to contract the vagina to hold it in place, and the weight of the cones is gradually increased to enhance the contraction of the patient’s vagina. Biological feedback therapy can be connected to an external pressure measuring device to measure the vaginal contraction force and display it to the patient through the screen of the pressure measuring device to visually guide the patient to correctly master the contraction method and improve the effect of pelvic floor exercise. These methods are simple and effective, with an efficiency of 70% to 100% after 3 to 6 months of adherence, and without any side effects. 2, Western medicine treatment: such as the use of tube pass, urinary spirit, etc., middle-aged and elderly women can also supplement the appropriate amount of estrogen as an auxiliary treatment. But the drugs have some side effects, so they must be used under the guidance of a doctor, and should not be used for a long time. 3, Chinese medicine treatment: the efficacy is certain and there are no obvious side effects. Such as taking traditional Chinese medicine, such as Tonic Zhong Yi Qi Tang, Shrinking Spring Pill, Mulberry Cuttlebone Pill, Kung Tee Pill, Solid Floating Soup, etc., and also acupressure with moxibustion. In addition, acupuncture points such as Zhongji, Guanyuan, Sansanli and Sanyinjiao also have the effect of enhancing the contraction of pelvic floor muscle groups. Surgical treatment can be used for patients with severe stress urinary incontinence. The purpose of urinary control surgery is to elevate the bladder neck, support the mid-urethra, or increase urethral resistance (artificial urethral dilator). In recent years, the “sling” procedure has been developed with the advantages of minimal invasiveness, good efficacy, and rapid postoperative recovery.