Question

Alvita is a frail 89-year-old woman residing in a nursing home. She is able to move slowly around the residence with the use of a walker but appreciates when her daughter is there to hold her arm and walk alongside her. When one of the health care staff changes Alvita, her daughter helps. Alvita’s incontinence has progressed, particularly over the last 6 years since she has resided in the nursing home. Alvita can smile at her lack of bladder control, however, and says that her incontinence really began when she was a young woman, just after the birth of her second daughter.

1. Alvita’s mobility is limited. How does this affect continence in the elderly?
2. Shortly after the birth of her second daughter, Alvita experienced mild incontinence, particularly after laughing or coughing. What was she experiencing? What is the pathophysiology behind this type of incontinence?
3. What information can you provide this patient to help her manage her incontinence?

Answer 1

The risk of incontinence is increased with age commonly due to functional impairment. Further, cognitive impairment increases the significant effect on incontinence which increases the urge to void. In this case, Alvita has limited mobility which makes her difficult to reach the toilet and results in urinary leakage. She needs assistance in removing of clothes and washing which resist her to frequent urination. Already the bladder has lost the control due to loss of motor skills ability as because of age, additionally, the pressure on bladder increases the incontinence of urine.

Alvita experiences incontinence after her second childbirth. This is due to the weakening of the pelvic floor following delivery. The bladder became tilts towards the posterior pelvic cavity and ureterovesical angle becomes widens. These increases the abdominal pressure on the bladder, and even the mild pressure (coughing, laughing) can cause urinary leakage.

The patient can be managed her incontinence by

• Ensure that she can able to reach the toilet easily.
• Make routine voiding habits by fixing scheduled time.
• Promote bladder training to improve bladder capacity.
• Promote strengthening exercises to improve bladder function.
• Make a schedule of drinking habits according to the need to avoid nocturia.
• Minimize pressure on the abdomen to avoid urinary leakage.