What are the Common Urinary Problems in Elderly?

Older men usually have difficulty passing urine. Most common symptoms include:

1. Slowing of the urine stream
2. Frequently getting up in the night to pass urine

Some men chose not to go in for treatment till the time symptoms are not bothersome and serious. Voiding symptoms include:

1. Poor Stream
2. Hesitancy
3. Intermittent flow
4. Straining when passing urine

The urinary difficulties are divided into Storage Symptoms (Called Irritative) and Voiding (Called Obstructive) symptoms groups. Storage symptoms include:

1. Increased Frequency and Urgency of Passing urine
2. Urinary leakage while going to the toilet
3. Need to get up at night to pass urine

Other symptoms may include:

1. Urge to pass the urine again just after you have emptied your bladder
2. Dribbling of urine after you have been to the toilet

What causes Urinary Problems?

1. Prostate Enlargement

   It is situated around the neck of the bladder. When it gets bigger it can cause voiding symptoms.

2. Overactive bladder

   As men and women get older, it is difficult to control the bladder as it may be less able to store urine. This causes you to pass urine more frequently and even leads to incontinence.

3. Water Balance Problems

   When you are ageing, it becomes harder for the body to reduce the amount of urine. This may cause you to get up more often at the night to pass urine. So it is normal for the elderly who are 65+ to pass urine at night. Other causes of LUTS include Diabetes Mellitus, Urinary infections, Bladder stones, Prostate cancer, Bladder cancer, and Neurological conditions.

What are the recommended tests?

Dr. Shailesh Chandra Sahay recommends a few tests to treat urinary problems: 

1. Rectal Examination

   Rectal examination (Palpation of Prostate through Rectum) may reveal a markedly enlarged prostate, usually affecting the middle lobe. Your expert may recommend a few blood tests to rule out prostate cancer.

2. Serum PSA

   A high Prostate Specific Antigen (PSA) level is a marker of prostate cancer, however, certain tests like PSA density, PSA free %, and rectal examination are required to confirm the diagnosis.

3. Blood sugar

   Blood sugar is tested to rule out the possibility of Diabetes Mellitus

4. Ultrasound KUB

   Ultrasound KUB is done to know the prostate size, status of the kidney, residual urine volume, and any other urinary stone problem.

Check out the article: Urologists: Who Are They and What Can They Do for Me?

What should be the treatment plan?

Lifestyle modification

1. Reduce the amount of fluid you drink especially in the evening. You should try to drink as little as possible after 4 pm if you are having nighttime symptoms. However, do not reduce the total amount of fluid to less than 1.5 litres each day.
2. Avoid alcohol, caffeine drinks (Tea, Coffee), and smoking.
3. Try to train your bladder. This means you should try to hold on to urine for longer if you are experiencing a frequent desire to pass urine. If you can, you should try to gradually increase the time between visits to the toilet and also increase the amount of urine that you pass each time. The bladder muscle can be trained to expand more in this way.
4. Pelvic floor exercises. These can help you to hold on to urine for longer

There are certain medicines which can be effective to improve symptoms of BPH, overactive bladder symptoms and storage symptoms. Those patients, in whom medical treatment fails, require surgical management.

Are there any surgical options to treat Prostate enlargement (BPH)?

There are two main surgical options for treating BPH- TURP and Laser Prostatectomy (HoLEP). TURP (transurethral resection of the prostate) is the most common surgery for BPH. It accounts for 90% of all BPH surgeries. The doctor passes an instrument through the urethra and trims away extra prostate tissue.

The recovery period for TURP is much shorter as well. Holmium-Laser Prostatectomy (HOLEP) is the most advanced form of endourological surgery for the prostate. Its advantage is less bleeding and early recovery after the operation.

What are the common Urinary problems in Females?

1. Burning or stinging when you pee (urinate).
2. Constant lower tummy (abdominal) ache.
3. Needing to pass urine often (frequency).
4. An urgent feeling of needing to empty your bladder (urgency).
5. Loss of bladder control (Incontinence).
6. Needing to get up to urinate several times in the night.
7. Feeling of needing to empty your bladder even after urinating or, dribbles of urine after you think you have finished.
8. Difficulty in urinating.
9. A slow stream of urine.
10. Urinary tract infections (UTI)

What changes does Menopause cause in women?

After menopause, levels of a female hormone produced by your ovaries (oestrogen) fall. Because of this, some women may notice changes in their vagina and genital area after menopause. These changes may include vaginal dryness, discomfort during sex and bladder symptoms. These can all usually be improved with hormonal replacement treatment.

How can Urge Incontinence and Stress Incontinence cause urinary problems?

Urge incontinence (detrusor instability)

In urge incontinence, urine leaks before you get to the toilet when you have urgency. Urgency and urge incontinence is often due to an unstable or overactive bladder, or detrusor instability. Bladder training exercises are the first line of treatment. Medication may also help.

Stress incontinence

Stress incontinence is the most common form of incontinence. It means you leak urine with actions such as coughing, laughing, sneezing or exercising. It happens when the pelvic floor muscles that support the bladder are weakened. Childbirth is a common reason for a weak pelvic floor.

The first treatment for stress incontinence is pelvic floor exercises. Surgery to tighten or support the bladder outlet can also help. Medication may be used in addition to exercises if you do not want, or are not suitable for, surgery. An operation may be required to repair or boost your pelvic floor in some cases.