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

Question

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.

Alvita's mobility is limited. How does this affect continence in the elderly?

Shortly after the birth of her second daughter, Alvita experienced mild incontinence, particularly after laughing or coughing. What was she experiencing?

Answer 1

Decreased mobility in the elderly has a significant effect on continence. Those who move slowly may not make it to the bathroom in time for urination. Arthritic individuals may find it difficult to move to the bathroom, manipulate door handles, or remove their clothes. If their vision is failing, it becomes a challenge to navigate to a bathroom, particularly in new surroundings or at night. Finally, stool impaction, a possibility with decreased mobility, leads to mechanical pressure on the bladder and subsequent incontinence.

What is the pathophysiology behind this type of incontinence?
Alvita began to experience stress incontinence after her second delivery. An intact pelvic floor maintains the position of the bladder in the pelvic cavity and the posterior urethrovesical angle between the bladder wall and urethra. When childbirth weakens the pelvic floor, the neck of the bladder descends and "funnels" into the lower pelvis. As it descends, the bladder also tilts posteriorly and widens the urethrovesical angle. These anatomical changes compromise continence so that relatively mild increases in intra-abdominal cause urinary leakage.