URINARY INCONTINENCE IN ELDERLY © Celeste Duke Clinical Psychologist (celeste.duque @ gmail.

com) According to data from the World Health Organization (WHO, 2003) Portugal has a population of 10,061,000 which is characterized by being deeply aging which, in itself, can already be evidence of a worsening of the costs of national health b udgets, since the probability of this population show any disease or suffer from chronic disease states increases. When the elderly urinary incontinence present s it turns out, directly or indirectly, become a source of constant concern for his family (and friends) and represents increased costs to a household budget, o ften small. We present below some data that while not having a direct bearing on the issues addressed here may bring some additional clarification and provoke t hought and curiosity to research other topics related to the elderly and the eld erly woman. As can be seen in Tables 1 and 2, which are listed below the life ex pectancy and healthy life expectancy at birth is different for men and women, al so with regard to infant mortality in adults and these differences are observed ( WHO, 2003) - Women are living longer and die less. Table 1 Life expectancy and healthy life at birth, gender Male life expectancy a t birth of healthy life expectancy at birth 74.0 years 66.7 years 81.0 years 71. 7 years Female Table 2 Infant mortality rates in adults, by gender Male (For 1000) Female (For 1000) Infant mortality Mortality in adults 7150 May 63 CD / cd 1 It is well known that life expectancy has increased in recent years, this is due not only to an improved diet, observance of basic sanitation and hygiene, but a lso to research in medicine and health, allowing a prevention more effective but also more awareness on the part of individuals to adopt lifestyles progressivel y more adapted to their condition (for example, need to eradicate risk behaviors such as poor dietary habits, use / abuse: alcohol, addictions alcohol, drugs or medicines, and smoking). People have more information on caring for ... foods t o avoid ... but the human body does not tolerate and there as time passes will s uffer changes, some very subtle and other more catastrophic! Plus, the aging of the human being is not processed in the same way, nor at the same pace in all su bjects and therefore can not be generalized conclusions, which requires from the health technician to individualized analysis of each subject, and must take int o account all of these variables to achieve better understanding of the patient as a unique being who actually is. The human body will then erode as time progre sses ... some only of cell aging caused others, however, deeply dependent on lif estyles and behaviors adopted and the type of personality, however, all deeply r ooted in the representations that the person does and has of himself, of others and the world life in general. Urinary incontinence can be broadly defined as th e involuntary loss of urine in inappropriate situations and locations. This invo luntary loss of urine acts as devastating as the patient's life and the causes c an be detected immediately established an adequate therapy, preventing evolve in to forms more difficult to treat and the inevitable consequences and additional

costs that the chronic forms present. It is important to note that incontinence affects both sexes (male / female), however, the incidence of urinary incontinen ce in women increases with age, reaching 25% after menopause. Urinary incontinen ce is an organic problem, objective, highly disabling, with harmful consequences for the subject both in physical terms (particularly in terms of hygiene: bad o dor, wet clothing) and psychological (producing low self-esteem and self-concept , increasing stress levels and leading to depressed mood or even depression), so ciocultural (social isolation and impoverishment of the relational life of the s ubject; use of the certificate, lower productivity or even radically altering th e rhythms of work or hobbies of the subject) and economic / financial (expense i ncreased in disposable diapers, medication, diagnostic procedures, etc.).. CD / cd 2 All the symptoms and disorders induced by the state of incontinence in the welfa re and quality of life of the subject,€disturbed patients, and particularly the elderly, and has direct repercussions in the other next to it - other family me mbers. One can easily infer that the inability to control the emission of urine is a deeply distressing situation and causing a serious disturbance in the cycle relational family, leading, naturally, a marked decrease in the quality of pers onal and social life. The inability to control urination can lead to: the feelin g of discomfort, unpleasant odor, damp or wet clothes and even skin lesions in a ddition to the negative psychological and sociological aspects. Despite repeated efforts from research to achieve greater understanding of the causes that lead to the disease, in order to make more effective prevention and adequate treatmen t, what happens is that most people who begin to feel the devastating effects of disease are deeply convinced that urinary incontinence is an inevitable conditi on of aging, and because of this, do not seek help to solve this problem. This w ay of thinking coupled with the reluctance to talk openly about the problem with doctors or family, means that patients suffering from this disease are not adeq uately treated and, shame, fear of becoming a laughing stock and / or criticism, just by becoming isolated from family and friends but also socially and cultura lly. Alongside this representation, widely circulated, urinary incontinence, som e clinicians also inadvertently end up sharing this belief that the involuntary loss of urine is a natural process of age and therefore do not pay any importanc e to the complaints of the patient (when the latter, timidly / subtly speaks of them) do not investigate or treat patients properly, it is not, in this case of negligence, not just normal value considering that certain situations succeed be cause they are common in older individuals. So, in spite of urinary incontinence is a problem that, with few exceptions, is liable to be treated, the truth is t hat the vast majority of older people regarded it as inevitable. PREVALENCE AND INCIDENCE The Portuguese Association of Urology (APU) indicated in 2002 that the prevalenc e of this disease that was between 15 and 30% in individuals over 60 years, with a tendency to increase with age. In the table is presented below one can observ e the percentage incidence of various types of incontinence. CD / cd 3 Table 3 Type of incontinence and the incidence rate (adapted from APU, 2002) Typ e Incontinence Stress incontinence significant loss for imperative * Percentage 5-8% 3-20% 50-20% Note: you can define as having one or more weekly episodes of involuntary loss o

f urine. Referring also to the age group above 60 years the women have a probability twic e as high for men to have incontinence and, in institutions caring for the elder ly, incontinence affects an average of 40% in some institutions it comes to achi eving the 80% (ibid.). Little is known about the incidence of the disease, howev er, estimated that the elderly, falls are 10% for men and 20% for females. Etiology Urinary incontinence depends, at any age, from an anatomical integrity and / or physiological as well as maintaining a normal mental state, a mobility (to move) and skill (to catch / hold the container for which goes pee ) and a motivation preserved perfectly maintained. Please note that, normally, these features are p reserved in the younger population but are undergoing changes / disruptions as t he various age and "setbacks" of life is accumulating (which can range from simp le limitation of mobility disability, to the deeper dependency, eg when you need the help of others to practice personal hygiene), and there are so last mention ed factors are becoming increasingly rare among the elderly, and indeed in some cases, solely responsible for incontinence. In physiological terms, with respect to factors that are directly related to micturition, in women, what happens, wi ll you be reduced bladder capacity, the maximum urethral closure pressure and fo rce the flow of urination. In men, what normally happens is that you will see an increase in urethral resistance, accompanied by a decrease in the strength of t he jet voiding. Succeed is still normal, but in both sexes, an increase of the r esidual bladder after voiding and detrusor contractions due to instability. CD / cd 4 With aging there in the bladder wall a greater number of collagen fibers and alt erations of smooth muscle cells accompanied by a decrease in their income. Recen t research found a parallelism between age and decreased density of smooth muscl e cells in the urethra (due to his death and subsequent replacement by fatty tis sue) and connective tissue cells. In this way, and when the volume of the cells replaced reaches a certain density, the sphincter no longer able to act properly arise as a consequence, urinary incontinence. More specifically in women, in ad dition to these factors, there are still problems static / dynamic level of the pelvic floor, which have different predisposing factors (greatly exacerbated aft er menopause, and as age advances), which can lead to incontinence, More specifi cally, effort and stress. There are other causes, including those linked to urin e production, these mechanisms also change with age, for example, the level of t he circadian rhythms which tend to be reversed (by changing the anti-diuretic ho rmone or renin aldosterone), and leading to nocturia (need to get up several tim es a night to urinate). As to these causes are not limited to changes described so far, there are still diseases that, together with these changes may contribut e to the rising level of urinary incontinence, particularly through or neurologi cal disorders, for example may be noted the following: Diabetes Mellitus Type I or II, disc herniations, Parkinson's disease, Stroke (CVA) or Alzheimer's diseas e. Noteworthy that none of these changes, which may arise with age are alone, be cause of incontinence but may increase levels of predisposition to ... That pred isposition, coupled with the typical pathological states / common in the elderly , increases the probability of occurrence of urinary incontinence. Therefore, as each subject is a case, and each case is different, what may happen is that the causes of urinary incontinence can a case be assigned exclusively to specific c auses of urinary tract abnormalities (organic causes), and either case, they dep end solely on the psychological causes (eg, linked to high levels of stress, dep ression and fatigue, etc..), in others the causes are multiple. In conclusion, a s already stated above, the causes may be: urological, gynecological, neurologic al, psychological, hormonal, environmental or iatrogenic (derived from the thera

py given to solve a specific problem). You can still say that there are cases wh ere, when treated the underlying pathology, urinary incontinence disappears. CD / cd 5 STANDINGS Urinary incontinence in the elderly may be classified in two types: transient an d chronic. Transient incontinence As the name indicates, these are situations where incontinence is manifested by a certain time period which may be reversible and whose causes in the elderly, f all generally outside the urinary tract. The risk is greater when in addition to the physiological changes characteristic of aging arise, they associated pathol ogical changes. Can cite an example, the following cases: one patient had a low activity of the detrusor is an anticholinergic prescribed to you, been developin g a framework for chronic urinary retention with incontinence regurgitation. In another case, a patient who has difficulty in mobilizing (walking) or even imper iousness bladder (a sudden and urgent desire to urinate) who is given a diuretic . The other type of incontinence, although designated transient immediately pres ents strong chance of becoming permanent if not treated properly. Causes of transient incontinence The causes of incontinence are: restricted mobility, fecal impaction, atrophic v aginitis or urethritis, Pharmacologic, Excessive production of urine, delirium a nd Psychological. Restricted mobility - due to objective causes, so common to th e elderly, eg, osteoarthritis of the lower limbs, which can lead to incontinence . This restriction on the level of mobility can be caused by events not as obvio us as is the case of orthostatic hypotension or postprandial (after food ingesti on), or on whether you are wearing shoes too tight / causing great difficulty in walking or Furthermore, the instability caused by the simple fear of falling to the ground. Fecaloma - resulted in 10% of cases of urinary incontinence in the elderly.€One of the mechanisms of this association could involve stimulation of opioid receptors. The suspicion of this situation must be taken into account wh en they appear, both urinary and faecal incontinence (where pasty or liquid fece s can pass around the fecaloma). Atrophic vaginitis - It is characterized by atr ophy of the vaginal mucosa, sometimes with small punctate erosions and bleeding, causes burning sensations and dysuria. In Atrophic Urethritis, also caused by d ecreased estrogen, there exists an effective mucosal coaptation of the urethra, CD / CD 6 allowing the involuntary passage of urine. The therapy indicated in these situat ions are estrogens, topical application, which function to relieve the symptoms. Pharmacotherapy - either by their primary effects, such as side, it appears as one of the most common causes of urinary incontinence. Thus, for example sedativ es or hypnotics (may cause incontinence by state obnibulação - cloudy thinking - which can cause), diuretics (may cause sudden increase in diuresis that the e lderly are unable to respond due to lack of mobilization), anti-cholinergic ( eg , major tranquilizers, anti-depressants, antiparquinsónicos, antihistamines fir st generation anti-arrhythmic, anti-spasmodic and opiates can cause urinary rete ntion, Overflow incontinence), agonists, and adrenergic receptor antagonists (eg , alpha and beta agonists adrenergic receptors may be responsible for urinary re tention; alpha-adrenergic antagonists, used to treat hypertension, can cause inc ontinence by relaxing the bladder neck and urethra), calcium channel blockers an d inhibitors of angiotensin converting enzyme (may induce episodes of cough that can cause stress incontinence in patients with poor sphincter). Excessive produ ction of urine - Incontinence can be due to increased fluid intake, taking diure

tics or metabolic abnormalities (eg, hyperglycemia or hypercalcemia). This chang e may be the cause of incontinence and therefore deserves special attention. One of the causes of excess urine production at night, in the elderly may be due to the existence of congestive heart failure. Another cause of increased diuresis at night is a reversal of the circadian rhythm of production of anti-diuretic ho rmone that manifests itself for unknown reasons. Apart from the grounds presente d here is necessary to try to understand to what extent the ease of mobilization and dexterity are impaired because they can easily transform nocturia in incont inence. These problems can be solved by simple strategies such as reducing fluid intake after the evening (if they are taken in an exaggerated manner) or suspen d products that irritate the bladder such as coffee or alcohol. The therapy reco mmended for this type of incontinence is to identify the behaviors less adapted and eradication of the same (need to wake up at night to urinate or educate the subject on the need to practice exercises that lead to an increase in bladder ca pacity. Therapy product must, as far as possible be devoted to treating the unde rlying cause (eg, if heart failure; in administering desmopressin to reduce noct urnal diuresis, or anti-cholinergic to increase the accommodation capacity bladd er). Also the dexterity and mobility patients can be improved through a workout that can be provided through physical therapy, or even by the administration of analgesics. Loathing - happens when a person sends ideas clearly in opposition t o reality and, moreover, is perfectly convinced of what he says. The presence of delirium requires a CD / cd 7 content from inappropriate thoughts (delusional theme) and the intervention of p sychological processes that operate pathological (generating mechanisms of delir ium). Delirium can be based on intuition (the subject strongly believes that a f alse idea is true without verification, logic does not require justification), i magination (in which he constructs a world situations / events that will be enri ching as it the reports), interpretation (the subject gives a false significance to a fact real), hallucinations (this is a perception without an object, ie, th e person says he sees something that nobody else perceives) and illusion (as, fo r example, the guy thinks he is being betrayed by his friend, the topics can ran ge from jealousy, persecution or even religious). It can be said that delirium c an then€be described as a confusional state characterized by a lack of floating attention and great confusion that can be induced by medications or disease sta tes. Manifesting itself in atypical fashion may in some situations it may be tha t incontinence is the first manifestation. The therapy relies on treatment of un derlying pathology. Also in this group, we have symptomatic urinary tract infect ion or asymptomatic oligo-(where the only symptoms are poliaquiúria and inconti nence). The pollakiuria imperiousness and under this condition, coupled with the difficulty to move, so common in the elderly, appear as the cause of involuntar y losses. The antibiotic treatment is correct. Psychological - also psychologica l problems can and often are the cause of incontinence in the elderly, in part. due to a weak overall feel as useless (or are treated as such), only a burden on family budgets (which are often abused / neglected by their children or other f amily members who live together). All these feelings can lead to a profound desp air and apathy for everything that surrounds it, and to devalue themselves (low self-concept) and do not like them (low self-esteem). Are then frequent imbalanc es / emotional disturbances, high levels of anxiety and stress, depress or sadde n. Sometimes the depression serves to draw the attention of family members (is t riggered as "SOS") for its "so forgetful" person, the point of being completely ignored, as someone who no longer exists despite still being alive. It is usual for the relatives hear they deal with the elderly, which is on your side, like " poor thing, is no longer able to do nothing" or "no longer provides anything sto p ... gives only expense, "even the possibility of retort / answer a question wh ich was made, it is forbidden, since the family came to think that the right to reply for him without even ask you what your opinion on the matter. Later on we will see how incontinence may be triggered, or be the triggering of psychologica l pathology and how these experiences influence the overall health of the subjec

t. CD / cd 8 Chronic urinary incontinence Describes four types of incontinence caused by: detrusor overactivity, stress (o r stress), regurgitation and functional. Incontinence caused by detrusor overact ivity has already a high prevalence of between 40 and 70% of cases. The most fre quent complaints relate to the urge to urinate (caused by increased pressure wit hin the bladder that causes a strong contraction of the detrusor) and involuntar y loss of urine. Detrusor overactivity The detrusor overactivity be only a tiny proportion of diseases affecting the ce ntral nervous system (CNS). The latter may be unable to control / inhibit affere nt sensory signals originating from the bladder is thus an involuntary contracti on (eg Stroke, Brain masses such as tumors, aneurysms, hematomas; Vertebro-Spina l Injuries, Diseases demyelinating diseases, Alzheimer's and Parkinson's disease s). There are also other pathological situations whose impact is much smaller, t hat although there was no impairment or disability of the CNS, it can not effect ively inhibit visicais afferent sensory signals, in these present themselves in a way above normal, are examples that cases of cystitis, urethritis, atrophic, o r even in women, uterine prolapse, and in man, benign prostatic hypertrophy. Not ed that cases of detrusor overactivity per se, are relatively rare, although the y may be present in cases of Diabetic Neuropathy or Spinal Cord Injury. The detr usor overactivity in the elderly may manifest itself physiologically in two ways : either the elderly presents a bladder contractile function of intact or she ha s committed itself (the latter is the most common subtype). When the bladder con tractile function is compromised can coexist two situations: detrusor overactivi ty and sagging bladder and should not be considered as two separate entities. Th is could result in urinary retention (due to the sagging bladder) and incontinen ce (where involuntary detrusor contractions are triggered by ... or occur at the same time as increases in intra-abdominal pressure and are too faint or weak to be detected. CD / cd 9 Stress incontinence Stress incontinence was established as the most common cause of urine loss in wo men at menopause (triggered by the relaxation of the pelvic floor,€which may ha ve been caused by situations of multiple births, or simply by aging). It is rela tively rare in men, and when it happens, is usually iatrogenic (as a result of i njuries caused by urethral sphincter maneuvers or urologic surgery). The symptom s are typical and is the involuntary loss of urine due to increased intra-abdomi nal pressure and this pressure increase, which is physiologic and is triggered w hen a person coughs, laughs, sneezes, or fold rises, passes to the urine that is inside the bladder and, if it exceeds the urethral closure pressure, allows an involuntary passage of urine. It can be caused by hyper-mobility of the urethra (manifests itself when there is a weakening of the pelvic floor, alongside an in crease in intra-abdominal pressure leads to lower and displacement of the bladde r neck out of the abdominal cavity, resulting from this Indeed, a disproportiona te increase of intraocular pressure on the bladder with urethral pressure conseq uent involuntary loss of urine), intrinsic urethral sphincter deficiency (occurs when there is a weakness of the internal sphincter, which is precisely why ajar - hypotonic and / or rigid - allowing the output of urine when intra-abdominal pressure increases) or mixed. They have similar clinical manifestations. This pr

oblem can, however, occur when they are administered therapeutic alpha adrenergi c blockers, since the latter to relax the bladder neck, also decrease the pressu re to close the urethra and can therefore cause stress incontinence. Overflow Incontinence Overflow incontinence is a cause about 10% of cases of incontinence in the elder ly and is mostly at night. In terms of physiological pathology can be observed i n two distinct ways: 1) the patient is able to urinate, but not completely empty the bladder, 2) the bladder loses the ability contractility. Urination by regur gitation occurs when the pressure within the bladder increases due to urine that enters the ureters and when this pressure is higher than the urethral, there wi ll be a loss of urine until the pressure within the bladder is balanced with the urethral pressure . Can be derived from urethral obstruction (eg, benign prosta tic hypertrophy, cancer of the prostate or urethra, large uterine prolapse, feca l impaction) and then, by weak detrusor contractile capacity (for cases of: diab etic neuropathies and alcoholic lesions of the spinal cord; or induced by the dr ug therapy of anti-cholinergic effects, such as some neuroleptics, narcotics, an tidepressants and muscle relaxants). CD / cd 10 Functional Incontinence In the latter type of incontinence there is the existence of difficulties or chr onic disorder of the mobilization and / or cognitive functions, which interfere inhibiting the ability to keep intact the normal habits of cleanliness. What is observed in practice is that the subject holds the ability to control their sphi ncters (the continent) but due to problems associated with disabling is faced wi th a real inability to hold urine (for example, can not reach in time to the toi let!). The difficulty of mobilization can be derived from severe arthritis, musc le contractures, or generalized weakness (do not forget also that the shoes can interfere, so this must be adapted to the standing and limitations of the subjec t, we advise you: easy to put on shoes, closed and the foot size!). For the cogn itively impaired they may be induced by drug therapy, resulting in delirium or d ementia, these patients generally show no alteration of the urinary tract, and u rinary incontinence due to external factors. DIAGNOSIS The establishment of the diagnosis of chronic urinary incontinence in the elderl y should: 1) determine the etiology of incontinence, 2) ascertain whether there is associated urinary pathology, 3) evaluate the physical and mental as well as the coexistence of other diseases (which make imperative the waiver of prescribe d medication before). The diagnosis can either be an almost trivial, as it may r equire extra effort from the physician to collect the patient's clinical history , since, in the elderly is relatively common to have a decreased consciousness a nd thought which leads to a large difficult dialogue, and memory in the short an d medium term may be compromised / affected.€When this happens it is necessary to enlist the aid of families (not always exist) and who can demonstrate a profo und lack of interest! Greatly complicating the process of collecting relevant da ta for proper evaluation and establishment of diagnosis. The make a proper diagn osis is of extreme importance not only to unleash the therapeutic measures to in dicate / implement, but also to know accurately what the consequences of urinary incontinence for the overall life of the elderly (to what extent this illness / problem affects you and incapacitates). Sometimes you need to quantify urine lo ss in such cases is relatively common to use the method of weighing the diapers, and gather up information on the quantity of diapers / pads used daily. CD / cd

11 The collection of clinical history should always be alert to the medical dimensi on in general and give special attention to research problems of surgical, urolo gical, gynecological and neurological. It should also, in addition, conduct a br ief assessment of mental status and mobilization / dexterity of elderly patients and that includes an analysis of psychological and social aspects. The physical examination should include, in addition to the urological and gynecological exa mination, searching for signs of neurological or medical condition in general. T he importance of this assessment lies in the fact that the frail elderly have a disproportionate tendency to isolate themselves from family and others (friends, society) and may, if not detected early, move to states of serious depression. Briefly, and very simply, we can say that some of the symptoms of depression in the elderly, are: isolation, excessive grief (emotional distress), loss of inter est in activities once considered pleasurable, discouragement, frustration, anxi ety, diffuse; stress, fatigue; low self-esteem and self-concept (high devaluatio n) and persisting for a period of more than six months. The analysis recommended in these situations of urinary incontinence are aimed at determining: if renal function is impaired, the levels of plasma glucose, as well as summary examinati on of urine urine culture and urine cytology, screening for the presence / absen ce of malignant cells. The examinations are recommended imaging sonography of hi gh and low urinary tract (with special attention to the measurement of residual bladder). In a second step, and if necessary can also be requested specialized t ests such as urodynamic or even cistouretroscopia. It is noted that all diagnost ic procedures and specialized diagnostic are only required when the conditions f or an efficient and effective treatment of the disease, since the elderly are no t always able to cooperate in these cases means choosing not to conduct intrusiv e tests to avoid suffering a plus. Concluding one can say that the presence of a disease is always a risk factor for the elderly shall be presenting changes in mood / affect. As urinary incontinence a disease that refers directly to physica l disability and loss of human dignity will certainly introduce profound limitat ions in quality of life and well being of the subject. Being even more dramatic when the elderly have preserved their cognitive abilities, but already well awar e that, often, deeply limited in psychomotor. CD / cd 12 As already mentioned the causes of urinary incontinence are multiple, and depres sion is widely present in the older population, may constitute themselves as a c ause or consequence, the same can be said for all the other psychological manife stations described here. In fact, there are situations in which the elderly will manifest urinary incontinence because it is deeply depressed and their cognitiv e abilities (thinking, consciousness, perception, memory) and psychomotor (mobil ity and dexterity) committed, in other instances it is the sickening physical (u rinary incontinence physiological cause) that will trigger the individual reacti ons that lead to ill also in terms of psychological and social. For example, whe n incontinence is manifested in elderly who are living in their old age in a ver y negative, but merely to survive, the more easily will sit back and let things "to collapse" around .. . devaluing themselves, losing the little they had the w ill to live. This disease will be strengthened to deliver even more sadness and lack of will and motivation to live, to feel even more helpless, and dependent, "a real burden," ... their dignity, if they existed, no longer makes sense.€Red uce to simple "plants" that creep deeper than its difficulty walking (resulting from osteoarthritis or other limiting condition and / or disabling). If instead the elder was someone who "always fought against the tide," which is so to speak , against the limitations of an aging body and the limitations imposed by life i tself, and, though she is now retired still have a working life, or have chosen a lifestyle full of activities that give you pleasure, you probably will do is s

eek medical help. But if the pair of incontinence is present another condition t hat the subject believes that was defeated by life, we can see a rapid degradati on of all abilities so wisely retained until that moment. The human face of adve rsity will trigger a series of defensive strategies and how they will react depe nds on the type of personality, specific moment in which the disease is triggere d, the mental representations that make the situation ... So he can fight or giv e up! Incontinence will stir feelings very close and may cause embarrassment, sh ame, frustration, despair, anxiety and stress, profound sadness, devaluation, la ck of motivation ... feelings, however, that, as seen in depression are present. So the advice that is needed is de-dramatize the situation, take care with empa thy, congruence, professionalism, respect and affection. Whenever possible, it i s advisable to make a few sessions of Health Education whose ultimate goal is to help (con) living with the disease and thus restore some lost dignity, restorin g the quality of life and joy of living ... CD / cd 13 Briefly: How does it develop? The loss of urine may occur transiently, usually associated with use of drugs, i nfections (urinary tract infection, vaginitis), constipation or problems with ho rmonal deficiency, which disappeared after treating the underlying cause, or may be persistent or permanent installation with progressive deterioration. Many wo men become incontinent after childbirth, hysterectomy (surgery to remove the ute rus) or other trauma to the pelvic region. Most common type Among the most common type of urine loss there is stress urinary incontinence or stress: that the loss of urine occurs when there is a sudden increase in intraabdominal pressure such as coughing, sneezing, laughing, jumping, running, or so me effort. How is it diagnosed? The diagnosis is clinical, based on detailed medical history. They are investiga ted: the onset of symptoms, ruling out the hypothesis that due to the presence o f urinary infection, calculations, tumors, diseases, neurological disorders and drug use. During the physical exam the patient is asked to cough, trying to play the urinary loss. It may also be performed in a test swab that is inserted into the urethra to determine its position and mobility. Shall be conducted an exami nation of urine analysis. A urodynamic test will determine if further changes in the bladder and urethra. How is it? The treatment will depend on the type and causes of urinary incontinence. Genera l measures include identifying the possible causes of loss of urine, such as the need: Lose weight, Stop smoking to reduce the chronic cough; Treating constipation; Tr eating depression; Implement strategies for greater accessibility to the toilet (in some cases, use of bedpan), etc.. CD / cd 14 Relief of symptoms can be achieved: Specific medications, physical therapy exercises for the pelvic floor muscles, c

alled Kegel exercises (up to 75% may improve the symptoms); With the use of vagi nal cones with different weights; current techniques include the use of stimulat ing electrodes; Techniques injection of collagen (around the urethra), or even s urgeries to correct the specific problem. How is it prevented? For prevention should be instituted routine of Kegel exercises, especially after vaginal delivery and after surgery of the pelvic region. SITES OF INTEREST: World Health Organization (WHO) URL: http://www.who.int Portuguese Association o f Urology (APU) URL: http://www.apurologia.pt/ PsiqWeb - Web site authoring G. J . Ballone, (areas: Psychiatry, Psychology, Psychopathology, Pharmacology, etc.). URL: http://virtualpsy.locaweb.com.br/index.php PsicoLogia.com.pt - The Portal of Psychologists URL: http://www . psicologia.com.pt / *** *** *** © Celeste Duque - 04/05/2008 CD / cd 15