TASK 10: URINARY SYSTEM

Incontinent Urinary are person that leaks urine unintentionally. While it can occur to anyone, urinary
incontinence is much more common in older adults, particularly women, than in younger people (NIA,
2017). According to (Mark Goepel, 2010) in their research study entitled Urinary Incontinence in the
Elderly, define as structure alterations in the smooth muscle, as well as degradation of neuronal control
and decreased function owing to aging in the urinary system, create this widespread and bothersome
ailment in the elderly. Coughing, sneezing, laughing, walking, the sense of sudden, overwhelming desires
to pee, excessive urination, waking up many times to urinate, and urinating while sleeping are some of
the most typical indications and symptoms that can be noted in the elderly. Most elderly people who
have this condition are asked to use adult diapers. There is three pathogenesis of urinary incontinence
that these are overactive bladder, stress incontinence, and diabetes. Overactive bladder is thought to be
caused by involuntary detrusor contractions mediated by muscarinic receptors, which can be validated
urodynamically even during the filling phase. Detrusor muscle also called detrusor urinae muscle is a
smooth muscled found in the wall of the bladder and this muscled undergoes changes as we age and
lose its elasticity and function which aids in bladder control. In Stress incontinence, inadequate
sphincter function at the urinary outlet was noticed and the diagnostic test confirmed involuntary
urinary loss as a result of a massive increase in intravesical pressure owing to the physical stimuli such as
coughing, sneezing, or crunching the abdominal muscles in the absence of the function of the detrusor
muscles. In elderly people with Diabetes Mellitus, found using urodynamic investigation found out that
they would likely have a reduced sensory reflex, detrusor hypercontractility, residual urine, and increase
urine capacity which will eventually lead to urinary incontinence. According to (Mark Goepel, 2010)
pelvic floor exercise and bladder management are some of the therapeutic options they can
recommend. Pelvic floor exercise can increase 17-fold of probability in regaining continence according to
the Cochrane Review of 13 randomized studies. Bladder management includes micturition and toilet
training as well as pelvic floor exercises taking into account patients’ mobility, motivation, and cognitive
competence. Medical treatment includes anticholinergics and duloxetine. Anticholinergic medications
are a class of drugs that block the neurotransmitter acetylcholine in the central and peripheral nervous
system Propiverine, tolterodine, fesoterodine, and trospium chloride are examples of this class of
medicines, which have a strong affinity for all muscarinic receptor types. M3 receptors are highly
selective for darifenacin and solifenacin. The main symptoms of the hyperactive urinary tract and urge
incontinence are greatly reduced by all available drugs mentioned. Duloxetine is a drug classified as a
selective serotonin/norepinephrine reuptake inhibitor and antidepressant but according to (Mark
Goepel, 2010) it has been a licensed drug to treat urinary incontinence. The number of incidents of
incontinence was reduced by more than half when duloxetine 240 mg was taken daily. The triggering of
motor neurons in the pudendal nerve, which begins in the sacral Onuf's nucleus, is the mechanism of
action. Duloxetine improves sphincter contractility without interfering with the bladder's and urethra's
synchronized function. Prostate therapy, depot injection, open or laparoscopic colposuspension, and
urethral sling suspension are among surgical options for urine incontinence. Prostate therapy, depots
injectable, advanced laparoscopic colposuspension, and urethral sling suspension are among surgical
options for urine incontinence. Urinary incontinence causes a tremendous deal of psychological distress,
social problems, and care issues, as well as significant demands on people around them in terms of time
and patience. It is imperative that the people or family who take care of them need to understand this
type of condition for them to be ready and for them to bank a large amount of patience towards these
people.