An intact cognition is important to perceive the sensation of bladder fullness with the ability to postpone micturition after the first sensation, motivation and desire to pass urine, sufficient mobility and coordination to reach the toilet with hand dexterity to manipulate clothing items in order to do so. In addition to the complex neuroanatomical and physiological reflexes to maintain continence, there are other faculties needed to maintain continence. During voiding, urethral sphincter activities ceases first followed by a rise in detrusor contraction and urine flows. The sympathetic system is inhibited during voiding. When the time is right for micturition, the parasympathetic nerves send efferent activating input to the bladder to promote contractions with input to the urethral sphincters causing relaxation of the sphincters. The Frontal Micturition Centre, basal ganglia and the Pontine Micturition Centre actively inhibit detrusor contraction and augment urethral contraction during filling. Micturition is coordinated and triggered through simultaneous activities of the bladder contraction with relaxation of the urethral sphincters via the somatic and autonomic nerves.Īs the bladder fills, the sympathetic innervation promotes bladder wall relaxation and distension with efferent input to the urethral sphincters to cause sphincter contraction. The central nervous system determines the "correct timing" of micturition, taking into account the social and behavioural part of micturition. However, micturition may not be appropriate at all times. The sensation of bladder fullness as it fills ascends via the spinal cord to be conveyed to the Pontine Micturition Centre, which promotes micturition via the parasympathetic supply to the urinary bladder. The parasympathetic nerves originate at S2-S4 and innervate the bladder via the Pelvic and Pudendal nerves. The sympathetic innervation originates at T11-L2, supplying the bladder via the Hypogastric nerve. The bladder is innervated by the autonomic nerves as well as the somatic nerves. This article reviews the common causes of UI among the elderly, especially the elderly with dementia and management strategies for UI among the elderly with dementia. Despite this, the causes of UI among the elderly with dementia are not well studied because of multiple confounding factors like cognitive and physical disabilities. The presence of UI is associated with more severe cognitive impairment and more frequent reports of behavioural symptoms of dementia. UI is also associated with increased risk for pressure ulcers, falls, fractures, increased risk of urinary tract infections and cost. Urinary incontinence among the elderly with dementia is associated with caregiver burden and is a contributing factor for nursing home placement. UI in the elderly is often due to a combination of factors arising from abnormalities of the lower urinary tract and factors not related to the urinary tract. Even though urinary incontinence is a common problem among the elderly, it should not be considered as synonymous with the normal ageing process. Among the elderly with dementia, the prevalence is higher with 22% of the community dwelling elderly and 84% of nursing home residents reported to have UI. It is a common problem among the elderly, estimated to affect about 11-21% of community dwelling elderly in an Italian study and up to 77% of the residents in nursing homes. Urinary Incontinence (UI) is defined as involuntary leakage of urine. Treatment options are limited by the multiple comorbidities, cognitive issues, medication side effects and limited efficacy among this group of frail elderlies.Įlderly, Urinary incontinence, Dementia, Functional incontinence There are many causes for urinary incontinence and among the elderly with dementia, the problem is often not related to abnormalities of the lower urinary tract. The elderly patients with dementia are often challenging to manage, especially if they have urinary incontinence.
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