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the disease can go undetected because the other kid
ney continues to function adequately. A symptom that
occurs regardless of where the obstruction lies is loin
or flank pain. An enlarged kidney might be palpable
on physical examination. If both kidneys are involved,
anuria and uremia can develop.
■ Diagnosis. Blood tests can show elevated creatinine
and electrolyte imbalance. Diagnosis is confirmed by
pyelogram.
■ Treatment. Treatment involves immediate draining of
the kidney pelvis by surgical intervention and immedi
ate relief of the obstruction.
■ Prevention. The causes of hydronephrosis usually
cannot be prevented. Prompt treatment of conditions
that may lead to hydronephrosis, such as kidney failure,
reduces the risk of complications.
Renal Calculi
■ Description. Renal calculi are commonly called kid
ney stones. These stones are often composed of calcium
salts and other substances. Size, location, and number
of stones can vary (Figure 13-7). Approximately 1 out
of every 11 people in the United States will get a kidney
stone. Urinary stones are more common in men, peo
ple who are obese, and those who have diabetes.
■ Etiology. Cause of stone formation is unknown in
most cases, but some precipitating factors include dehy
dration, chronic urinary tract infection, and immobility
or prolonged bed rest, leading to release of calcium from
the bones. Less commonly, stones are the result of met
abolic disorders such as hyperparathyroidism, severe
bone disease, and gout.
Staghorn calculi are one of the more common types
of stones. These form in the pelvis of the kidney and
can become so large that they fill the entire kidney pel
vis. Calculi commonly form in the kidney, but they also
can form in the urinary bladder. Bladder stones cause
difficulty with emptying the bladder, often leading to
frequent or chronic bladder infections. Individuals can
frequently form small kidney stones that easily pass
through the urinary tract unnoticed, and stones can be
present in the kidney yet cause no problems. It is only
when stones become caught in the ureters or obstruct
the urinary tract that problems and symptoms arise.
■ Symptoms. Typical symptoms of kidney stones are
hematuria and renal or urinary colic. Urinary colic is an
extreme, spasmodic flank pain caused by the contrac
tion of an obstructed ureter. This pain is often described
as “the worst pain I’ve had in my entire life.”
(A)
Ureterolithiasis
Ureter
StaghornZ-
- -calculus
Nephrolithiasis
Cystolithiasis
Bladder
Urethrolithiasis
Urethra
Figure 13-7 (A) Types and location of renal calculi.
(B) Renal calculi—internal view.
■ Diagnosis. Diagnosis is commonly confirmed by
using an IVP. A KUB and renal ultrasound also can be
beneficial for diagnosis.
■ Treatment. Treatment during an acute attack of kid
ney stones includes administering pain medication and
increasing fluid intake with the hope the stone will pass
in the urine. Urine is often strained through a filtering
device in an effort to catch the stone for identification.
Even though stones feel like they should be quite large
to the individual passing them, the ones that are voided
and filtered are usually quite small, ranging in size from
a grain of salt to a small piece of rice.
268 Chapter 13
If the urinary tract is totally obstructed, emergency
surgery must be performed to prevent hydronephrosis
and kidney damage. Surgery called a stone basket pro
cedure can be performed in which a retrieval instru
ment is passed through the urethra, bladder, and ureter
to remove the stone.
Another method is called Extracorporeal Shock
Wave Lithotripsy (ESWL) and is used to break the
stones into pieces for retrieval or in hopes that the
pieces can be passed. This breaking of the stone is called
lithotripsy (litho = stone, tripsy = breaking). During
ESWL, the affected individual is placed on an exam
table on top of a soft water-filled cushion. A lithotrip-
tor emits high energy shock waves that hit and break the
stones into pieces (Figure 13-8).
■ Prevention. Prevention of further stone development
can include medications, correcting any causative meta
bolic conditions, and increasing water intake.
Polycystic Disease
■ Description. Polycystic kidney disease (PKD) causes
massive enlargement of both kidneys due to develop
ment of multiple grape-like cysts (Figure 13-9). These
cysts can cause the kidneys to increase to a weight of 20
or 30 pounds. Polycystic disease is a slow, progressive
disease that affects teenagers and young adults, usually
leading to renal failure by age 30 or 40. There is no cure
for the disease.
■ Etiology. PKD is an inherited disorder. Most com
monly, it is autosomal dominant, meaning if one parent
has the disease, there is a 50% chance that the disease
gene will pass to a child.
Figure 13-9 Polycystic kidney. (A) Exterior view
kidney. (B) Internal view of kidney.
Courtesy of Mark L. Kuss
Figure 13-8 Lithotriptor used to perform ESWL lithotripsy Non-
invasive Extra Corporeal Shock Wave Lithotripsy (ESWL).
of
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Urinary System Diseases and Disorders 269
■ Symptoms. As the disease progresses, kidney tissue
is destroyed and function becomes increasingly paired.
Hypertension generally develops as the kidneys fail.
Symptoms include lumbar pain, hematuria, and recur
rent UTIs.
■ Diagnosis. Diagnosis includes a family and clinical
history. CT scan, especially when combined with dye
infusion, is one of the most sensitive tests available and
confirms the diagnosis.
■ Treatment. Treatment involves management of
hypertension and UTIs. Dialysis and kidney transplant
are often needed for end-stage treatment.
■ Prevention. PKD is an inherited disease and is not
preventable.
Renal Failure
■ Description. Renal failure is the failure of the kidneys
to cleanse the blood of waste products. The primary
method of cleansing the body of waste involves the for
mation of urea in the liver, which the kidneys filter out
of the blood and excrete in urine. When the kidneys
fail, the urea remains in the blood. A high urea level
in the blood is called uremia, meaning, literally, urine
in the blood. Urea is eventually converted to ammonia,
leading to toxicity and related symptoms in all systems
of the body (Figure 13-10).
■ Etiology. Acute renal failure is usually related to
decreased blood flow to the kidneys due to conditions
such as hemorrhagic or surgical shock, embolism,
Nervous System
mental confusion,
drowsiness,
visual disturbances,
convulsion, coma
Digestive System
nausea, vomiting,
diarrhea
Integumentary System
pruritis, dryness, rash
Respiratory System
urine smell to breath
Urinary System
pyuria, hematuria,
glycosuria
Figure 13-10 Areas of the body affected by toxic levels of circulating ammonia.
270 Chapter 13
congestive heart failure, and dehydration. Blockage of
urine flow, caused by tumors, stones, or enlarged pros
tate, also can lead to acute failure. Reversal of acute renal
failure, which involves treating the cause of the failure, is
usually quite successful. Dialysis might be needed tem
porarily to remove toxic wastes from the individual’s
blood until kidney function is restored. Individuals in
acute renal failure are placed on a limited diet to allow
the kidneys to rest and regenerate function.
Chronic renal failure occurs slowly and is usually
the result of chronic kidney disease such as glomerulo
nephritis, pyelonephritis, renal hypertension, and PKD.
Long-term substance abuse, alcoholism, and diabetes
also can cause chronic renal failure.
■ Symptoms. Symptoms of renal failure are not signif
icant until approximately 75% of kidney function has
been destroyed. Symptoms can include those of acute
failure and problems of infertility; impotence; and bone
weakness, leading to pain and fractures.
■ Diagnosis. History and physical exam along with
blood testing assist in diagnosis. Elevated blood creat
inine levels along with an elevated BUN are indicative
of kidney failure.
■ Treatment. Treatment includes management of
the related cause of the failure, limiting protein and
sodium in the diet, and monitoring fluid intake and
urine output. Medications can include antihyperten
sives, diuretics, and antibiotics as needed. Dialysis and
kidney transplantation might be options for long-term
treatment.
Dialysis is a procedure that cleanses the blood of
waste products when the kidneys have failed or are
failing to perform this function. There are two types
of dialysis; both require the same components: the
patient’s blood, a semipermeable membrane, and a
washing or dialyzing solution. In both types of dialy
sis, the waste products in the individual’s blood pass
through the semipermeable membrane by diffusion to
enter the dialyzing solution, thus cleansing the blood.
The most common type of dialysis is hemodialysis
(Figure 13-11). During hemodialysis, the individual’s
blood is routed out of an artery (usually the brachial or
radial artery) and through an artificial kidney machine,
or hemodialyzer, which mechanically cleans the blood.
This machine is filled with semipermeable, cello
phane-like material and dialyzing solution. As blood
passes through the machine, the waste products diffuse
through the membrane into the dialyzing solution to
cleanse the blood. The clean blood reenters the patient
through a venous access.
Figure 13-11 Hemodialysis unit.
Courtesy of Mark L. Kuss
One common problem with hemodialysis is main
taining vascular access. Vascular access is usually in
the arm, but may also be in the thigh. Access many be
accomplished in two ways. For shorter-term dialysis,
an arteriovenous (AV) shunt may be created by con
necting an artery to a vein with a synthetic graft. The
graft material is tough and can tolerate multiple needle
sticks (Figure 13-12). Complications of an AV shunt
include infection and clotting.
For longer-term dialysis, an arteriovenous fistula
may be created by surgically connecting a vein and an
artery. A fistula provides an access with good blood
flow, has a lower risk of infection, and is considered
the “gold standard” in hemodialysis access.
The other type of dialysis is peritoneal dialysis. This
procedure involves performing a paracentesis to instill
dialyzing solution into the peritoneal cavity. This type
of dialysis uses the membrane that lines the peritoneal
cavity to act as the semipermeable membrane. The dia
lyzing solution is allowed to stay in the abdomen for
varying amounts of time (dwell time), during which
waste products diffuse out of the peritoneal capillaries
and into the dialyzing solution. Solution is then drained
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Urinary System Diseases and Disorders
271
Blood from dialysis
machine
Vein
Artery
Blood to dialysis
machine
Graft
(A)
Figure 13-12 Hemodialysis. (A) Arteriovenous vein graft
shunt. (B) Arteriovenous fistula.
and disposed of. Peritoneal dialysis can be performed
by several methods such as the following:
■ Continuous ambulatory peritoneal dialysis
(CAPD) is a self-dialysis that does not use a machine.
Solution drains by gravity into and out of the perito
neal cavity by way of a permanently connected cath
eter into a bag worn around the individual’s waist.
CAPD is performed several times a day and usually
once at night (Figure 13-13).
Peritoneal
dialysis
solution
Peritoneal
cavity
(A)
Transfer set
Figure 13-13 Continuous ambulatory peritoneal dialy
sis. (A) Infusion of solution. (B) Empty solution container
is rolled up and hidden under clothing.
■ Continuous cycling peritoneal dialysis (CCPD)
uses a cycling machine and proceeds while the indi
vidual sleeps.
■ Intermittent peritoneal dialysis (IPD) is performed
several times a week, usually in a medical clinic.
Hemodialysis is a much faster and more efficient
process than peritoneal dialysis, but it is also much
more expensive and more time-consuming. Also, access
to an artificial kidney machine might be limited to large
metropolitan areas.
Renal transplantation is a procedure to transplant
a kidney of a donor into a recipient. This is a relatively
Chapter 13
simple surgical procedure performed on individuals
with chronic renal failure commonly due to diabetes,
hypertension, and glomerulonephritis.
Best results from kidney transplants are obtained
when the donor and recipient are close human leuko
cyte antigen (HLA) matches or are histocompatible.
An identical twin provides the greatest probability of
match, with a fraternal twin, sibling, parent, and bio
logical child the next best matches, in that descending
order. The greatest problems with renal transplant are
obtaining a kidney that is histocompatible with the
recipient and dealing with postoperative organ rejec
tion and complications with lifelong administration of
immunosuppressant medications.
■ Prevention. Some causes of kidney failure might not be
preventable. Controlling risk factors and conditions that
cause kidney failure is the best preventive method. Because
kidney disease is often caused by hypertension and dia
betes, keeping these under control is important. Other
preventive activities include not smoking, maintaining a
healthy weight, eating healthy, and exercising regularly.
Adenocarcinoma of the Kidney
■ Description. Cancer of the kidney is relatively uncom
mon. When it does occur, the most common type is
renal cell carcinoma or renal cell adenocarcinoma
(Figure 13-14). These tumors are more common in
men than in women and usually affect men 55 years of
age or older.
Figure 13-14 Adenocarcinoma of the kidney.
■ Etiology. The cause of this tumor is unknown,
although cigarette smoking is considered to be a risk
factor. Adenocarcinoma of the kidney frequently metas
tasizes to the liver, brain, and bone before symptoms
appear.
■ Symptoms. The most common initial symptom is
painless hematuria. Later, as the tumor increases in size,
the individual experiences flank pain and fever.
■ Diagnosis. A KUB, IVP, CT scan, and biopsy of the
kidney can confirm the diagnosis.
■ Treatment. Treatment, whether metastasis has
occurred or not, is nephrectomy (neh-FRECK-
toh-me; nephr = kidney, ectomy = excision or
removal). If metastasis has occurred, chemotherapy
and radiation also might be employed, but prognosis
varies with the extent of spread. Cure might be possi
ble if no metastasis has occurred, but with metastasis,
prognosis is poor.
■ Prevention. Kidney cancer might not be preventable,
but controlling risk factors by living a healthy lifestyle,
including not smoking, eating more fruits and vegeta
bles, staying active, maintaining normal body weight,
and controlling blood pressure, might be helpful in
prevention.
Diseases of the Bladder
With the exception of incontinence, diseases of the
bladder are relatively uncommon compared to the
many other disorders of the urinary system. However,
incontinence is very common, especially in the older
adult. It can cause many physical and psychological
problems for an individual.
Urinary Incontinence
■ Description. Urinary incontinence is the loss of
control of urine flow. Approximately 13 million peo
ple are affected with incontinence and 85% of them
are women. One out of 10 people age 65 or older are
affected (emedicinehealth, 2019).
■ Etiology. Pregnancy, childbirth, hysterectomy, and
menopause can all affect female continence. Obesity,
in both men and women, may also increase incon
tinence by placing added pressure on the bladder.
Men are also affected by incontinence, but not nearly
as often as women. As men age, the prostate is often
enlarged, leading to urinary dribbling, the inabil
ity to control flow. Prostate surgery also can affect
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Urinary System Diseases and Disorders 273
Herbal Medicine
for Incontinence
Complementary and Alternative Therapy
I
ncontinence is a very common problem in all ages but is often only considered a prob
lem that occurs with aging. It is also often labeled a problem in women only, but it is
almost as common in men. Whether it is stress incontinence or an overactive bladder,
there are a variety of botanicals that have been used to alleviate the bladder problems
without the use of pharmacologic agents. Some of the botanicals that have been success
ful include various mixtures of astragalus, thyme, lavender, hops, equisetum, red clover,
cypress, and agrimonia. There are also other botanicals that have been used alone or
in combinations to relieve incontinence problems. Individuals should be educated by
health care providers about common bladder problems and the potential treatments,
including alternative therapies.
Source: Schepker, K. (2020)
continence. Urinary incontinence in both sexes can
be related to other diseases such as stroke and UTI.
Sleeping pills, antihistamines, muscle relaxants, and
medications to control hypertension also might cause
urinary incontinence.
■ Symptoms. Incontinence affects all areas of an indi
vidual’s life by disrupting sleep, physical activity, travel
plans, and sexual activity. Often, the fear of urinary
accidents drives affected individuals away from social
activity and into a life of seclusion.
There are several types of incontinence. Stress
incontinence is the inability to hold urine when the
bladder is stressed by coughing, sneezing, or laughing.
Urge incontinence occurs with a sudden uncontrollable
urge to empty the bladder. Overflow incontinence is
caused by the bladder not properly emptying and leak
ing when overfilled.
■ Diagnosis. A complete medical history and physical
exam, including a voiding diary, are helpful in diagno
sis. Diagnostic testing can include urinalysis and CBC
to determine any underlying infections. Specialized
urodynamic testing uses cystometry to measure ana
tomic and functional status of the bladder and urethra.
Postvoid residual volumes of the bladder use a urinary
catheter placed into the bladder to measure any urine
remaining in the bladder after voiding. Cystoscopy
might help identify the presence of bladder tumors,
cysts, or foreign bodies.
■ Treatment. Treatment of incontinence depends on
the type of incontinence and may include behavioral
techniques, medication, medical devices, therapeu
tic intervention, and surgery. A combination of these
treatments may be needed. Incontinence can be man
aged by wearing sanitary napkins, incontinence pads,
adult diapers, or waterproof briefs. Men also might use
external appliances to catch the urine.
Behavioral techniques include activities such as
double voiding, scheduled toileting, bladder training,
fluid restriction, and accessory muscle exercise. The
goal of double voiding is to assure complete emptying
of the bladder. One voids, waits a few minutes, and
then tries again. Scheduled toileting involves voiding
every two to four hours instead of waiting for the urge
to urinate. Bladder training consists of emptying the
bladder every hour for 7 to 10 days, and then gradually
increasing the length of time until one is toileting every
three to four hours. Fluid restriction involves reducing
the overall amount of fluids consumed during the day,
not drinking any fluids around bedtime, and avoiding
fluids containing alcohol and caffeine.
Accessory muscle exercise employs frequently
emptying the bladder and exercising the pelvic muscles
and external sphincter to strengthen these structures.
Exercise of these muscles is called Kegel exercise. This
exercise is performed by tightening or contracting the
pelvic muscles as one would do to hold or stop urine
flow. Performing repetitions of 20 to 40 Kegel exercise
several times a day can be quite effective in controlling
some types of stress incontinence (Figure 13-15).
Depending on the cause of the incontinence, medica
tions may be used. Medications may calm an overactive
bladder, treat urge incontinence, relax the bladder neck,
and improve tone in the urethra and vagina. Female stress
incontinence can be improved with estrogen therapy
because low estrogen levels weaken the urethral sphincter.
274 Chapter 13
Urinary bladder
Sphincter muscles
(weak)
Incontinence
(A)
Sphincter muscles
(stronger)
Continence
(B)
Figure 13-15 Kegel exercises: (A) Before
exercises, pel
vic muscles are thin, the sphincter is weak, and the ure
thra cannot close. (B) After exercises (three months), the
muscles are thicker and stronger, closing the sphincter.
Figure 13-16 Collagen injection for incontinence.
Medical devices used to treat women with inconti
nence include a urethral insert and a pessary. A urethral
insert is a small disposable tampon-like device that is
inserted in the urethra to act as a plug to prevent leak
age. A pessary may be used to prevent incontinence due
to a prolapsed bladder or uterus. This small stiff ring is
inserted into the vagina and lifts the bladder to prevent
urine leakage.
Therapeutic interventions include collagen injec
tions, Botox injection, and nerve stimulation. Collagen
injection involves injecting collagen near the external
sphincter to narrow the urethra (Figure 13-16). Botox
injections into the bladder muscle may benefit people
who have an overactive bladder. Nerve stimulators
resemble a small pacemaker and may be implanted
under the skin of the buttocks to deliver painless elec
trical pulses to the sacral nerves which are involved in
bladder control.
If other treatments are not effective, surgery may be
needed. Surgery is usually a last alternative because it is
quite expensive. Urinary incontinence surgeries include
sling procedure, bladder neck suspension, and artificial
urinary sphincter.
The sling procedure is often completed laparo
scopically and involves using tissue, mesh, or sutures
to develop a “sling or hammock” under the urethra or
bladder neck. The bladder neck is an area of thickened
muscle where the urethra connects to the bladder. This
sling attaches to pelvic tissue or the abdominal wall and
supports the urethra to help keep it closed.
Bladder neck suspension requires an open incision
and general anesthesia. This surgery reinforces the
bladder neck so it does not sag and lead to urine leak
age. In this type of surgery, sutures are placed in the
tissue near the bladder neck and secured in a ligament
of the pubic bone (Burch procedure) or secured in the
cartilage of the pubic bone (Marshall-Marchetti-Krantz
[MMK] procedure).
Surgery to insert an artificial urinary sphincter
may be necessary to treat males with incontinence
often related to prostate surgery or prostate cancer. A
small fluid-filled ring (artificial sphincter) is implanted
around the bladder neck to hold the urinary sphinc
ter closed. In order to urinate, the male presses a valve
implanted under the skin that deflates the ring and
allows urine flow.
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Urinary System Diseases and Disorders 275
■ Prevention. Incontinence is not always preventable.
Decreasing risk involves maintaining a healthy weight,
not smoking, avoiding bladder irritants such as coffee
and alcohol, eating more fiber, and remaining physically
active.
Consider This...
The average adult goes to the restroom to
urinate about six times a day.
Transitional Cell Carcinoma of the Bladder
■ Description. Bladder cancer is the most common
neoplasm of the urinary tract. It usually occurs in
men after age 60 and is more common in men than
in women. Transitional cell carcinoma arises from
the lining of the bladder. Bladder cancer commonly
metastasizes before symptoms appear, making it highly
malignant (Figure 13-17).
■ Etiology. The cause of these tumors is unknown.
The most important risk factor is cigarette smoking,
which increases the chance of cancer proportionate to
the number of cigarettes smoked during the life of the
affected individual. Other predisposing factors include
exposure to industrial chemicals and chronic cystitis.
■ Symptoms. Symptoms include hematuria, dysuria,
and nocturia, but these symptoms do not usually appear
until late in the course of the disease.
Figure 13-17 Bladder cancer.
■ Diagnosis. Diagnosis can be confirmed by cystos
copy and biopsy.
■ Treatment. Treatment depends on the stage of
the tumor. Transurethral resection (TUR) (trans
= through, urethral = urethra; resection = partial
excision) can be performed to remove the tumor, or,
more frequently, a radical (radical = a treatment that
seeks to cure; aggressive, not palliative or conserva
tive) cystectomy (sis-TECT-toh-me; cyst = bladder,
ectomy = excision or removal) is performed. If metas
tasis has occurred, radiation and chemotherapy also
might be used. Prognosis depends on the stage of the
tumor when discovered. Usually, discovery is late in the
course of the disease, and prognosis is poor.
■ Prevention. Prevention consists of not smoking,
avoiding exposure to industrial chemicals, and promptly
treating cystitis.
Trauma
Straddle Injuries
Straddle injuries commonly cause injury to the urethra.
This type of injury occurs when an individual acciden
tally falls in a straddling position. These injuries are
more common in males. Instances when straddle inju
ries can occur include walking a fence or roof beam or,
in some cases, riding a horse or motorcycle. Treatment
varies, depending on the severity of the injury.
Neurogenic Bladder
■ Description. Neurogenic bladder is dysfunction of the
bladder due to some type of injury to the nervous sys
tem supplying the urinary tract or bladder.
■ Etiology. A common trauma that causes neurogenic
bladder is a spinal cord injury such as those sustained in
motor vehicle accidents or diving accidents. Other trau
matic causes include cerebrovascular accidents, strokes,
tumors, and herniated lumbar disks. Diabetes, demen
tia, and Parkinson’s disease are metabolic disorders that
often lead to neurogenic bladder.
■ Symptoms. Symptoms of neurogenic bladder vary,
depending on the nerves involved. Individuals might
have no feeling of the need to void, or they might feel
like they need to void all the time. Other symptoms are
mild to severe urinary incontinence, difficulty or inabil
ity to empty the bladder, and bladder spasms.
276 Chapter 13
■ Diagnosis. Neurogenic bladder is difficult to diag
nose. A detailed history, physical and neurologic exam
inations, and a series of urologic studies might be
needed to confirm a diagnosis.
■ Treatment. Treatment goals are aimed at prevention
of UTIs and controlling incontinence. Indwelling uri
nary catheters can control incontinence. Intermittent
self-catheterization can be taught to individuals unable
to empty the bladder to prevent hydronephrosis and
possible renal failure.
The prognosis of neurogenic bladder depends on
the possibility of reversing the nerve damage. Herniated
lumbar disks that cause neurogenic bladder are com
monly repaired and rapidly restore bladder function.
If nerve damage is permanent, neurogenic bladder will
also be permanent.
■ Prevention. Neurogenic bladder, in many cases, is not
preventable. In other cases, prevention is aimed at rapid
diagnosis and treatment of the cause.
Rare Diseases
Goodpasture Syndrome
Goodpasture syndrome is an autoimmune disorder
characterized by glomerulonephritis and pulmonary
hemorrhage. For some unknown reason, the body’s own
antibodies attack the membranes of the kidneys and
lungs, leading to symptoms of hemoptysis (he-MOP-tih-
sis; hemo = blood, ptysis = saliva), or coughing or spitting
up blood; dyspnea (dys = difficulty, pnea = breathing);
chest pain; and anemia. Good-pasture syndrome usually
results in renal failure and, ultimately, death.
Interstitial Cystitis
Interstitial cystitis is a chronic nonbacterial cystitis due
to inflammation of the inner lining of the bladder. Typ
ically, this disease affects young women and is thought
to be autoimmune in nature.
The inflammation and swelling of the inner lining
of the bladder decrease the capacity of the bladder, lead
ing to the need to urinate frequently. Often, the lining
is ulcerated, leading to hematuria. Other symptoms
include pain above the pubic area and lower abdomen,
bladder fullness, and urgency.
Treatment includes instillation of liquid medica
tions into the bladder to distend the bladder and treat
the disorder. Treatment can be needed for up to 12
weeks, but response to treatment is generally good.
Effects of Aging on the System
The most common problem of the urinary system in the
older adult is urinary incontinence. It is frequently due to
changes in other body systems in the aging process rather
than to the urinary system. Because the urinary elimina
tion process is primarily controlled by the nervous system,
changes with aging or diseases of this system can affect
the individual’s ability to control urine flow. Individuals
with Alzheimer’s disease, brain tumor, or other disorders
of the nervous system might not be aware of the urge to
urinate or be able to communicate the need to urinate.
In older men, benign prostatic hypertrophy is a
common disorder that often causes urinary frequency,
dribbling, pain or burning with urination, and difficulty
starting the urine flow. In older women, the changes in
estrogen levels can cause a decrease in vaginal muscle
tone and, along with the changes in structure, cause
increased frequency and some urine incontinence.
Changes in lower abdomen muscle tone, usually the
result of multiple pregnancies or obesity, also contrib
ute to some urinary incontinence in older women. (See
Chapter 17, “Reproductive System Diseases and Disor
ders,” for more information on changes in the female
and male reproductive systems.)
Older individuals with other common system dis
orders such as stroke or severe circulatory impairment
might not feel the urge to urinate and, thus, have urinary
incontinence. Chronic UTIs also can affect bladder func
tion so that the result over time is urinary incontinence.
Urinary problems in the older adult might not be due
to the aging process at all, however, but to many other
events occurring in the individual’s life. For instance,
fecal impactions that are common in the institutional
ized older individual also can cause urinary incontinence.
Some medications can cause changes in the ability
of the bladder to empty thoroughly, causing overflow
incontinence. Many older adults take medications such
as antidepressants, narcotic pain relievers, or cardiac
drugs that can cause some urinary retention, eventually
resulting in incontinence.
Older adults who have mobility problems fre
quently have urinary incontinence. Individuals who
have some difficulty rising from a chair or bed, or who
walk slowly, often have periods of incontinence simply
because they cannot get to the restroom in time. Lack
of mobility causes the individual to be dependent on
others for toileting, and this frequently leads to urinary
incontinence problems. This is a common problem for
the older adult living in residential care facilities.
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