Dedicated to Change in the Delivery of Health Care


In a prior lesson I discussed constipation. For a lot of seniors continence may be a bigger problem.

If you take medicine for dementia you may experience bladder and bowel urgency and incontinence. Medicines such as Aricept and Namenda are called cholinergic (ko-lin-urge-ik) drugs because they stimulate certain nerve endings. When those nerve endings are stimulated intestinal and urine bladder activity increase. You feel the urge or need to have a bowel movement or empty your bladder. The best treatment is pre-emptive. Get in the habit of going to the bathroom on a schedule - say every four hours - even though you may not have the urge to go. This may prevent the sudden urge to go and, not being near a bathroom, avoid sudden incontinence.

What about urine urgency diagnosed as overactive bladder, a catchy phrase invented by the pharmaceutical manufacturers.

As we age our anatomy changes. Things seem to sag or fall. The anatomic relationship between the bladder and colon or rectum changes. They become closer together. When the rectum is full, pressure is exerted on the bladder, giving you the urge to empty your bladder. The key to at least improve that sense of sudden urgency to empty your bladder is to be sure your rectum is empty by having a bowel movement. If the sense of urgency seems to suddenly become worse with a more and more frequent need to pass urine a full rectum may be the cause. Try a dose of a laxative to see if the urine urgency improves. If the urge lessens you will know what to do when it worsens.

If you seek advice from your doctor about overactive bladder she may prescribe a medication that relaxes the bladder, allowing it to hold more. The medication is an anti-cholinergic (see above). Anticholinergics may impair cognition and are not recommended for seniors.

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