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Pathophysiology of urinary incontinence in the elderly

Incontinence in the elderly is not a normal condition, but is a predisposing factor for urinary
incontinence. Various anatomical and physiological changes occur in the elderly. These
changes are associated with a decrease in estrogen levels in women and the androgen hormone
in men.

In the bladder wall there is an increase in fibrosis and collagen content, causing contractile
function to be ineffective, and easily forming trabeculation until diverticular. Mucosal atrophy
also occurs, changes in submucosal vascularization, and depletion of the urethral muscle layer,
resulting in decreased urethral closure pressure.

Pelvic floor has an important role in maintaining micturition. Weakening of pelvic floor
function is due to various physiological and pathological factors (trauma, surgery). The basic
physiological features of the pelvis are listed in the table below

Physiologic changes related to aging process in lower urinary tract

Bladder Morphological Changes

• Trabeculation ↑
• Fibrosis ↑
• Autonomic nerves ↓
• Formation of diverticula

Urethral Morphological Changes Physiological Changes

• Capacity ↓
• Ability to hold the tone ↓
• Involuntary contraction ↑
• Residual volume after urination ↑

Urethra Physiological Changes


• Mobile components ↓
• Deposit collagen ↑
• Closure pressure ↓

Prostate Hyperplasia and enlarged.

Vagina • Mobile Component ↓

•Atrophic mucosa

Pelvic floor • Deposit collagen ↑


• The ratio of connective tissue - muscle ↑
• Muscles weaken

Overall changes due to aging process in the urogenital system cause the position of the bladder
prolapse thereby weakening the bladder exit pressure.

Reference: Setiati, siti. 2015. Buku ajar ilmu penyakit dalam “Inkontinensia urine” Jilid III.
Jakarta: interna publishing. Hal.3777