Changes in the nervous system and their effects on urinary incontinence

Changes in the nervous system and their effects on urinary incontinence

The nervous system plays a central role in bladder control. Age-related changes in the nervous system can impair the ability to properly control the bladder and contribute to the development of urinary incontinence. This section describes the mechanisms by which the nervous system influences bladder function, the effects of age-related changes, and possible treatment approaches.

Mechanisms of bladder control by the nervous system

1. Central nervous system (CNS):

   • The brain and spinal cord control the conscious and unconscious control of bladder emptying.
   • The micturition center in the brain and the pontine micturition center coordinate bladder contraction and relaxation of the urethral sphincter.

2. Peripheral nervous system (PNS):

   • The peripheral nervous system, especially the sacral nerves, transmits signals from the brain to the bladder and back.
   • Sensory nerves report the bladder fill level to the brain, while motor nerves control the bladder muscles and sphincter.

Age-related changes in the nervous system

1. Degeneration of nerve cells:

   • With age, the number of nerve cells decreases, which can slow or disrupt signal transmission between the brain and bladder.
   • This leads to reduced sensitivity and delayed reactions to bladder filling and emptying.

2. Reduced neurotransmitter production:

   • The production of neurotransmitters necessary for signal transmission decreases with age, which impairs communication between the nerves and the bladder.

3. Impairment of the reflex arcs:

   • Age-related changes can disrupt the reflex arcs responsible for automatic bladder control, leading to uncontrolled urination.

4. Neurological diseases:

   • Diseases such as Parkinson's disease, multiple sclerosis, stroke and diabetic neuropathy, which are more common in old age, can directly affect the nerves that control the bladder.

Effects on bladder function

1. Overactive bladder (urge incontinence):

   • Disrupted nerve communication can lead to an overactive bladder, in which the bladder contracts spontaneously and frequently, resulting in sudden and strong urges to urinate.

2. Bladder emptying disorders:

   • Difficulty coordinating bladder contraction and sphincter relaxation can lead to incomplete bladder emptying and overflow incontinence.

3. Reduced bladder sensitivity:

   • Reduced sensitivity can lead to affected individuals not feeling the urge to urinate until the bladder is almost full, which increases the risk of incontinence.

4. Reflex incontinence:

   • Disturbances in the reflex arcs can lead to involuntary bladder emptying, regardless of the bladder's fullness level.

Treatment options

1. Drug therapy:

   • Anticholinergics: These medications relax the bladder muscles and increase bladder capacity, which relieves the symptoms of an overactive bladder.
   • Beta-3 adrenoceptor agonists: These medications help relax the bladder and increase its capacity.
   • Botulinum toxin injections: Botulinum toxin can be injected directly into the bladder muscles to reduce overactive bladder contractions.

2. Bladder training and behavioral therapy:

   • Bladder training: Patients learn to control the urge to urinate and gradually increase the time between visits to the toilet.
   • Biofeedback: This method helps patients improve control of the pelvic floor muscles by receiving visual or auditory feedback about muscle activity.

3. Physiotherapy:

   • Pelvic floor exercises: Exercises to strengthen the pelvic floor muscles can improve bladder support and increase control over urination.

4. Neuromodulation:

   • Sacral neuromodulation: An implanted device sends electrical impulses to the sacral nerves to improve bladder control.
   • Tibial nerve stimulation: External electrical stimulation of the tibial nerve can regulate bladder function.

5. Lifestyle changes:

   • Fluid management: Drink enough, but not excessively, to avoid overloading the bladder and to regulate urination.
   • Dietary adjustments: Avoid bladder irritants such as caffeine, alcohol and spicy spices.
   • Weight control: A healthy body weight reduces pressure on the bladder and can relieve incontinence symptoms.

conclusion

Age-related changes in the nervous system can contribute significantly to the development of urinary incontinence. A thorough understanding of these changes is crucial for developing appropriate treatment strategies. A combination of medication, bladder training, physical therapy, neuromodulation, and lifestyle changes can alleviate symptoms and improve the quality of life of those affected. Early diagnosis and treatment are crucial to maintaining bladder function and preventing complications.