Urology and Aging

As humans progress through different stages of life, our bodies undergo various physiological changes, and urological health is no exception. The term “urologic diseases” encompasses conditions related to the filtering and carrying of urine out of the body. These diseases can affect people from all walks of life; men, women, and children of all ages. In females, they involve the urinary tract, whereas in males, they affect the urinary tract OR the reproductive organs. 

In this article, however, we will only be looking at urological changes in the elderly as they address the unique needs and challenges associated with aging and also look at some tips to maintain urological wellness in the later stages of life. 

The impact of aging on the urinary system

The anatomy of the urinary system comprises several components such as:

1. kidneys (filter blood to remove waste)
2. ureters (move urine away from the kidneys)
3. bladder (stores and expels urine)
4. urethra (where urine leaves the body)

Etc.

Some of the natural, age-related changes to these organs include:

1. Reduced kidney function -> decreased blood flow and the ability to filter waste
2. Reduced bladder capacity -> weakened muscles and decreased sensitivity
3. Inflamed urethra -> restricts urine flow
4. Enlarged prostate in men -> reduces urine flow 

Experiencing some or all of these issues may then lead to changes in urination patterns.

Overview of some of the most common urological diseases

1. Urinary incontinence

This condition happens when there is a loss of bladder control which subsequently leads to unwanted leakage of urine. There are 3 main types of urinary incontinence, namely:

1. Stress incontinence - happens when pressure on the bladder from coughing, laughing, or exercising causes urine leakage
2. Urge incontinence - when someone urgently needs to urinate and can’t “hold it in”
3. Overflow incontinence - occurs when small amounts of urine leak from a full bladder

Due to the combination of weakened pelvic floor muscles, reduced bladder capacity and changes in the nerve signaling, urinary incontinence incidences increase more and more among older individuals.

2. Urinary Tract Infection (UTI)

UTIs are the result of pathogenic bacteria or viruses invading the urinary tract, causing an infection. A common hallmark of a UTI is a burning sensation felt or pain when urinating. Others include increased urination frequency, and the feeling that the bladder is not completely empty, even after urinating.

Women are generally more susceptible to UTI due to changes in estrogen levels during the menopausal period which leads to thinning of the urethral lining, although men can get them too. Other factors such as weaker immune responses and potential bladder retention issues may also increase the susceptibility to UTIs. 

3. Kidney stones

   Kidney stones are minerals and salt deposits that form inside the kidneys. They can develop anywhere along the urinary tract, but they are most commonly found in the kidneys, hence the name. These stones can block urine flow and removing them out of the body can be very painful, but they typically don’t cause any permanent damage. Many people can still expel small stones from the body without any medical interventions, larger stones on the other hand may result in blockage and medical or surgical procedures may thus be warranted to remove them. Generally, kidney stones do not cause any harm if discovered at an early stage.

Kidney stones usually develop among aging individuals as there are changes in the calcium metabolism and when urine becomes too concentrated, causing crystallization of the minerals. 

4. Benign Prostate Hyperplasia (BPH)

BPH refers to a non-cancerous swelling/enlargement of the prostate in men, which can lead to frequent urination. This enlargement would obstruct urine and flow, therefore causing symptoms such as difficulty starting or stopping urination, more frequent urination, weak urine stream and a feeling of incomplete emptying.

It is a fairly common condition seen in older men, possibly due to an increasing dihydrotestosterone (DHT) within the prostate as they age. While BPH is not considered a serious or life-threatening condition, it can significantly impact a man’s quality of life due to the urinary symptoms it causes, hence early detection such as routine screening is highly encouraged.

5. Pelvic Organ Prolapse (POP)

POP refers to a condition where one or more pelvic organs, such as the bladder, uterus or rectum shift from their normal positions and either bulge or descend into the vaginal or anal canal. Some reasons this may occur include weakened pelvic floor muscles and connective tissues, leading to a loss of support for the organs within the pelvic cavity.

A prolapse is not an emergency or life-threatening but it can cause pain and discomfort. Symptoms can usually be improved with just routine pelvic floor exercises and lifestyle modifications. In severe cases, medical treatment may be needed.

Other urological conditions that we may know of include:

1. Prostate cancer
2. Bladder cancer |
3. Erectile dysfunction
4. Prostatitis (swelling of the prostate)
5. Interstitial prostatitis/ bladder pain syndrome
6. Hematuria (presence of blood in urine)

What are the screening tests for urological conditions?

Symptoms of urological conditions are diverse and can actually mean other underlying diseases. Hence, a comprehensive screening is required to accurately diagnose and treat the condition. Screening is especially crucial for patients presented with persisting, recurring urological conditions as early identification is always key in treating these problems. Screening may include: 

•  Imaging tests such as ultrasound, CT as well as MRI scans 
•  Cystoscope; a long, thin tube with a camera that can be used to see inside the urinary tract and take a sample of tissue for testing 
•  Urinalysis and urine culture to examine for any bacteria or presence of blood
•  Biopsy to check for cancer and other possible disorders 
•  Urodynamic testing that can indicate how fast the urine leaves the body, the volume of urine left behind after urinating and the amount of pressure in the bladder

When to see a urologist?

While all the above symptoms seem common, you may consider making an appointment with an urologist should you have the following symptoms:

• blood in urine
• frequent urge to urinate all the time
• pain in your sides, pelvis or lower back
• pain or burning sensation felt when urinating
• dribbling or weak urine flow
• incontinence
• difficulty urinating

If you are a man, you should also make a visit to the urologist if you: 

• felt a lump in your testicle 
• have issues achieving and maintaining an erection

Tips for a healthier urinary system

To manage urological health effectively as people age, regular medical check-ups, screenings, and discussions with urologists or healthcare providers should be prioritized. Lifestyle modifications, such as staying hydrated, maintaining a healthy diet, engaging in regular exercise, avoiding tobacco as well as excessive alcohol along with pelvic floor exercises (Kegel exercises) can also contribute to better urological health in later years. 

This article is written by Janelle Leong, Bpharm(Hons) (DOC2US),
reviewed by Dr. Muhamad Syaqir bin Shukri, MBBS (DOC2US). 

References

1.  https://www.baptisthealth.com/blog/family-medicine/understanding-how-urological-care-changes-as-we-age
2.  https://www.msdmanuals.com/home/kidney-and-urinary-tract-disorders/biology-of-the-kidneys-and-urinary-tract/effects-of-aging-on-the-urinary-tract 
3.  https://www.healthline.com/health/renal-and-urological-disorders 
4.  https://www.pantai.com.my/urology 

Written By

Janelle Leong, Bpharm(Hons) DOC2US

Reviewed By

Doc2us Medical Board