From the Guidelines
The elderly man's urinary incontinence is most likely caused by a combination of factors, including his congestive heart failure treatment, particularly diuretics, and potential functional incontinence due to mobility limitations. To address this issue, the patient's medication regimen should be reviewed, and adjustments made as necessary, such as taking diuretics like furosemide (20-80mg daily) or spironolactone (25-50mg daily) earlier in the day rather than evening 1. A urinalysis should be performed to rule out a urinary tract infection, which is common in elderly patients after hospitalization. The patient should also be assessed for functional incontinence, and practical interventions such as ensuring clear pathways to the bathroom, adequate lighting, and scheduled toileting every 2-3 hours during the day should be implemented. Some key points to consider in the management of this patient's urinary incontinence include:
- Reviewing the patient's medication regimen and adjusting as necessary to minimize the risk of urinary incontinence 1
- Assessing the patient for functional incontinence and implementing practical interventions to address mobility limitations
- Performing a urinalysis to rule out a urinary tract infection
- Considering the use of pelvic floor exercises (Kegel exercises) to help strengthen urinary control
- Using absorbent products temporarily while addressing the underlying causes of incontinence. It is essential to address the patient's urinary incontinence promptly to improve his quality of life and prevent potential complications such as skin irritation and falls.
From the Research
Causes of Urinary Incontinence in CHF Patients
The cause of urinary incontinence in an 83-year-old man with a history of congestive heart failure (CHF) can be attributed to several factors, including:
- Worsening heart failure pathophysiology 2
- Medications used to treat heart failure, such as diuretics, angiotensin-converting enzyme (ACE) inhibitors, and β-blockers, which can indirectly provoke or exacerbate urinary symptoms 2, 3
- High doses of furosemide (>20 mg daily) 3
- Low doses of beta-blockers 3
Mechanisms of Urinary Incontinence in CHF Patients
The mechanisms by which heart failure medications aggravate lower urinary tract symptoms are discussed in the literature 2. These include:
- Diuretics, which can increase urine production and lead to urinary incontinence
- ACE inhibitors, which can cause a decrease in blood pressure and lead to a decrease in renal function, resulting in urinary incontinence
- β-blockers, which can cause a decrease in cardiac output and lead to a decrease in renal function, resulting in urinary incontinence
Management of Urinary Incontinence in CHF Patients
Management of urinary incontinence in CHF patients can be achieved through:
- Titrating diuretics to minimize their adverse effects on urinary symptoms 2
- Switching ACE inhibitors to minimize their adverse effects on urinary symptoms 2
- Treating lower urinary tract infections to prevent exacerbation of urinary incontinence 2
- Appropriate fluid management to prevent fluid overload and exacerbation of urinary incontinence 2, 4
- Daily weighing to monitor fluid status and adjust diuretic therapy accordingly 2
- Uptake of pelvic floor muscle exercises to improve urinary continence 2