From the Guidelines
Bladder distention and lack of emptying in elderly women can be caused by a combination of factors, including urinary tract infections, neurological conditions, medications, and age-related changes, as identified in the 2017 guideline by the American Urological Association 1. The causes of bladder distention and incomplete emptying in elderly women are multifaceted.
- Urinary tract infections can irritate the bladder and disrupt normal function, as noted in the 2014 clinical practice guideline from the American College of Physicians 1.
- Neurological conditions like stroke or Parkinson's disease can interfere with nerve signals to the bladder.
- Medications such as anticholinergics, antihistamines, and certain antidepressants can reduce bladder contractility, as mentioned in the 2014 guideline 1.
- Age-related changes in bladder muscle strength and capacity can also contribute to these issues.
- Diabetes can cause nerve damage that affects bladder sensation and function.
- Constipation is another factor, as a full rectum can physically obstruct bladder emptying. Treatment depends on the underlying cause but may include medication adjustments, pelvic floor physical therapy, bladder training exercises, or in some cases, intermittent catheterization to ensure complete emptying, as considered in the 2017 guideline for surgical treatment of female stress urinary incontinence 1. Maintaining adequate hydration, regular toileting schedules, and prompt treatment of urinary tract infections are important preventive measures for elderly women experiencing these symptoms. Identifying and managing conditions that may cause or worsen urinary incontinence, such as urinary tract infections and impaired mental conditions, is crucial, as emphasized in the 2014 guideline 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Causes of Bladder Distention and Lack of Emptying in Elderly Women
- Neurological conditions, such as neurogenic bladder, can lead to incomplete bladder emptying and bladder distention in elderly women 2, 3
- History of back surgery or injury, and pelvic surgery, have been significantly associated with incomplete bladder emptying in older women with overactive bladder symptoms 4
- Underactive bladder (UAB) is a common cause of lower urinary tract dysfunction, characterized by an incompetent detrusor contraction, and can lead to bladder distention and lack of emptying 2
- Detrusor failure is often an underlying factor that complicates interpretation of urinary retention in women, including elderly women 5
- Other causes of urinary retention in elderly women include infective, pharmacological, anatomical, myopathic, and functional factors, as well as Fowler's syndrome 5, 6
Risk Factors and Associations
- Age, vaginal parity, diabetes mellitus, and a history of cerebrovascular accident, back surgery or injury, pelvic surgery, anti-urinary incontinence surgery, and pelvic organ prolapse have been included in univariate and multivariate logistic regression models to determine factors associated with incomplete bladder emptying 4
- Post-void residual (PVR) volume is an important factor in assessing incomplete bladder emptying, and PVR volumes of 100 mL or greater, 150 mL or greater, and 200 mL or greater have been used to classify incomplete bladder emptying 4
Management and Diagnosis
- Evaluation of urinary retention in elderly women should include a comprehensive history and physical examination, post-void residual, and urinalysis, with consideration given to urodynamic testing in select patients 6
- Management of incomplete bladder emptying and bladder distention in elderly women may include intermittent catheterization, antimuscarinic medications, and neuromodulation, as well as reconstructive urological surgery in select patients 2, 3