Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 70

In the bladder, the detrusor muscle collagen content and nerve endings increase with age. Both striated and smooth muscle density in the bladder wall decrease.⁶⁵ M₃ muscarinic receptor stimuli by acetylcholine cause contractions in the detrusor muscle, which is controlled by parasympathetic nerves. This mechanism is diminished with age, resulting in less contractility of the detrusor muscle. Sensorial nerve endings remain the same in older adults.⁶⁶ However, sensorial centres in the brain cortex, which check bladder filling, have diminished activity. In addition, the frontal cortex for processing sensorial input and executing decisions for voiding is impaired with cognitive decline. Also, white matter lesions from microinfarcts may interfere with sensorial input transfer to cortical areas. All of these mechanisms play a role in incontinence in geriatric populations.⁶⁷

Symptoms related to the lower urinary tract (LUT) include irritability, incontinence, and retention or a feeling of obstruction. The prevalence of these symptoms increases with age; 19% of women and 8% of men older than 65 complain of LUT symptoms.⁶⁸