Causes of Urinary Incontinence
Temporary incontinence
A number of conditions can cause temporary incontinence, including urinary tract infections, excess fluid intake, constipation, severe depression, and restricted mobility, drugs like alpha–adrenergic, caffeine, sedatives, anti–depressants, anti–psychotics, and anti–histamines.

Stress incontinence
Stress incontinence is caused by poor functioning of the urethra and sphincter muscles. The weakening and stretching of the pelvic floor muscles allows the bladder to sag down within the abdomen. This sagging pulls the bladder neck and changes its angle in relation to the urethra which prevents the internal sphincter from closing completely. In severe cases the sphincter itself may tear. This occurs when urine leaks during exercise, coughing, sneezing, laughing, lifting heavy objects or other body movements that put pressure on the bladder. Women who have had several children through vaginal deliveries are particularly at risk for stress incontinence, because pregnancy and childbirth strain the muscles of the pelvic floor. Hysterectomy, which may damage the pelvic floor muscles, the sphincter itself, or the nerves which make the sphincter muscles to contract, is a common cause of stress incontinence in women. After menopause, the loss of estrogen causes the urethra to thin out so that it may not close properly, thus causing incontinence. Prostate surgery is a leading cause of stress incontinence in men. Both surgery and radiation treatment for prostate cancer commonly cause incontinence.

Urge incontinence
In urge incontinence, the bladder contracts more frequently than normal which can be due to infections, anxiety, the normal aging process, damage to the central nervous system caused by stroke, multiple sclerosis, and Parkinson’s disease causing the bladder to become over–active. An outer layer of muscle fiber, called detrusor muscles, becomes unstable and contracts inappropriately. It can also be a warning signal of early bladder cancer. In men, it is often a sign of an enlarged prostate.

Overflow incontinence
Overflow incontinence is the result of an impediment to the normal flow of urine out of the bladder. It can be caused by tumors, medications, benign prostatic hyperplasia, or scar tissues. Overflow incontinence may also be caused by spinal cord injuries or diseases such as diabetes, and multiple sclerosis which can desensitize the nerves so much so that they fail to sense fullness and don’t trigger off the contraction of the bladder.

Functional incontinence
In functional incontinence, the urinary system is itself normal, but the patient cannot use it properly because of severe physical disorders, such as in Parkinson’s disease, or mental diseases, including Alzheimer’s disease and other forms of dementia, as there is failure in recognition of the need to void and locating a bathroom.
Diagnosis of Urinary Incontinence
The first and most important step in treating bladder control problems is to see a doctor for a complete medical examination. The doctor will ask for a detailed history of your health and put you through a physical examination. The doctor may want to check your urine samples. You may be referred to a urologist, a doctor who specializes in diseases of the urinary tract, or to a gynecologist, a specialist in the female reproductive system.
Treatment of Incontinence

• Behavioral techniques such as pelvic muscle exercises, biofeedback and bladder training can help control urination. These techniques can help you sense your bladder filling and help delay voiding until you can reach a toilet.
• Anticholinergic agents inhibit the involuntary contractions of the bladder, increase its capacity. They are useful in treating urge incontinence.
• Antispasmodic drugs help relax the bladder muscle and are used for urge incontinence.
• Alpha–adrenergic agonists are used to strengthen the smooth muscle that opens and closes the internal sphincter and are most effective in patients with stress incontinence not caused by nerve damage.
• Retropubic suspension is used in stress incontinence to correct the position of the bladder and urethra by sewing the bladder neck and urethra directly to the surrounding pelvic bone or nearby structures.
• For severe stress incontinence, a sling procedure is preferred. The procedure is performed through the vagina and also through a small incision in the abdomen. A piece of body tissue or synthetic material is attached under the urethra and bladder neck, and then secured like a sling to the abdominal wall and pelvic bone. This sling then compresses the urethra back to its original position.
• You can get special absorbent underclothing that is no more bulky than normal underwear and can be worn easily under everyday clothing.

Delirium in Seniors
Delirium is an acute reversible state of confusion which is characterized by changes in consciousness and cognition over a period of time.

Signs and Symptoms of Delirium

• Reduced level of consciousness and alertness.
• Inability to focus, maintain, or shift attention.
• Disorientation.
• Language difficulties.
• Impairments in learning and memory.
• Perceptual disturbances in the form of illusions, delusions, and hallucinations.
• Emotional disturbances in the form of anxiety, fear, irritability, anger, depression.
• Behaviors such as drowsiness, normal wakefulness and agitation may occur within minutes to hours of each other.

Treatment of Delirium
There is increasing evidence that the symptoms of delirium are not transient, but often persist, even with appropriate treatment.

Hormone Replacement Therapy
Hormone replacement therapy is currently prescribed to millions of women. This includes the indications, contraindications, risks and benefits of estrogen replacement therapy.

Indications

• Postmenopausal women for prevention and treatment of osteoporosis.
• To improve cardiovascular health by lowering the risk of myocardial infarctions (heart attacks) and strokes.
• Estrogen replacement therapy can improve the elasticity, moisture and thickness of vaginal, perennial tissues, thus decreasing symptoms of vaginal dryness, dyspareunia (pain during sexual intercourse) and urinary urgency.

Contraindications

• Vaginal bleeding.
• Deep venous thrombosis or pulmonary embolism. (a clot in a blood vessel)
• Breast and uterine cancer.

In general, the ideal way to prescribe HRT is to recommend the lowest dose of estrogen that effectively retards bone loss, improves cardiovascular risk factors, and reduces vasomotor symptoms. The ideal dose of progestin is also used which is enough to protect the endometrium from endometrial hyperplasia and carcinoma, but is low enough to limit the negative effects of progestins on serum lipids.

Side Effects of Hormone Replacement Therapy

• Nausea within the first two months of therapy. This side–effect may be diminished by taking the medication with food, and at bedtime.
• Breast tenderness due to the estrogen component. Lowering the dose may be helpful.
• Migraine headaches.
• Mood swings.
• Abdominal bloating is another common side–effect related to progestins.