Voiding difficulties in the elderly.

Voiding difficulties are more common in the elderly. This occurs because of physiological changes such as replacement of muscle fibres with collagen, from life effect insults such as the effects of childbirth, lead to a reduction in contractility and changes in the nerve supply from cholinergic to NANC fibres lead to a change in sensation leading to a delay in first sensation. Symptoms are often similar to those of overactive bladder and the history in older women should include those of hesitancy and poor flow. Likewise, the diagnosis should be considered in women presenting with recurrent urinary tract infections. A failure to consider voiding difficulties can precipitate a crisis and simple strategies such as teaching self-catheterization and using estrogen cream may prevent problems occurring. When acute problems occur, catheterization is required and a review of precipitating factors may identify medications contributing to the condition. The mainstay for treatment, however, remains draining with an indwelling catheter or clean intermittent clean catheterisation.