GENITOURINARY FUNCTION

Changes in the bladder occur with the aging process, re­sulting in a possible decline in function. Overall, the smooth muscle and supportive elastic tissue are replaced with fibrous connective tissue. This can cause incomplete bladder emptying and a diminished force of urine stream. Bladder capacity also decreases with age, whereas the fre­quency of urination increases. As elastic tissue and mus­cles weaken, stress incontinence becomes more prevalent.

In aging women, atrophy of perineal structures can cause the urethral meatus to recede along the vaginal wall. Atrophy of other pelvic organs occurs in the aging woman because of diminished estrogen production after meno­pause: vaginal secretions diminish; the vaginal lining is thinner, drier, less elastic, and more easily traumatized; and normal flora are altered. These changes can result in vaginal infections, pruritus, and painful intercourse.³⁷

In aging men, benign prostatic hyperplasia (BPH) is very common. The incidence progressively increases to ap­proximately 80% of men by 80 years of age. The condition often is asymptomatic until approximately 50 years of age. Thereafter, the incidence and severity of symptoms in­crease with age. BPH can cause obstructive symptoms such as urinary hesitancy, diminished force of stream, reten­tion, and postvoid dribbling; it also can cause irritative symptoms such as frequency, nocturia, urgency, and even urge incontinence³⁸ (see Chapter 45).

Sexual activity remains possible into late life for men and women. In general, the duration and intensity of the sexual response cycle is diminished in both sexes. Penile erection takes longer to develop because of changes in neural innervation and vascular supply. Women take longer to experience the physiologic changes of vaginal expan­sion and lubrication during the excitement phase. Social factors affecting sexual behavior include the desire to re­main sexually active, access to a sexually functioning part­ner, and availability of a conducive environment.^39,40

In summary, there is a general decline in the structure and function of the body with advancing age, resulting in a de­creased reserve capacity of the various organ systems, in­cluding the integumentary, musculoskeletal, cardiorespiratory, nervous, sensory, immune, gastrointestinal, and genitourinary systems. This results in a reduction of homeostatic capabilities, making the older adult more vulnerable to stressors such as illness, trauma, surgery, medication administration, and envi­ronmental changes.