摘要和感想

The prevalence of urinary incontinence and other lower urinary tract symptoms (LUTS) increases in association with increasing age. This effect is more noticeable in men after the seventh decade of life and, in women, postmenopausally. However, the changes in the lower urinary tract, peripheral nervous system and central nervous system that underpin this observation are both multifactorial and inadequately understood; much debate exists regarding whether these observed changes are pathological or are a part of the ‘normal’ ageing process; with both health professionals and older people often holding the view that incontinence is an expected part of normal ageing. Here we aim to summarize the current level of knowledge regarding the physiological and hormonal changes that take place during the ageing process and discuss whether the occurrence of urinary incontinence or other LUTS in later life better reflect part of the ‘normal’ ageing process or the presence of unaddressed pathology.

在諸多的下尿路症狀中,尿失禁盛行率隨年齡增加。在七十歲以上的男性和停經後的女性尤其明顯。泌尿系統和中樞神經系統的老化都可能引發下尿路症狀的變化。動物實驗顯示,膀胱的肌肉量和神經傳導物質會隨老化而發生改變。隨身體老化，腎臟製造的尿液會漸漸減少，膀胱中的膠原蛋白沉積和不自主的自發性收縮會增加，殘尿量和男性的攝護腺大小會增加，膀胱容量和尿道壓力則會下降。由於六十歲以後，夜間抗利尿激素的分泌會漸漸喪失，因此老年人也較可能出現夜間多尿的問題。功能性核磁共振也顯示大腦關於禁尿控制的部分活性會減少。綜合以上種種原因會引發尿失禁的產生。尿失禁會造成患者的生活不便與困擾，如能進一步了解相關病理機轉，對於後續研究治療方式或許會有助益。