Defined as the complaint of any involuntary leakage of urine, urinary incontinence is a common and bothersome condition in elderly persons. The prevalence of incontinence increases with age and with increasing frailty, and is 1.3 to 2.0 times greater in older women than in older men. Among community-dwelling older women, the prevalence of any urinary incontinence is approximately 35%; among older men, it is approximately 22%. The prevalence of daily urinary incontinence in older community-dwelling persons is approximately 12% for women and 5% for men. The prevalence approaches 60% among nursing home residents. Incontinence ranges in severity from occasional episodes of dribbling small amounts of urine to continuous urine leakage with concomitant fecal incontinence. In addition, many older people who do not “leak urine” still may have bothersome lower urinary tract symptoms such as urgency, frequency, and nocturia that require changes in lifestyle and/or the use of pads.
Physical health, psychological well-being, social status, and the costs of health care can all be adversely affected by incontinence. Urinary incontinence can be cured or greatly improved, especially in those who have adequate mobility and mental functioning. Even when not curable, incontinence can always be managed to allow for more patient comfort, make life easier for caregivers, and minimize costs of caring for the condition. Because many elderly patients are embarrassed to discuss their incontinence and may not be aware that treatment is available, it is essential for specific questions about incontinence to be included in periodic assessments and for incontinence to be noted as a problem (Table 59-1). This chapter briefly reviews the pathophysiology of incontinence in older persons and provides detailed information on the evaluation and management of this condition.
Table 59-1 Asking About Urinary Incontinence ||Download (.pdf)
Table 59-1 Asking About Urinary Incontinence
Questions about incontinence should be open-ended and phrased in language easily understood by the patient:
“Tell me about any problems you are having with your bladder?”
“Tell me about any trouble you are having holding your urine (water)?”
If the responses to the above questions are negative, following up with questions may be helpful:
“How often do you lose urine when you don't want to?”
“How often do you wear a pad or other protective device to prevent urinary accidents?”
Continence requires effective functioning of the lower urinary tract, adequate cognitive and physical functioning, motivation, and an appropriate environment (Table 59-2). Anatomic and physiologic aspects of the lower urinary tract, as well as functional, psychological, and environmental factors, contribute to the pathophysiology of incontinence in older persons. Normal urination is a complex process; the neurophysiology ...