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ESSENTIALS OF DIAGNOSIS
Urinary incontinence is the involuntary loss of any amount of urine.
Urinary incontinence is a syndrome caused by medical conditions, medications, lower urinary tract disease and dysfunction, or functional and cognitive impairment, often in combination.
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Older women and men are more likely to experience urinary incontinence (UI) than younger adults; however, it is not an inevitable product of aging. Approximately 15% to 30% of community-dwelling older adults experience some urinary leakage. The prevalence is nearly 50% in frail community dwellers and between 50% and 75% in nursing home residents. UI occurs more frequently in women than in men in most age groups, but the prevalence of UI increases with age in both men and women. Leading risk factors for UI in older adults include increasing age, female sex, cognitive impairment, genitourinary surgery, obesity, and impaired mobility.
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Patients often do not report UI because of embarrassment, the misconception that it is a normal part of aging, or a lack of knowledge of potential treatment options, and clinicians rarely ask about it. Less than 20% of incontinent adults are assessed for this condition by primary care providers. The reasons cited for lack of inquiry are time constraints, underappreciation of the prevalence, and uncertainty about the management.
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The financial impact of incontinence is substantial. Contemporary direct cost estimates of UI are hard to find. The best available cost data are over 20 years old, and in 1995 dollars, the annual direct cost was estimated to be over $16 billion in the United States. These costs include continence supplies, diagnostic evaluation, medical and surgical treatment, and complications. Based on the growth of the geriatric population and the prevalence of UI, the cost in current dollars is likely to be substantially greater.
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UI has long been classified as a geriatric syndrome: a symptom complex found more frequently in older adults that is often multifactorial in etiology and that requires a multidimensional approach to risk factor modification and treatment. To understand how to prevent, diagnose, and treat the condition accurately, it is important to understand the normal physiology of voiding and how normal voiding can be disrupted.
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To maintain continence, a person must have intact cognitive, neurologic, muscular, and urologic systems. Consciousness, motivation, comprehension, and attention are needed to properly recognize the need to void and sequence the necessary steps to pass urine in an appropriate time and location. Diseases such as dementia, depression, stroke, and delirium can disrupt the cognitive function needed to exert control over voiding. Muscular dexterity is needed to manipulate clothing and toileting supplies and to physically reach a toilet or urinal. Arthritis and muscular conditions, which impair ambulation and joint functioning, can result in incontinence episodes.
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Neurologically, micturition is a coordinated balance between the spinal cord sympathetic ...