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Chapter 28 - Urinary Incontinence

from Section III - Care of the Elderly by Organ System

Published online by Cambridge University Press:  30 June 2022

By
Theodore M. Johnson ,
Lisa Muirhead  and
Jan Busby-Whitehead
Edited by
Jan Busby-Whitehead ,
Samuel C. Durso ,
Christine Arenson ,
Rebecca Elon ,
Mary H. Palmer  and
William Reichel
Jan Busby-Whitehead
Affiliation:
University of North Carolina, Chapel Hill
Samuel C. Durso
Affiliation:
The Johns Hopkins University, Maryland
Christine Arenson
Affiliation:
Thomas Jefferson University, Philadelphia
Rebecca Elon
Affiliation:
The Johns Hopkins University School of Medicine
Mary H. Palmer
Affiliation:
University of North Carolina, Chapel Hill
William Reichel
Affiliation:
Georgetown University Medical Center
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Summary

Urinary incontinence (UI), the involuntary loss of urine, has a significant psychological, social, and economic impact on quality of life. While not an inevitable part of aging, UI is much more prevalent in older adults and particularly so in those who require assistance with activities of daily living. Patients may be reluctant to discuss UI given the associated stigma and should be asked about it during medical visits. Evaluation begins with a detailed history of the nature, severity, and burden of UI. Maintaining continence requires a complex interaction of cholinergic, adrenergic, and somatic control. A careful, directed physical exam that focuses on the abdomen, urogenital area, perineal skin, mobility, strength, reflexes, and sensation should be performed. An initial evaluation should include a urinalysis and, if renal function or polyuria is expected, blood tests for creatinine, blood urea nitrogen, glucose, and calcium. Major types of UI include urgency, stress, mixed (stress and urgency combined), and overflow UI. Absorbent products can be a useful adjunct to formal health care for helping manage leakage. Treatment modalities for UI include behavioral strategies, medication treatment, and minimally invasive procedures and surgical approaches. Older adults can have symptomatic improvements, or even cure, for this important clinical problem.

Keywords

urinary incontinenceagingpelvic floorphysical therapy modalitiesdrug therapyurologygynecologyquality of lifeactivities of daily livingdelivery of health care
Type
Chapter
Information
Reichel's Care of the Elderly
Clinical Aspects of Aging
 , pp. 350 - 363
Publisher: Cambridge University Press
Print publication year: 2022

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