Update in office management
Office Management of Geriatric Urinary Incontinence

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Abstract

Urinary incontinence is a common and potentially disabling condition affecting 15% to 30% of those aged 65 years and older. It adversely affects physical health, psychological well-being, and health care costs. Even when it is not curable, proper management of urinary incontinence can lead to improved quality of life for patients and caregivers. Despite its prevalence, many geriatric patients suffering from urinary incontinence are undiagnosed and untreated. Patients often do not report the problem, and health care professionals often do not ask about it. Health care professionals should therefore learn to identify, evaluate, and manage urinary incontinence based upon the available evidence and practice guidelines. Although the evidence base for specific recommendations for the office evaluation and management of geriatric urinary incontinence is limited, a basic evaluation to identify treatable causes of incontinence, referral of appropriate patients for further evaluation, and several noninvasive management strategies can greatly improve these symptoms in many older patients.

Section snippets

Pathogenesis of Urinary Incontinence

Normal urination requires the coordination of several physiological processes. Somatic and autonomic nerves carry information on bladder volume to the spinal cord and motor output is adjusted accordingly. The cerebral cortex exerts a predominantly inhibitory influence while the brain stem facilitates urination by coordinating urethral sphincter relaxation and detrusor contraction.5, 6 As the bladder fills, sympathetic tone contributes to closure of the bladder neck and relaxation of the dome of

Clinical Presentation

There are 2 basic categories of urinary incontinence: acute or “transient” and chronic. Chronic urinary incontinence is further classified as stress, urge, mixed, overflow, and functional types. This classification does not include all of the possible etiologies but is helpful in evaluating and treating this condition in office practice.

Office Evaluation of Incontinence in Older Patients

Many older patients who are bothered by urinary incontinence do not spontaneously complain about it. Thus, screening questions should be used to identify this condition. Simple questions included in a review of systems can be helpful, such as: “Do you have trouble with your bladder?” “Do you lose urine when you do not want to?” “Do you wear pads or adult diapers for protection?”1, 6

Once urinary incontinence has been identified, the main goals of office management are to diagnose and treat

General Principles

There are several therapeutic options available for managing urinary incontinence in older patients. Table 3 outlines the primary treatments for the basic types of chronic incontinence. Treatment decisions should be individualized and will depend on the findings of the basic evaluation and preferences of the patient and the health care provider.

Supportive measures can be helpful in managing urinary incontinence and should be used with other, more specific treatment measures. Education about

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