Urinary incontinence in the elderly: part 3 of a series of articles on incontinence

Abstract

Background: Urinary incontinence is a common and distressing complaint in the elderly. Its causes include structural changes in vesical muscle as well as impaired neural control and age-related changes of the lower urinary tract. Incontinence can also be a side effect of medication.

Methods: The PubMed database was selectively searched for publications containing the terms "urinary incontinence" and "elderly." Studies with a high level of evidence were chosen as the main basis for this review.

Results: The individualized diagnostic evaluation of the incontinent elderly patient should generally be non-invasive. The evaluation may reveal urinary incontinence of several different types: stress incontinence, overactive bladder, and mixed incontinence. The treatment generally involves medication, such as anti-muscarinic agents, alpha-receptor blockers, and/or serotonin/noradrenalin reuptake inhibitors, combined with modifications of personal behavior, such as bladder training, altered fluid intake, and pelvic floor contraction. A number of minimally invasive surgical techniques can be useful for patients in operable condition, whenever such an operation seems reasonable in view of the patient's overall situation.

Conclusion: Urinary incontinence in the elderly can be readily evaluated, and the currently available forms of treatment often bring satisfactory relief with an economical use of medical resources and with little or no additional discomfort for the patient.

Figure 1

Main effects of licensed anticholinergic substances, shown by respective licensing study a) Frequency of micturition, b) Frequency of incontinence episodes. From: Goepel M, Steinwachs KC: Wie beeinflussen Medikamente zur Therapie der Harninkontinenz die Gehirnfunktion beim älteren Menschen, Der Urologe A 2007; 46 (4): 387–92. With permission from Springer. ER = extended release; TDS = transdermal delivery system

Figure 2

Side effects of licensed anticholinergic substances, shown by respective licensing study a) Dryness of mouth, b) Constipation. From: Goepel M, Steinwachs KC: Wie beeinflussen Medikamente zur Therapie der Harninkontinenz die Gehirnfunktion beim älteren Menschen, Der Urologe A 2007; 46 (4): 387–92. With permission from Springer. ER = extended release; TDS = transdermal delivery system

Figure 3

Prevalence of urinary tract symptoms in the general population relative to people’s age, modified from (2)