URINARY

INCONTINENCE IN
THE ELDERLY
Urinary Incontinence
(UI)
• The involuntary loss of urine sufficient
to be a social or health problem

• UI is the involuntary loss of urine that

is objectively demonstrable and a social
or hygienic problem
• Urinary incontinence (UI) is a symptom,
not a specific disease
 Urinary Incontinence (UI)
 UI that is a social or hygienic problem needs treatment
 Leads to pad use, embarrassment , sense of self
 Bathroom mapping, social isolation and depression
 UI has a severe impact on QOL
 Prevalence

• UI is among the 10 most common

chronic conditions in the U.S.
• UI is more common than
hypertension, depression or
diabetes

Prevalence of urinary incontinence by decade of life. Melville JLet al. Urinary

incontinence in US women. Arch Intern Med 2005;165:537–42.
 Prevalence of UI in
elderly
• 15-30% community dwellers, above age 65 but under-reported by 50%
• F>M until age 80 years, then M=F
• 30-35% in acute care hospitals
• 50%+ in nursing homes
 Clinically significant anxiety occurs in
30%-50%
 Clinically significant depression occurs
in 20-30%
 UI imposes a severe burden on caregivers
 UI is the leading cause for admission into
nursing homes
 Fall Risk / Mobility

> 35%
Hip
Nocturia Fall Mortalit
Fracture
y
 Types of Established UI
1. Stress UI
2. Overflow UI
3. Urge UI
4. Functional UI
 1. Stress UI
• “urethral insufficiency”
• Involuntary loss of small amounts with increased intra-
abdominal pressure
 1. Stress UI
• Obesity
• Pelvic floor surgery
• Peripheral (pudendal) neuropathy
• Post-radiation
 2. Overflow UI

• Leakage of small amounts

resulting from mechanical forces
on an over-distended bladder
 2. Overflow UI

• Outlet obstruction
• Anticholinergic meds
• Diabetic neuropathy
 Urge UI

• “detrusor instability”
• Leakage of large amounts due to
inability to delay voiding after a
sensation of fullness
 Urge UI

• Uninhibited cortical stimulation

(CVA, PD, dementia)
• PELVIC FLOOR INFECTIONS
 4. Functional: UI
• Urine loss due to inability to toilet
• Physical restraints, sedatives, diuretics, OA, weakness,
 Exam and Testing
 Urinalysis
 Exam: cough stress test, atrophic vaginitis, post void residual volume
• A PVR urine measurement less than 50 mL is negative for overflow
• 100 to 200 mL is considered indeterminate
• greater than 200 mL is suggestive of over-flow
 UI: Cystometric Findings
Urinary Cystometric Findings
Incontinence
Stress Normal

Overflow Little or no detrusor contractions despite high bladder

volume

Urge Involuntary detrusor contracitons that cannot be

suppressed

Functional Normal
 Medications that cause UI
• Loop Diuretics
• Antipsychotics
• Tricyclic antidepressants
• Alpha adrenergic blockers
• Calcium channel blockers
• ACE inhibitors
• Gabapentin
 Behavioural Treatment
• BLADDER DIARY
• Bladder Training
• Frequent voluntary
voiding
• Pelvic Muscle Exercises
– Kegel
 Rings and Pessaries

Anti-incontinence rings are for treating

SUI
 UI: Primary Treatments

• Stress: Weight loss, surgery, Kegel’s, -adrenergic agents

• Overflow: intermittent cath, timed voidings, cholinergic
drugs, -blockers
• Urge: Kegel’s, bladder training, scheduled toileting, anti-
spasmodics
• Functional: Replace drugs, improve patient mobility,
scheduled toileting
 Indications for Urologic Referral
Incontinence associated with relapse or recurrent symptomatic urinary tract infections
Incontinence with new-onset neurologic symptoms, muscle weakness, or both
Marked prostate enlargement
Pelvic organ prolapsed past the introitus
Pelvic pain associated with incontinence
Persistent hematuria
Persistent proteinuria
Postvoid residual volume > 200 mL
Previous pelvic surgery or radiation
Uncertain diagnosis
THE END