URINARY
INCONTINENCE IN
THE ELDERLY
Dr. Muhammad Tariq (PT)
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
• MS
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, neglect
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: TURP, 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
Case 1
Ruth: 75 year old G2P2
High functioning, likes to socialize
‘Professional’ volunteer
“Every time I play tennis I leak urine”.
“ I will stop playing tennis
Case 2
Marge: 83 year old
Lives at home with help from daughter & aide
Needs assistance with IADLs > 75% of the time
Marge is always looking for a bathroom
Daughter : “She never want to go anywhere”
“Nothing can be done. I don’t want a bag”.
CASE 3
• PR is a 75-year-old woman with a chief complaint of urinary frequency, urgency, nocturia, and
urge incontinence. She's had these symptoms for about 7 years, but had not sought treatment
because she thought it was "just a fact of getting older...the same with my memory." Her
symptoms are erratic. On bad days she voids "almost constantly during the day" and has an
urgent need to void 3-4 times a night. On good days, she voids every 2-3 hours, has urgency 2-
3 times a day and urge incontinence once a day, but still has nocturia 3-4 times associated with
urgency and urge incontinence. She denies any voiding symptoms. She has had 4 or 5
episodes of bacterial cystitis over the past 20 years, the last one about 3 months previously.
After treatment of her last urinary tract infection, she showed marked improvement. One
month before presenting, her urinalysis and culture results were normal. Since then, though,
her symptoms have gradually worsened.
• Medications: Levothyroxine (Synthroid, Abbott), alendronate (Fosamax, Merck)
• Surgery: Noncontributory
• Medical History: Unremarkable except for mild hypothyroidism
THE END
