Primary care approach to urinary incontinence in the elderly

Abstract

Urinary incontinence, which is the involuntary leakage of urine, is very common in the elderly. Temporally, incontinence can appear suddenly (transient), or be chronic in nature (established). Transient incontinence is usually due to the appearance of a new identifiable problem, the causes are embodied in the mnemonic DIAPPERS: Delirium, Infection, Atrophic vaginitis, Pharmaceuticals, Psychological, Excessive urine, Restricted mobility, Stool impaction. Established Incontinence is one that persists even after correction of precipitating factors, or, lack of identifiable factors. The types are: stress, urge, and overflow, mixed, and functional. Stress incontinence: A weakened pelvic floor in females, leads to prolapsed pelvic organs, causing sphincter dysfunction. The role of pelvic floor exercises (Kegels exercises) and newer surgical interventions is discussed. Urge incontinence: The disturbance in cortical control of the pontine centers of micturition is highlighted. The use of anti-muscarinic agents, sympathetic receptor blockers, and agonists is explained. Overflow incontinence: The role of removing obstruction to urine flow, or catheterization in atonic bladders is discussed.