Management of Urinary Incontinence in the Elderly

Abstract

Urinary incontinence is common in the elderly, affecting 6–8% of people over 64 years in the community and up to 31 % in hospital and long-term care. It is possible to establish the diagnosis clinically in most incontinent patients with the likelihood of improving symptoms in the majority. Treatment of patients with urinary incontinence requires attention to general and specific measures. General measures include moderation of fluid intake to about 1.5 litres/day, reduced intake of caffeine-rich drinks, treatment of aggravating conditions such as urinary infection, oestrogen deficiency, increased solute load as in diabetes mellitus and uraemia, and drugs like diuretics, sedatives and antidepressants. Specific measures include pelvic floor exercises, vaginal cones, interferential therapy and oestrogens for patients with stress incontinence. Bladder retraining and anticholinergic drugs are for patients with urge incontinence, and alpha-blockers and 5-alpha reductase inhibitors for patients with overflow incontinence due to prostatic hyperplasia.

Sydney multicenter study of Parkinson's disease: Non‐L‐dopa–responsive problems dominate at 15 years

“…The underlying pathology may be loss of nigrostriatal dopaminergic function, which is thought to be inhibitory to the bladder 36. Urinary incontinence is reported to affect 8% of community dwellers and 31% of nursing home dwellers 37. In the pre– L ‐dopa era, urinary tract infections were one of the leading causes of death in Parkinson's disease9 but they were an uncommon cause of death in the general population then.…”

Haematogenous Vertebral Osteomyelitis in the Elderly

“…Vaginal bacterial colonisation owing to the low pH related to postmenopausal decrease in circulating estrogen [20]; 2. Urinary incontinence, affecting 6%±8% of people over 64 in the community and up to 31% in hospitals and long-term care [22]; 3. The presence of indwelling catheters, frequently used in elderly individuals resident in long-term care institutions [23]; 4.…”

Medical urology: a specialty long overdue. A personal view

“…Treatment of the overactive bladder is by bladder drill which includes the use of pelvic floor muscle exercises and inhibiting the response to urgency, with or without anticholinergic therapy 1920 Burgio et al recently showed in a randomised controlled trial that such behavioural treatment was more effective than oxybutynin or placebo, and led to far fewer requests to change to other treatments. Oxybutynin was more effective than placebo 20.…”

“…20 Burgio et al recently showed in a randomised controlled trial that such behavioural treatment was more effective than oxybutynin or placebo, and led to far fewer requests to change to other treatments. Oxybutynin was more effective than placebo 20. Improvements in therapy have already followed a better understanding of the clinical pharmacology and specificity of the drugs used, such as oxybutynin21and tolterodine 22.…”