New Options and Strategies for the Treatment of Urinary Incontinence

Abstract

often underreported medical condition within the elderly population. Published prevalence rates of urinary incontinence have varied based on the subset of the population studied and the definition of urinary incontinence used. 1-3 Reported prevalence rates of incontinence have been highest at 43% to 60% 4 in elders living in nursing homes, followed by approximately 35% 2 in those admitted to the acute care setting and 8% to 34% 3 in those living independently within the community. In addition, prevalence rates have varied based on the age of the individuals studied. It has been established that prevalence rates increase with age. 1,2 This was illustrated in a study conducted by Sier and colleagues. Via nursing staff, they evaluated the prevalence of urinary incontinence within patients older than 65 years who were admitted to a university hospital. 2 They found that incontinence during hospitalization, defined within the study as 1 or more episodes of incontinence documented on the patient's monitoring record, was greater in elderly patients older than 75 years than in patients between the ages of 65 and 74 years (48% vs 24%, P < .001). Likewise, there have been reports of gender-related differences in prevalence of urinary incontinence, with higher prevalence seen in women across all settings. 2,3 The NOBLE study, one of the largest population-based surveys conducted in this area of study to date, evaluated community-dwelling individuals within the United States for prevalence of overactive bladder (OAB), both with and without urge incontinence. This study provides a more detailed description of gender-related differences using a broader definition of urinary incontinence-OAB-to capture patients exhibiting urinary symptoms associated with urinary incontinence but without overt incontinence. Many previous studies have focused on those with urge incontinence only. However, more recent evaluations often use the terms urinary incontinence and OAB interchangeably. The results of this survey reveal that overall prevalence rates of OAB are similar between genders at approximately 16% when a broader definition is used. This study suggests that gender-associated differences are more related to the types of symptoms experienced; more women experience OAB with urge incontinence, whereas OAB Urinary incontinence is a prevalent, although often unreported, disease within the elderly population, with consequences spanning many aspects of the patient's life. Treatments differ for each subtype of urinary incontinence: urge incontinence, stress incontinence, and incontinence associated with bladder outlet obstruction and lower urinary tract symptoms in men. Limitations in current therapies have negatively affected care for each of these subtypes, particularly in the vulnerable elderly population. An emergence of new treatment options and strategies has created opportunities to optimize care for the general population. These include the use of trospium, darifenacin, solifenacin, and duloxetine as well as the strategic use of antim...