Urinary incontinence in elderly women

Urinary incontinence is a common, morbid, and costly condition affecting 10–50% of community-dwelling women over age 65.1 Among elderly women urge incontinence is more prevalent than stress incontinence and, thus, is rarely amenable to cure by a single therapeutic intervention.2 As both the number and population percentage of elderly women increase, gynecologists will be increasingly called upon to manage this chronic condition that impairs quality of life and socialization opportunities for millions of elders. Types, contributing factors, compensatory mechanisms, and response to therapy all differ somewhat in older compared to younger women. This article focuses on differences and nuances in the elderly that determine the likelihood of successful management. Besides bladder and urethral function, other urinary tract factors, such as sensation, and factors external to the lower urinary tract, such as mobility, influence whether an older person can remain continent. The practitioner must review the patient's medications and understand her medical history as it relates to current function. Postvoid residual measurement and a voiding record are virtually essential to understand both bladder and patient behavior. A positive urine culture must be interpreted with caution, because of the high incidence of asymptomatic bacteriuria in the elderly. Therapeutic success will increase in proportion to recognition and treatment of multiple factors. Treatment is partially or completely successful in most individuals, and almost all can obtain “social continence.”3