Urinary Incontinence IN Older Adults

Meet the patient

A 78-year-old woman with hypertension and mild cognitive impairment leaks urine when she coughs, but also rushes to the toilet several times a night and does not always make it. She takes a morning diuretic, oxybutynin prescribed elsewhere, and is chronically constipated. She has fallen twice rushing to the bathroom at night.^[1][9]

The two questions that decide her plan are the two that decide every continence assessment: what is the mechanism? — stress, urgency, mixed, overflow, or functional — and what is making it worse? — her diuretic, her constipation, her oxybutynin, her cognition. Classify the mechanism, fix the reversible contributors, then match the therapy. That is the whole topic.^[2]

References13ShowHide

1. [1]Batmani S, Jalali R, Mohammadi M, et al. Prevalence and factors related to urinary incontinence in older adults women worldwide: a comprehensive systematic review and meta-analysis of observational studies BMC Geriatr, 2021.PMID 33781236
2. [2]Searcy JAR Geriatric Urinary Incontinence Nurs Clin North Am, 2017.PMID 28779825
3. [3]Dumoulin C, Cacciari LP, Hay-Smith EJC Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women Cochrane Database Syst Rev, 2018.PMID 30288727
4. [4]Woodley SJ, Lawrenson P, Boyle R, et al. Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women Cochrane Database Syst Rev, 2020.PMID 32378735
5. [5]Millard RJ, Moore K, Rencken R, et al. Duloxetine vs placebo in the treatment of stress urinary incontinence: a four-continent randomized clinical trial BJU Int, 2004.PMID 14764128
6. [6]Li J, Yang L, Pu C, et al. The role of duloxetine in stress urinary incontinence: a systematic review and meta-analysis Int Urol Nephrol, 2013.PMID 23504618
7. [7]Bragg R, Hebel D, Vouri SM, et al. Mirabegron: a Beta-3 agonist for overactive bladder Consult Pharm, 2014.PMID 25521658
8. [8]Chapple CR, Cardozo L, Nitti VW, et al. Mirabegron in overactive bladder: a review of efficacy, safety, and tolerability Neurourol Urodyn, 2014.PMID 24127366
9. [9]Gray SL, Anderson ML, Dublin S, et al. Cumulative use of strong anticholinergics and incident dementia: a prospective cohort study JAMA Intern Med, 2015.PMID 25621434
10. [10]Nishtala PS, Chyou TY Risk of delirium associated with antimuscarinics in older adults: A case-time-control study Pharmacoepidemiol Drug Saf, 2022.PMID 35587029
11. [11]Funada S, Yoshioka T, Luo Y, et al. Bladder training for treating overactive bladder in adults Cochrane Database Syst Rev, 2023.PMID 37811598
12. [12]Ford AA, Rogerson L, Cody JD, et al. Mid-urethral sling operations for stress urinary incontinence in women Cochrane Database Syst Rev, 2017.PMID 28756647
13. [13]Fader M, Cottenden AM, Getliffe K Absorbent products for light urinary incontinence in women Cochrane Database Syst Rev, 2007.PMID 17443507