Urinary incontinence in an elderly person affects the patient's and his/her family's quality of life as well as health care costs. It increases the need for assisted accommodation and round-the-clock care and the risk of falls, for example.
The patient is often too embarrassed to seek appropriate help.
Various treatment options that ease the situation are available to manage urinary incontinence in an elderly person.
Urinary incontinence should be actively brought up in health care contacts.
Prevalence and types
More common in women and in those living in round-the-clock care
Among individuals aged over 70 years, over half of women and about a quarter of men suffer from troublesome urinary incontinence.
Urge incontinence
Characterised by involuntary loss of urine in association with a sudden urge to urinate (urgency)
Part of overactive bladder syndrome, the other symptoms of which include urinary urgency without incontinence, urinary frequency and nocturia
The most common type in men. The underlying cause is often the increased resistance to urine flow in the outflow tract caused by benign prostatic hyperplasia (BPH).
Stress incontinence
Involuntary loss of urine during physical exertion or strain
Common in women
Rare in men, mostly seen as a complication of prostate surgery
Mixed incontinence
A combination of urge and stress incontinence
The most common type in women
Overflow incontinence
Incontinence caused by either acute or chronic urinary retention
Changes connected with aging
Women
Atrophy of urogenital mucous membranes
Weakening of the pelvic floor supporting structures
But asymptomatic bacteriuria is very common in elderly people and requires no treatment.
Medication
Diuretics
Drugs with anticholinergic properties
Analgesics acting on the central nervous system
Hypnotics and sedatives
Acetylcholinesterase inhibitors used in Alzheimer's disease
Polypharmacy
Treatment
Due to the multifactorial nature of the disorder, various forms of treatment can be combined.
Lifestyle advice is recommended for all elderly people to prevent and to treat urinary incontinence.
In cases where the patient has a memory disease, several comorbidities or is using multiple medication, special emphasis in management should be placed on a holistic approach and rehabilitation.
Lifestyle advice
Sufficient protein and energy intake should be ensured. Malnutrition is common, and it may lead to sarcopenia, or loss of muscle bulk and strength Assessment of Nutritional Status in the Elderly.
Unintentional weight loss should be addressed.
The attitude to intentional weight reduction in elderly people should be reserved.
Fluid restriction should be avoided to avoid dehydration.
Constipation should be actively prevented and treated with fibre products and laxatives, as necessary Obstipation in the Adult.
As physical activity will improve bladder control, physical exercise and strength training should be recommended for everyone.
Smoking should be stopped and alcohol avoided.
Overactive bladder with associated urge incontinence
Drug therapy
The disadvantages and advantages of drug therapy should be carefully weighed Managing the Medication of Elderly People. Initial doses may be lower and follow-up more frequent than usually.
Beta-3 adrenergic receptor agonist that does not have the typical adverse effects of antimuscarinics. One should be careful, however, especially when treating persons with cardiovascular diseases, such as hypertension.
Other illnesses or mild memory disorder do not prevent excercises.
Encouragement to general physical excercise
Invasive procedures
Sling procedures performed in local anaesthesia are also suitable for the management of stress incontinence in the elderly Urinary Incontinence in Women.
Injection of polyacrylamide hydrogel (Bulkamid® ) around the urethra
Overflow incontinence
The volume of residual urine should be measured with ultrasonography or by single catheterisation after urination.
Any obstruction to urine flow must be excluded; obstruction may be caused by benign prostatic hyperplasia in men and by a cause such as a significant prolapse in women.
Treatment of constipation, gradual withdrawal of drugs that relax the urinary bladder (anticholinergics in particular)
Complete emptying of the bladder must be ensured, preferably with intermittent catheterisation carried out at sufficiently frequent intervals
Use of an indwelling catheter should be avoided in the treatment of chronic urinary retention.
Rehabilitation aspects
Maintenance and promotion of mobility and functional capacity improve bladder control.
Speedy and effective rehabilitation should be provided after an acute illness or surgery, using appropriate mobility aids.
An indwelling catheter should be removed as soon as possible in order to preserve bladder control and to avoid catheter-induced infections and other complications.
It must be ensured that the patient has an obstacle-free and safe route (e.g. adequate lighting etc.) to the toilet or commode to reduce the risk of falling Falls of the Elderly.
Incontinence protection
High quality incontinence pads that are changed sufficiently frequently to ensure convenience of use and to prevent skin complications
Various collection bags and bottles are available for men
Guidance and counselling related to the use of incontinence protection is important.
Other points of importance
Listen to the wishes of the patient and his/her family
Observe the mood of the incontinent patient and start pharmacotherapy for depression, if necessary.
In persons with a memory disorder, also consider other possible aetiological factors of urinary incontinence than the memory disorder.
Referral criteria
Suspicion of urinary obstruction (e.g. a prolapse in women and prostate problems in men)
Severe symptoms
No results achieved with conservative treatment
Postoperative complications
References
Gibson W, Johnson T, Kirschner-Hermanns R et al. Incontinence in frail elderly persons: Report of the 6th International Consultation on Incontinence. Neurourol Urodyn 2021;40(1):38-54. [PubMed]
Gibson W, Wagg A. New horizons: urinary incontinence in older people. Age Ageing 2014;43(2):157-63. [PubMed]
Thüroff JW, Abrams P, Andersson KE, et al. EAU guidelines on urinary incontinence. Eur Urol 2011;59(3):387-400 [PubMed]