Urinary Incontinence in the Older Patient

It is difficult to age gracefully when you can't sneeze, cough, or laugh without losing control of urine (stress incontinence).  Urge incontinence occurs when a bathroom must quickly be found due to a strong urge to urinate.  Urge and stress are two common types of urinary incontinence (UI) experienced by many people as they get older.

The most common cause of UI in older individuals is over activity of the bladder wall muscle (detrusor).  By the time the individual realizes that the bladder is full, the bladder has already started working on emptying (urge incontinence).  Stress incontinence is usually caused by weakened pelvic floor muscles, common in women but rare in men. 

When evaluating UI, a thorough history and exam are done.  Easily resolved causes for UI (medications, urinary tract infections, constipation or stool impaction, too much caffeine or alcohol, mobility restrictions) are addressed.  Sometimes resolution of these issues clears up the problem.  In a small number of women, surgery is recommended. 

For the remainder of patients, UI can be effectively treated by a rehabilitation specialist (usually a physical therapist) who helps the patient strengthen his or her pelvic muscles with Kegel exercises and biofeedback.  This, as well as other modifications in daily routine, such as scheduled visits to the toilet, usually end the problem of UI. 

For more information, see: "Diagnosis and Management of Urinary Incontinence in the Older Patient," Tannenbaum, C MD; Perrin, L BSc PT; DuBeau, C MD; Kuchel,G MD, Archives of Physical Medicine and Rehabilitation.