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Managing Urinary Incontinence in the Elderly

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After 2002, The International Continence Society (ICS) has actually redefined urinary incontinence (UI) as ‘the complaint of any involuntary leakage of urine. The severity of UI has been variously defined. While some researchers define it as any reported daytime UI, others specify the presence of at least two episodes of urinary leakage per week in the previous 2 weeks (Durrant, 2003). Urinary incontinence is often associated with pelvic organ prolapse because they are common diseases and have similar rates of incidence and can often be treated surgically simultaneously (Swift, 2007). The lifetime prevalence of UI in all ages has been estimated to be about 6.6% in males and 14.5% in females (Durrant, 2003). There is a prevalence of 6% in the over 65s and 15% in the over 85s (Durrant, 2003). UI is more common in elderly women. It affects 15-30% of the general geriatric population. Of this 85 % are women. However, after the age of 80 years, the incidence is almost the same in both sexes (Ogundele, 2006). There is a substantial overlap between UI and physical dependency (Durrant, 2003). Multiple factors have been incriminated in the etiology of urinary incontinence in the elderly. Age is an important risk factor because the elderly population tends to have more medical problems that contribute to the development of urinary incontinence. Physiological aging is associated with changes in the lower urinary tract, prostate, vagina, pelvic floor, and nervous system, which make elderly people more vulnerable to suffer incontinence (Bravo, 2004). Also, bladder contractility, bladder capacity and ability to defer voiding decrease with aging, increasing the post-voiding residual urine volume (Bravo, 2004). Older people also suffer from co-morbid conditions, functional impairment and take more drugs which makes than more prone to UI (Bravo, 2004). These include diabetes, certain medications like anticholinergic agents and calcium channel blockers, changes in the mental status, alteration in volume status and urine excretion and declining urinary tract function. UI has a strong association with diabetes. In a study by Ebbesen and others (2007), they reported that the prevalence of incontinence among women with diabetes was 39% when compared to 26% in women without diabetes. Also, women with diabetes had more urge and mixed incontinence. Even tobacco use, alcohol and caffeine can contribute to urinary incontinence. Other etiologic conditions include complications following a neurological event like a stroke, neurosurgery or abdominopelvic surgery and structural and functional abnormalities of the central nervous system, spinal cord, bladder, and urethra (Ogundele, 2006). UI affects 22% of those suffering from dementia (Bravo, 2004). In those with advanced chronic brain failure management of UI is difficult (Tobin, 1986).