Urinary Incontinence

Extract

[...] Although it is commonly hidden and not discussed with health professionals, urinary incontinence is a prevalent, morbid, and expensive condition. Half of young and middle-aged women experience urinary incontinence, often in association with childbirth. Urinary incontinence is a common manifestation of benign and malignant prostate enlargement in middle-aged and older men. Definition and Scope of the Problem The prevalence and incidence of urinary incontinence are higher in women and increase with age. Among relatively healthy community-dwelling adults age 60 years and older, about one third of women and nearly 20% of men have some degree of urinary incontinence. [...]

[...] Pharmacologic treatment of an underactive bladder associated with chronic urinary retention and overflow incontinence is not generally effective. Treatment Surgical treatment can be highly effective in women with stress incontinence, at least over a 1-to 5-year period. Women with intrinsic sphincter weakness (as opposed to urethral hypermobility) may benefit from periurethral injections of collagen. Recommendations No strategies have proved effective in preventing urinary incontinence. Three approaches may be of some benefit, however, and are worthy of brief consideration. First, general education about bladder health and the behavioral and dietary factors that can affect it can help people understand that urinary incontinence and related urinary problems are not normal and that when such symptoms do occur, patients should seek evaluation and treatment. [...]

[...] These basic types of urinary incontinence commonly coexist. Clinical Manifestations A substantial proportion of women have symptoms of urge and stress incontinence (generally referred to as a mixed type). Frail geriatric patients commonly have urge incontinence with bladder overactivity and functional impairments that contribute to the incontinence problem. Diagnosis The basic evaluation of incontinent patients includes a focused history (which can be enhanced by a voiding diary), a targeted physical examination, urinalysis, and a postvoid residual determination. Postvoid residual determination is essential in almost all patients because the symptoms of overflow incontinence are non-specific, and the physical examination alone is not sensitive in detecting significant urinary retention (i.e., postvoid residual >200 mL). [...]

[...] Clinical Manifestations Urinary incontinence may be of sudden onset. In geriatric patients, a sudden onset commonly is associated with an acute medical illness and/or one or more potentially reversible factors. More commonly, urinary incontinence is a chronic problem, and patients often delay for years after its onset before discussing it with a health professional. Clinical Manifestations For this reason, the physician periodically should ask screening questions specifically about bladder control problems. Persistent types of urinary incontinence can be categorized into four basic types. [...]