Urinary Incontinence

In this brand new Elderly Care podcast we give a brief overview of the significant problem of urinary incontinence in the elderly. Specifically, the definition and impact of urinary incontinence, the causes (DRIP), classification, investigations and management options.

 

Video Duration: 6 minutes

  • Urinary Incontinence
    Created by Matthew Ball
    General
    Epidemiology

    Involuntary loss of urine in sufficient amount or frequency to constitute a social or hygienic problem.

    Increased prevalence in the elderly, pregnant women or women post childbirth and Men who have had prostate surgery.

    Pathology

    4 main types:

    • True incontinence
      • secondary to a congenital fistula
    • Overflow incontinence
    • Overactive bladder divided into
      • Stress incontinence
      • Urge incontinence
    • Functional incontinence
    Top three causes

    Functional incontinence occurs due to:

    • Disease or frailty preventing normal toileting

    In women:

    • Pregnancy, childbirth,
    • Prolapse
    • Menopause -> atrophic urethra

    In men:

    • Prostate surgery
    Clinical Features
    Symptoms

    Involuntary loss of urine.

    Especially with sneezing, coughing, laughing.

    May be:

    • Associated with caffeine, alcohol and stress.
    • Nocturia, polyuria, frequent toileting.
    • Lower urinary tract symptoms
    • linked to other conditions:
      • Neurological; Stroke, Neuromuscular conditions
      • Infection; UTI, other infection --> delirium
    Signs

    Prolapse - cystocele or vaginal

    Investigations
    Cultures

    Urine Dip + M,C & S

    Bloods

    FBC (looking for signs of infection)

    U&Es (managing electrolyte balance which may cause confusion or result)

    Imaging

    None

    Scopic/Biopsy

    None

    Functional

    Urodynamic measurements can help to determine if stress or urge

    Treatment
    Conservative

    Lifestyle factors:

    • Smoking cessation
    • Avoiding: Caffeinated drinks, alcohol.
    • Bladder Diary
    • Muscle training - pelvic floor
      • Only shown to be effective if physio assisted
    • If urgency try to increase time between urination

    Management of functional factors - environment

    Medical

    Anticholinergics can be used (beware can cause confusion in the elderly)

    Last resort involves long term catheter use

    Surgical

    Uro-gynaecological surgery can be used in young fit women.

    Correction of prolapses can also help with internal tape fixation and other surgery.