incontinence

1. incontinence is common among
older people
• The impact of incontinence is
significant•
Incontinence is not an
inevitable consequence of ageing
• It can be treated after a
proper assessment
• A lot can be done to
promote the comfort and dignity of
older people with intractable
incontinence

2. Incontinence is defined as ‘any
involuntary leakage of urine’.
Although more common,
incontinence is not inevitable in old
age,
and much can be done to prevent
and treat it. A positive attitude
and a thorough assessment can
mean maintaining dignity and
independence for most people.

3. The prevalence and impact of
incontinence
Up to 1 in 5 women and around 1 in 10 men over
the age of
65 suffer from incontinence.
The prevalence increases with increasing age and
co-morbidity. Two-thirds of care home residents
are incontinent of urine

4. Changes in the urinary tract with ageing
• Shortening of the urethra
• Post-menopausal atrophy of the urothelium
• Reduced bladder sensation
• Reduced detrusor muscle function
• Increased residual bladder volume
• Less effective urethral closure

5. Drugs that can worsen or
precipitate incontinence
• Diuretics
• Sedatives
• Alpha blockers
• Any drug with cholinergic
properties

7. There are five main types of urinary
incontinence in older
people:
• urge incontinence (or over-
active/unstable bladder)
• stress incontinence
• mixed incontinence (both urge
and stress)
• voiding problems (due to
obstruction or a neurogenic
bladder)
• functional incontinence (due to an
inability to get to the toilet,
or confusion).

8. Key components of a continence assessment
• History of onset and duration of problems
• Symptom sorter
• Previous medical, surgical and obstetric history
• Medications
• Assessment of functional abilities
•
Examination of the abdomen, rectum (and perineum/vagina in
women)
• Urinalysis
• Urea and electrolytes, glucose, calcium (and

9. prostate-specific
antigen in men)
In addition, patients are asked to keep a ‘bladder diary’.
It is also
very important to ask about bowel problems, as
constipation leading to fecal loading can cause urinary
problems.
In a continence clinic, further assessments are typically
undertaken,
which include:
•

10. post-micturition bladder scan (to
look for evidence of voiding
problems)
• measurement of urine flow
(using a special commode)
• quality of life score
• measurement of body mass
index

11. Treatment
General measures
General measures that can help
promote continence in older
people include:
• staying active
• losing weight if necessary
• drinking water rather than
caffeine or alcohol.

12. Yes to the following suggests
STRESS INCONTINENCE
• I leak when I cough, laugh,
sneeze, exercise
• I leak small amounts of
urine
• I know when I have leaked
• Only my pants get wet
• I leak during sex

13. Yes to the following suggests
URGE INCONTINENCE
• I have an urgent need to
pass urine
• I sometimes do not reach
the toilet in time
• I get up more than twice at
night
• I pass urine more than 7
times a day
• I get very wet

14. Yes to the following suggests
VOIDING PROBLEMS
• My urine fl ow stops and
starts
• Sometimes I cannot pass
urine straight away
• I sometimes feel I have not
emptied my bladder properly
• I have a feeling of fullness
in my bladder area
• I get frequent urine
infections

15. yes to the following suggests
FUNCTIONAL INCONTINENCE
• I have lots of health
problems
• I have problems with
memory and concentration
• I need help to move about
• I have problems adjusting
my clothing
• I have a feeling of sadness,
depression, loneliness