Developed by the American Geriatrics Society Urinary Incontinence Education Initiative Editorial Board
Patricia S. Goode, MD, Chair; Jeanette Brown, MD; Catherine DuBeau, MD; Jane Frahm, PT; David Guay, PharmD; Thomas Griebling, MD; Ted Johnson, MD; Janis Luft; NP, MS; Peggy Szwabo, PhD, LCSW, RN/CSS

Most people with Urinary incontinence (UI) do not need to be referred to a specialist. As the primary health care provider, you can help your incontinent patients by following these simple, quick screening and treatment guidelines. The following step-wise, patient-centered approach is designed for busy practitioners. Remember, everyone who suffers from UI can be helped and many patients can be cured, with appropriate screening and intervention.

Background

Urinary incontinence (UI) is defined as "a multifactorial syndrome produced by a combination of genitourinary pathology, age-related changes, and comorbid conditions that impair normal micturition or the functional ability to toilet oneself, or both." (1) Urinary incontinence affects more than 13 million people in the United States. It is more common in women until around age 85, when the prevalence in men and women becomes approximately equal.

Many older adults think of UI as an inconvenience that is a normal part of aging. Patients often attempt to handle the problem themselves by using absorbent products or by other means, such as limiting travel outside the home or restricting fluid intake. However, UI is not a normal part of aging. People with UI have a high incidence of complications such as skin breakdown, urinary tract infections, falls and fractures - complications that are all associated with substantial morbidity and mortality. Moreover, UI and its associated complications often contribute to the decision to institutionalize frail elders. (3-4)

Urinary incontinence also contributes to decreased self-esteem and difficulty in maintaining independence and lifestyle, (5) limits social interaction, and negatively affects sexual activity, (2) thereby diminishing older adults' quality of life.

In addition to its negative impact on the patient, the economic impact of UI is substantial. It is estimated that UI-related costs total more than $36 billion annually. (1) In 1996, an estimated $1.1 billion was spent on disposable absorbent products for adults. (6)

Screening for UI

Discussing incontinence is difficult and embarrassing and many older people do not tell their health care providers that they have urinary incontinence. (7) Thus, it is important for health care providers to question all patients about incontinence as part of their routine patient assessment. Reassure patients that most cases of UI can be treated with behavioral techniques, pelvic floor muscle exercises, and/or medications -- without surgery.

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