Clinical Review

Managing urinary incontinence in older people

BMJ 2010; 341 doi: http://dx.doi.org/10.1136/bmj.c3835 (Published 09 August 2010) Cite this as: BMJ 2010;341:c3835
  1. Subashini Thirugnanasothy, specialist registrar
  1. 1Department of Care of the Elderly, Freeman Hospital, Newcastle upon Tyne, NE7 7DN
  1. S Thirugnanasothy subathiru{at}yahoo.co.uk
  • Accepted 8 July 2010

Summary points

  • Urinary incontinence is common in older people and is associated with considerable morbidity

  • Older people are more likely to delay seeking help for urinary incontinence, and symptoms are often poorly managed in primary and secondary care

  • Chronic urinary incontinence can be classified into stress, urge, mixed, overflow, and functional types on the basis of history, examination, and simple investigations

  • Good evidence exists that conservative treatment and drug treatments are effective in older people; older people, however, are often undertreated

  • First line treatment for stress incontinence is pelvic floor muscle exercises

  • Bladder retraining, alone or in combination with antimuscarinic drugs, is the first line treatment for urge urinary incontinence

  • If conservative treatment is unsuccessful, selected surgical interventions may be appropriate in older people

Urinary incontinence is defined by the International Continence Society as involuntary urinary leakage.1 The condition is common among older people. It affects more than a fifth of people aged over 85 years, according to a recent cohort study,2 although this is probably an underestimate. Urinary incontinence has both physical and psychological consequences, including damage to skin, urinary tract infections, an increased risk of falls, avoidance of going far from home, and a feeling of alienation.3 Urinary incontinence can also be difficult for carers to manage, and a cohort study of about 6000 patients found that urinary incontinence was second only to dementia as a reason for admission to long term care.4

In the United Kingdom, the 2001 report National Service Framework for Older People highlighted a need for continence services to be integrated across primary, acute, and specialist care.5 A recent national audit of continence care for older people found that urinary incontinence is poorly managed both in the community and in secondary care. Fundamental assessments such as rectal examination and measurement of …

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