Update in office managementOffice Management of Geriatric Urinary Incontinence
Section snippets
Pathogenesis of Urinary Incontinence
Normal urination requires the coordination of several physiological processes. Somatic and autonomic nerves carry information on bladder volume to the spinal cord and motor output is adjusted accordingly. The cerebral cortex exerts a predominantly inhibitory influence while the brain stem facilitates urination by coordinating urethral sphincter relaxation and detrusor contraction.5, 6 As the bladder fills, sympathetic tone contributes to closure of the bladder neck and relaxation of the dome of
Clinical Presentation
There are 2 basic categories of urinary incontinence: acute or “transient” and chronic. Chronic urinary incontinence is further classified as stress, urge, mixed, overflow, and functional types. This classification does not include all of the possible etiologies but is helpful in evaluating and treating this condition in office practice.
Office Evaluation of Incontinence in Older Patients
Many older patients who are bothered by urinary incontinence do not spontaneously complain about it. Thus, screening questions should be used to identify this condition. Simple questions included in a review of systems can be helpful, such as: “Do you have trouble with your bladder?” “Do you lose urine when you do not want to?” “Do you wear pads or adult diapers for protection?”1, 6
Once urinary incontinence has been identified, the main goals of office management are to diagnose and treat
General Principles
There are several therapeutic options available for managing urinary incontinence in older patients. Table 3 outlines the primary treatments for the basic types of chronic incontinence. Treatment decisions should be individualized and will depend on the findings of the basic evaluation and preferences of the patient and the health care provider.
Supportive measures can be helpful in managing urinary incontinence and should be used with other, more specific treatment measures. Education about
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