Urinary Incontinence in the Elderly

Ivan Merkelj, MD, Department of Geriatric Medicine and Gerontology, College of Medicine, East Tennessee State University, and the Extended Care and Geriatric Department, James H. Quillen VA Medical Center, Mountain Home, Tenn

South Med J. 2001;94(10) 

In This Article


Urinary incontinence (UI), the involuntary loss of urine so severe as to have social and/or hygienic consequences for individuals and/or their caregivers, is a major clinical problem and a significant cause of disability and dependency. Urinary incontinence affects all age groups and is particularly common in the elderly.

Over the past decade, a considerable amount of research has increased our understanding of the pathophysiology and optimal treatment for this common geriatric condition. However, there is a persistent myth that UI is a normal consequence of aging. While normal aging is not a cause of UI, age-related changes in lower urinary tract function predispose the older person to UI in the face of additional anatomic or physiologic insults to the lower urinary tract or by systemic disturbances such as chronic illnesses common in the elderly.

Frail nursing home residents often have UI that can be significantly improved or cured. Persons with UI should be alerted to the importance of reporting their symptoms to a health care professional and of asserting their right to proper assessment and treatment.

Despite the increased knowledge about clinical forms, diagnostic tests, and treatments, opinions differ widely concerning the best approach to the specific forms of the disorder because of the lack of well-defined guidelines.

Because only about half of the people with incontinence in the community have consulted a physician about the problem, the true clinical extent and public health impact of UI are underestimated. The costs of incontinence have been estimated to be more than $10 billion annually in the United States. In nursing homes alone, the costs of labor, laundry, and supplies necessary to manage incontinence and its complications are more than $3 billion.


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