25th July 2023

Overview

Continence is the ability to control one’s bladder and bowel. This topic will mainly focus on urinary incontinence in the elderly. Urinary incontinence is defined as the involuntary leakage of urine and can be classified as below.

• Functional incontinence: inability to reach the toilet in time due to poor mobility and/or unfamiliar surroundings.
• Stress incontinence: secondary to exertion or effort/sneezing/coughing/laughing. The bladder sphincter is incompetent and can be associated with genitourinary prolapse.
• Urge incontinence: associated with or immediately preceded by the urge to urinate. Urgency can be defined as the sudden and strong desire to urinate that cannot be deferred. It is because of detrusor instability or hyperreflexia, which leads to involuntary detrusor contraction. This may be idiopathic or secondary to neurological conditions such as multiple sclerosis, Alzheimer’s dementia, spinal cord injury and Parkinson’s disease. It can also be caused by infection or bladder stones which cause local irritation.
• Overactive bladder (OAB) syndrome: a condition that causes urgency either with or without incontinence. It is caused by detrusor overactivity.
• Mixed incontinence: a combination of urge and stress incontinence.
• Overflow incontinence: urinary leakage due to either detrusor underactivity or chronic bladder outflow obstruction (BOO). Both can cause urinary retention and subsequent leakage. BOO is often due to prostate problems in men, which can lead to obstructive nephropathy secondary to back pressure.
• True incontinence: a fistula forms between the vagina and the ureter or bladder or urethra and predisposes to continuous urine leakage.

Urinary incontinence is more prevalent with age and is common in those living in institutions such as assisted living and care homes. Risk factors include high BMI, diabetes mellitus, pregnancy and childbirth, hysterectomy, multiparity, recurrent UTI, cognitive impairment, neurological disorders, and prostate disorders.