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loss of voluntary control of micturition unintentional leakage of urine at inappropriate times; often neglected or dismissed as part of growing old; common symptom in geriatric medicine
very common embarrassing problem; prevalence of up to 50% in the institutionalised older persons and up to 20% of the community dwelling older persons
has significant negative impact of lives of those with it – medically (associated with decubitus ulcers, urinary tract infections, kidney disease), socially (loss of self esteem, restriction of social activities, depression, dependence on caregivers), economic (commonly a reason for admission to long term care facility)
risk factors – older age, multiparity, obesity, neurological disorders, smoking, dysmobility
precipitating factors – urinary tract infection, medications, neurological lesions, changed environment
common causes of transient incontinence – delirium or confusional state; urinary infection; atrophic urethritis; drugs (eg sedatives, loop diuretics, anticholinergic agents, calcium channel blockers); psychological problems (eg depression); dysmobility; excess urine output (eg hyperglycaemia); stool impaction
common causes of persistent incontinence – stress (usually daytime only; usually only on physical exertion or increased intra-abdominal pressure – a cough or laugh; commonly due to pelvic prolapse or sphincter weakness); urge (leakage followed by a strong urge to void; increased frequency, nocturia; due to detrusor overactivity – uncontrollable contractions; occurs in CNS damage (eg multiple sclerosis, stroke, Parkinsons, Alzheimer’s) or local bladder disorder, such as calculi, tumour, infection); overflow (leakage without urge to void; due to outlet obstruction, underactive detrusor or neurogenic factors); functional (due to factors outside the urinary system, eg iatrogenic, illness, dysmobility, cognitive problems, medication etc)
management – identify cause; patient education; pharmacological management; pelvic muscle rehabilitation; behavioural modification; adoption of regimented voiding routines; weight loss if obese; biofeedback; electrical stimulation; catheterisation; surgical
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