Urinary incontinence: keys to diagnosis of the older woman.1

Up to 38% of women age 65 and older experience urinary incontinence to some degree, although the prevalence in this population may be even greater. Aging, childbirth, and hormonal changes affect the muscle and tissue support of the urethra and bladder, decreasing their ability to hold urine. Neurologic injury related to disease, trauma, or surgery may impair the pathways between the brain and bladder, leading to inappropriate urgency and frequency. Older women often do not talk about their incontinence, because they are embarrassed or believe there is no cure. Therefore, it's important for clinicians to ask about the involuntary loss of urine. A careful history alone can often reveal 80 to 90% of the diagnosis.