Evaluation and management of urinary incontinence in elderly women

Urinary incontinence is a common problem among older women, with a great impact on their quality of life, self-esteem and ability to live independently. Although often neglected by both patients and health-care providers, a variety of behavioral, pharmacologic and surgical interventions are now available to resolve or improve the symptoms of most older women who are incontinent. Since many of the factors which contribute to continence in late life lie outside of the bladder, the assessment of urinary incontinence in older women must extend beyond the genitourinary tract, assessing domains such as mobility, fluid balance and cognition. The primary care physician in uniquely placed in being able to diagnose this problem, to initiate treatment in many patients and to refer those requiring additional specialized expertise.