Urinary incontinence: medical and psychosocial aspects

Recognition has been growing over the past two decades that urinary incontinence is a rather widespread condition among older adults. Prevalence rates of about 30% for any incontinence and about 5% for severe incontinence among older adults were suggested by several European studies and have recently been confirmed by American studies. The rates are typically higher among women than men. Despite these findings, much about the true distribution of urinary incontinence remains to be firmly established. The proportion of different types and the differences between sexes, ages, and races need to be confirmed using representative population samples and valid measures of incontinence. These distributions cannot be accurately described using clinical populations. Perhaps because urinary incontinence is viewed as highly embarrassing, it has not been a focus of media coverage or public discussion. More attention by the media and by health-care professionals would build public awareness of the condition. Older adults and their caregivers need to know that urinary incontinence is common and treatable, so that they will identify it promptly and bring it to their physicians' attention. Health-care providers and social workers must also be alert to the possibility of incontinence among their clients. They should be prepared to ask older patients directly, because many patients may disregard urine loss or be too embarrassed to mention it. Currently, much of the management of urinary incontinence appears to be self-devised. Many incontinent persons have not talked to a physician about their problem. The largest proportion of those who attempt to control their urine loss use absorbent products or try to avoid loss by awareness of toilet locations and frequent toileting. Reliance on these methods is unfortunate because much progress has been made in developing diagnostic and treatment procedures for urinary incontinence. For example, surgical procedures to rectify an incompetent sphincter have been shown to be effective and are generally accepted. There are a number of medications effective for controlling detrusor instability. Further, various behavioral techniques appear to be promising as noninvasive initial interventions for many patients. We are on weaker ground regarding the prevention of and early intervention in urinary incontinence. The existing epidemiological data on the development of incontinence are poor. We do not know the proportion of urinary incontinence that is transient and the proportion that is chronic or established. Nor do we know the risk factors for onset and progression of the condition.(ABSTRACT TRUNCATED AT 400 WORDS)