[Urinary incontinence in geriatric patients: behavioral therapy, toilet training and physiotherapy]

1/2019 we presented an update of the AWMF guideline 'urinary incontinence in frail elderly - diagnostics and therapy. Since its introduction in 2015 the guideline has been under a continuous revision process by the working group 'Incontinence' of the German Society for Geriatrics (DGG). From this guideline which is accredited as an official guideline of the DGG we present here the chapter about 'behavioral therapy', 'toilet training' and 'physiotherapy'.

A profound literature search was done in a structured evaluation process in the context of a 'frail elderly'. Most medical societies define a 'frail elderly' as someone older than 70 years and multimorbide or older than 80y. We focused on randomized, double blind, placebo controlled studies as well as already published guidelines in this field. In the case no studies were available or not feasible other publications such as not randomized studies or case reports were taken into consideration for our guideline. Recommendations resulted from a structured voting process and the results are stated as percentage of members who agreed.

Considering the vulnerability of frail elderly and the limitations of pharmacological and surgical treatment any conservative treatment modalities get a special meaning. All behavioral treatment approaches, however, are only successful if the patient is to some extent compliant and mobile. Keeping these limitations in mind we looked at effect and feasibility of weight loss, fluid management, use of diuretics, bowel regulation and toilet training as well as active and passive phsiotherapeutical interventions.

Behavioral treatment, toilet training, and phsiotherapeutical interventions are indispensable modules in the multifaceted approach to improve continence in frail elderly. Caring for multimorbide frail elderly requires carefully outweighing risks of pharmacological and surgical treatment against benefits of low risk interventions such as conservative therapy. Frail elderly often benefit from conservative treatment alone or in combination with other treatment modalities.