Urinary incontinence in the elderly: physiology, pathophysiology, diagnosis, and treatment

Urinary incontinence is a problem affecting 5% of 10% of the elderly in the community and up to 50% of the elderly in institutions. Despite complex factors governing normal micturition, the causes of urinary incontinence can be classified into detrusor instability, overflow incontinence, sphincter insufficiency, functional illness, and iatrogenic causes. An accurate pathophysiologic diagnosis is a prerequisite to successful treatment. A decision sequence is presented to help design a reasonable diagnostic approach. With appropriate therapy, most incontinent elderly patients can expect significant improvement or cure.