Urinary Incontinence in Older Adults
Nicole Strong, Sara Z. Salim, Jean L. Nickels, and K. Rao Poduri
CONTENTS
- 9.1 Introduction..........................................................................................................................158
- 9.2 Definitions.............................................................................................................................158
- 9.3 Impact...................................................................................................................................159
- 9.3.1 Physical Health.........................................................................................................159
- 9.3.2 Psychological Well-Being.........................................................................................160
- 9.3.3 Social Balance..........................................................................................................160
- 9.3.4 Financial Condition..................................................................................................160
- 9.3.5 Quality of Life..........................................................................................................160
- 9.4 Basic Anatomy/Physiology...................................................................................................160
- 9.4.1 Innervation................................................................................................................161
- 9.4.2 Micturition Reflex.....................................................................................................162
- 9.4.2.1 Anatomical Changes with Age..................................................................162
- 9.5 Pathophysiology .................................................................................................................... 162
- 9.6 Risk Factors..........................................................................................................................163
- 9.7 Comorbidities........................................................................................................................164
- 9.8 Evaluation.............................................................................................................................165
- 9.8.1 History......................................................................................................................165
- 9.8.2 Physical Exam........................................................................................................... 166
- 9.8.3 Diagnostic Studies .................................................................................................... 166
- 9.9 Treatment..............................................................................................................................167
- 9.9.1 Behavioral Therapy..................................................................................................167
- 9.9.2 Lifestyle Adjustments...............................................................................................168
- 9.9.3 Pharmacologic..........................................................................................................169
- 9.9.4 Invasive Procedures and Surgical Options...............................................................169
- 9.9.4.1 Bulking Agents..........................................................................................169
- 9.9.4.2 Botulinum Toxin (Botox)...........................................................................170
- 9.9.4.3 Vaginal Devices.........................................................................................170
- 9.9.4.4 Neurosacral Modulation/Sacral Nerve Stimulation (SNM or SNS)..........170
- 9.9.4.5 Pudendal Nerve Stimulation......................................................................170
- 9.9.4.6 Percutaneous Tibial Nerve Stimulation.....................................................171
- 9.9.4.7 Surgery....................................................................................................... 171
- 9.9.5 Management by Type of UI......................................................................................172
- 9.9.5.1 Stress UI.....................................................................................................172
- 9.9.5.2 Urgency UI................................................................................................. 173
- 9.9.5.3 Mixed UI....................................................................................................173
- 9.9.5.4 Overflow UI ............................................................................................... 173
- 9.9.5.5 Transient UI...............................................................................................174
- 9.10 Management of Urinary Incontinence in the Older Adult across Different Settings...........174
- 9.10.1 In-Hospital and Inpatient Rehabilitation Units.........................................................174
- 9.10.2 Skilled Nursing Rehabilitation Units and Long-Term Care Facilities......................175
- 9.10.3 Home.........................................................................................................................176
References ...................................................................................................................................... 177
