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

 
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