URINARY-INCONTINENCE IN THE ELDERLY - DRUG-TREATMENT OPTIONS

Urinary incontinence is commonly seen in the elderly. It has multiple complications and is often the reason an elderly person is forced to a bandon independent living and enter a nursing home. There are multiple causes of urinary incontinence: it is not a single entity or a specif ic diagnosis. In most patients, the incontinence can be placed into 1 of the following 4 categories: detrusor overactivity (urge incontinenc e), overflow incontinence, stress incontinence (outlet incompetence) o r functional incontinence. To understand the pathophysiology of urinar y incontinence, some knowledge of the urinary tract anatomy and physio logy is required. It is also important to know how the anatomy and phy siology changes in response to the aging process. Successful treatment depends on the specific cause of the incontinence. If incorrectly dia gnosed, various treatments may actually worsen the incontinence or cau se other problems. Since most elderly patients do not volunteer a prob lem of urinary incontinence, questions regarding the presence of sympt oms must be asked. In most patients, the specific type of incontinence can be diagnosed with a thorough medical history and physical examina tion. Several simple and widely available laboratory tests may also be useful in the evaluation. Occasionally, urological consultation or ur odynamic testing should be performed. Once correctly diagnosed, there are a large number of pharmacological as well as nonpharmacological tr eatments (behavioural, surgical) available. This article concentrates on the pharmacological therapies for patients with various types of ur inary incontinence. Since most patients with urinary incontinence are elderly, they are more susceptible to the effects as well as the adver se effects of medications. This must be taken into account before any pharmacological therapy is initiated. Although many elderly patients b elieve their symptoms of urinary incontinence to be a part of growing old, urinary incontinence is never a normal change of aging. With prop er evaluation and treatment, the majority of patients with urinary inc ontinence can be helped or cured.