Repeat to yourself: urinary incontinence is not a normal part of aging, urinary incontinence is not a normal part of aging, urinary incontinence is not a normal part of aging…
While urinary incontinence (UI) is not a normal part of aging, it is commonly seen in older patients. About 15 to 30% of elderly living at home have UI. Up to 50% of institutionalized elderly are incontinent. The reasons that the elderly are prone to become incontinent include age-related changes to the GU tract, co-morbid conditions, medications and environmental obstacles.
When hospitalized patients develop UI, you should first look for reversible causes. Remmber the mnemonic: DRIP.
- if possible, discontinue the offending drug
- Physical restraints
- put down the bed rails
- eliminate restraints whenever possible
- treat underlying infections
- control diabetes mellitus
- treat hypercalcemia
- Urge incontinence
- prompted voiding (patient is reminded to void every hour to keep bladder empty)
- smooth muscle relaxants
- if patient has other indications (such as hypertension), try CCB
- oxybutinin has both smooth muscle relaxant and anticholinergic effects. Use with care in the elderly: Start low and go slow.
- Overflow incontinence
- If acute, may need to use indwelling catheter
- after 7 to 10 days, remove catheter and check PVRs
- if still has retention
- Intermittent catheterization
- Indwelling catheter if cannot do intermittent catheterization
- TURP in male patient with BPH