Geriatric Quick Consult

Urinary Incontinence

Do's / Don'ts

 

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.

Treatment

  • Medication-induced
    • if possible, discontinue the offending drug
  • Impaction
    • treat with enemas
  • Physical restraints
    • put down the bed rails
    • eliminate restraints whenever possible
  • Infections
    • treat underlying infections
  • Polyuria
    • 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

DO all of these

DON'T do any of these

Get a good history forget to review meds
Examine patient skip rectal exam
Check PVR by ultrasound place/leave bladder catheters
Check for infection keep patients in bed
Check for chemical abnormalities restrain patients physically