[Urinary incontinence]. / Inkontinenz.

Urinary incontinence is a common health problem of older adults and affects more than 50% of nursing home residents. Different types of urinary incontinence can be distinguished: urgency, stress, overflow (urinary retention) and extra-urethral incontinence. The pathogenesis of urinary incontinence in older patients is multifactorial. Age-related physiologic changes, urological or gynaecological ailments, neurological diseases, behavioural patterns and functional decline frequently contribute to incontinence to some extent. These pathogenetic factors may appear in close relation to frailty. As incontinence on the one hand may substantially contribute to decompensation of health reserves, and on the other hand is an indicator for frailty, early assessment and treatment are important. Clinical diagnostics focus on history, physical examination, bladder diary and measurement of postvoid residual volume. Diagnostic and therapeutic approaches to urinary incontinence should focus on finding and treating reversible causes. Behavioural interventions such as toileting procedures may reduce the level of incontinence even in severe cases. Frail older adults with functional decline and urgency incontinence often do not respond well to drug treatment. Paramount for the adequate care for incontinent seniors is the instruction of the affected person and--if necessary--of their caregiver in handling incontinence aids.

The effect of age on lower urinary tract function: a study in women.

OBJECTIVES: To identify age-associated changes in female lower urinary tract function across a wide age spectrum, controlling for detrusor overactivity (DO). DESIGN: Secondary analysis of a cross-sectional study of DO and aging. Eligible volunteers were stratified by age group and presence of DO. SETTING: Community-based volunteers, evaluated in research laboratory. PARTICIPANTS: Eighty-five ambulatory, nondemented, community-dwelling female volunteers, with and without bladder symptoms suggestive of DO, recruited by advertising, mean age 54 (range 22-90); 75% Caucasian, 21% African American. MEASUREMENTS: Comprehensive assessment included bladder diary, uroflowmetry, and detailed videourodynamics. Predefined urodynamic and diary variables were examined for association with age and DO. Mean values of these variables were calculated for subgroups aged 20 to 39, 40 to 59, and 60 and older (14 subjects > or =70). RESULTS: Maximum urethral closure pressure, detrusor contraction strength, and urine flow rate declined significantly with age (P<.001, P<.001, P=.006, respectively), regardless of whether DO was present. Most elderly individuals continued to empty their bladder almost completely, with normal voiding frequency. Mean number of nocturnal voids was less than one in all age groups. Bladder capacity did not decrease with age (mean 522 mL in oldest group) but was smaller in subjects with DO. Bladder sensation diminished significantly with age (P<.001) but was stronger in subjects with DO. CONCLUSION: Female bladder and urethral function appear to deteriorate throughout adult life, whether DO is present or not. Specifically, detrusor contractility, bladder sensation, and urethral pressure decline. The common belief that bladder capacity shrinks with age may be related to DO rather than to aging itself.

Geriatric patients' preferences for treatment of urinary incontinence: a study of hospitalized, cognitively competent adults aged 80 and older.

OBJECTIVES: To elicit preferences for different urinary incontinence (UI) treatments of geriatric patients, to contrast these answers with answers from potential health proxies and providers, and to understand how select demographic factors might explain differences in patients' preferences. DESIGN: Cross-sectional, descriptive. SETTING: German geriatric hospital. PARTICIPANTS: Medical inpatients aged 80 and older in a geriatric hospital, their physicians and nurses, and their family members. MEASURES: Six forced-choice paired comparisons of four UI treatments were measured on an 11-point visual analog scale, with verbal anchors. RESULTS: One hundred seventeen patients (mean age 84.6; 43% with UI), 72 staff members, and 71 family members participated. Although some preferred even "unpopular" management strategies, most respondents preferred diapers (79%), medications (78%), and scheduled toileting (79%) to urinary catheters; 64% preferred scheduled toileting to diapers. When choosing between diapers and medication, equal proportions preferred each option. In regression models, sex, activity of daily living score, and past treatment experience were significantly associated with expressed preferences. Proxies expressed greater preference for scheduled toileting than for diapers than patients did (P<.001). Intraclass correlation coefficients indicated at most only slight to fair agreement between patients and most other groups; spouses showed moderate to almost perfect agreement with patients. CONCLUSION: Preferences of cognitively competent geriatric patients for treatment of UI differed from those of their potential proxies (other than spouses), which emphasizes the need for focused communication to properly elicit patient preferences to achieve appropriate treatment decisions.

Parameters of bladder function in pre-, peri-, and postmenopausal continent women without detrusor overactivity.

AIMS: To determine normative data for lower urinary tract function in asymptomatic continent women without detrusor overactivity (DO) across the age span. METHODS: Healthy female volunteers aged > or =20 years were recruited from the community. Comprehensive assessment included bladder diary, physical examination, uroflowmetry, and video-urodynamics. Continent women without history of frequent urgency and without DO were selected. Data on bladder storage, voiding and urethral sphincter function, urine output and frequency are presented for pre-, peri-, and postmenopausal women. RESULTS: Twenty-four asymptomatic women (mean age 50.2 years, range 22-80 years) met the inclusion criteria, including 7 pre- (29.2 years), 7 peri- (48.8 years), and 10 postmenopausal (66.0 years) women. For all subjects, maximum single voided volume in bladder diary was 500 ml and maximum cystometric capacity was 580 ml (median values). Strong desire to void (SDV) was reported at 287, 366, and 425 ml for pre-, peri-, and postmenopausal groups, respectively. The maximum flow rate was 25, 32, and 23 ml/sec in uroflowmetry and 23, 24, and 18 ml/sec in pressure-flow study, respectively. Median post-void residual volume (PVR) was below 20 ml in all groups. At maximum flow rate subjects voided with detrusor pressures of 29, 26, and 24 cm H(2)O, respectively. Maximum urethral closure pressure was 94, 74, and 42 cm H(2)O, respectively. CONCLUSIONS: We provide normative data on bladder function in asymptomatic, continent, pre-, peri-, and postmenopausal women without DO.

The impact of detrusor overactivity on bladder function in younger and older women.

PURPOSE: We examined the relationship of DO and aging, and bladder function in female volunteers. MATERIALS AND METHODS: We recruited 85 cognitively competent, fully functional female volunteers who were 22 to 90 years old (median age 54) with and without symptoms suggestive of DO. Comprehensive assessment included a bladder diary, uroflowmetry and videourodynamics. We examined predefined urodynamic and diary variables for associations with DO and age, summarizing results in the 3 subgroups no DO, intermediate DO and clinically relevant DO. RESULTS: Compared to women without DO those with DO showed a decrease in maximum cystometric capacity (558 vs 448 ml), mean daytime voided volume (260 vs 175 ml) and volume at strong desire to void (363 vs 283 ml) but an increase in maximum isovolumetric pressure (41 vs 64 cm H2O) and maximum detrusor pressure during involuntary contraction (intermediate and relevant DO 22 and 37 cm H2O, respectively). The positive association between increased detrusor contraction strength and DO was present at younger ages but absent in older subjects. Maximum urethral closure pressure and detrusor contraction strength decreased significantly with age. CONCLUSIONS: From young adulthood to old age DO appears to affect bladder function parameters. It is associated with decreased bladder capacity and increased bladder sensation. Moreover, in younger adults DO is also associated with increased detrusor contraction strength, which is an association not seen in older individuals. This age associated loss of muscle function may be related to sarcopenia, implying that different treatments may be appropriate in older adults.