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Care of the Aging Patient: From Evidence to Action | Clinician's Corner

Incontinence in Older Women

Patricia S. Goode, MSN, MD; Kathryn L. Burgio, PhD; Holly E. Richter, PhD, MD; Alayne D. Markland, DO, MSc
JAMA. 2010;303(21):2172-2181. doi:10.1001/jama.2010.749.
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Urinary incontinence is a common geriatric syndrome that affects at least 1 in 3 older women and can greatly diminish quality of life. Incontinence has been associated with increased social isolation, falls, fractures, and admission to long-term care facilities. Often unreported and thus untreated, it is important to include incontinence as part of the review of systems for all older women. Using the case of Mrs F, we highlight the chronicity of incontinence and discuss the evidence base for evaluation of incontinence in older women, with proper initial diagnosis of the type of incontinence—stress, urgency, or mixed—in order to prescribe optimal treatment. We present an evidence-based discussion of available incontinence treatments including pelvic floor muscle exercises, stress strategies, urge-suppression strategies, fluid management, medications, intravaginal pessaries, intravesical injection of botulinum toxin, percutaneous tibial nerve stimulation, sacral neuromodulation, and surgical procedures for stress incontinence. Special considerations in evaluation and treatment of patients with dementia are presented. Urinary incontinence treatments yield high levels of patient satisfaction and improvements in quality of life.

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Figure. Step-Wise Approach to Treatment of Urinary Incontinence in Older Women
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