In elderly patients, urinary incontinence commonly follows any loss or impairment of urinary sphincter control. The incontinence may be transient or permanent. In all, about 10 million adults experience some form of urinary incontinence; this includes about 50% of the 1.5 million people in extended-care facilities.

Contrary to popular opinion, urinary incontinence is neither a disease nor a part of normal aging. It isn’t inevitable and can be avoided or reversed with support and interventions. Incontinence may be caused by childbirth, confusion, dehydration, fecal impaction, or restricted mobility. It’s also a sign of various disorders, such as prostatic hyperplasia, bladder calculus, bladder cancer, urinary tract infection (UTI), stroke, diabetic neuropathy, Guillain-Barré syndrome, multiple sclerosis, prostatic cancer, prostatitis, spinal cord injury, and urethral stricture. It may also result from urethral sphincter damage after prostatectomy. In addition, certain drugs, including diuretics, hypnotics, sedatives, anticholinergics, antihypertensives, and alpha antagonists, may trigger urinary incontinence.

Urinary incontinence is classified as acute or chronic. Acute urinary incontinence results from disorders that are potentially reversible, such as delirium, dehydration, urine retention, restricted mobility, fecal impaction, infection or inflammation, drug reactions, and polyuria. Chronic urinary incontinence occurs as four distinct types: stress, overflow, urge, and functional (total) incontinence.

With stress incontinence, leakage results from a sudden physical strain, such as a sneeze, cough, or quick movement. With overflow incontinence, urine retention causes dribbling because the distended bladder can’t contract strongly enough to force a urine stream. With urge incontinence, the patient can’t control the impulse to urinate. Finally, with functional incontinence, urine leakage occurs despite the fact that the bladder and urethra are functioning normally and is usually related to cognitive or mobility factors.

Patients with urinary incontinence should be carefully assessed for underlying disorders. Most can be treated; some can even be cured. Treatment aims to control the condition through bladder retraining or other behavioral management techniques, diet modification, drug therapy, pessaries and, possibly, surgery.
Corrective surgery for urinary incontinence includes transurethral resection of the prostate in men, urethral collagen injections for men or women, repair of the anterior vaginal wall or retropelvic suspension of the bladder in women, urethral sling, and bladder augmentation. (See Artificial urinary sphincter implant.)