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Current Geriatrics Reports
Published in: Current Geriatrics Reports 2/2022

01-06-2022 | Stress Incontinence | Geriatric Urology (H Richter and C Parker-Autry, Section Editors)

Challenges and New Insights in the Management of Urinary Incontinence in Older Women

Authors: Isuzu Meyer, Holly E. Richter

Published in: Current Geriatrics Reports | Issue 2/2022

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Abstract

Purpose of Review

This article highlights the potential challenges in the management of urinary incontinence in older women.

Recent Findings

Urinary incontinence is a highly prevalent condition associated with profound morbidity and psychosocial consequences especially among older women. Simple conservative approaches including life-style modification and behavioral management can be quite effective in improving urinary incontinence symptoms. However, options beyond first-line management are limited due to adverse effects related to medications or surgery.

Summary

Urinary incontinence is a multifactorial condition in older women, and management is often complicated given multiple comorbidities and unique physiologic changes related to aging. The management should be individualized based on the patient's clinical history and goals of therapy. More research is needed to overcome current challenges associated with the management of urinary incontinence in older women. A treatment algorithm that provides safe yet effective treatment options specifically tailored to older women is needed.
Literature
1.
2.
Schnelle JF, Leung FW. Urinary and fecal incontinence in nursing homes. Gastroenterology. 2004;126(1 Suppl 1):S41–7.PubMedCrossRef
3.
Thom DH, Haan MN, Van Den Eeden SK. Medically recognized urinary incontinence and risks of hospitalization, nursing home admission and mortality. Age Ageing. 1997;26(5):367–74.PubMedCrossRef
4.
Morrison A, Levy R. Fraction of nursing home admissions attributable to urinary incontinence. Value Health. 2006;9(4):272–4.PubMedCrossRef
5.
Lobchuk MM, Rosenberg F. A qualitative analysis of individual and family caregiver responses to the impact of urinary incontinence on quality of life. J Wound Ostomy Continence Nurs. 2014;41(6):589–96.PubMedCrossRef
6.
Luo X, et al. Prevalence, management and outcomes of medically complex vulnerable elderly patients with urinary incontinence in the United States. Int J Clin Pract. 2015;69(12):1517–24.PubMedPubMedCentralCrossRef
7.
Lussier M, et al. Are stress and mixed urinary incontinence associated with impaired executive control in community-dwelling older women? J Clin Exp Neuropsychol. 2013;35(5):445–54.PubMedCrossRef
8.
Melville JL, et al. Major depression and urinary incontinence in women: temporal associations in an epidemiologic sample. Am J Obstet Gynecol. 2009;201(5):490.e1–7.CrossRef
9.
National Academies of Sciences, Engineering, and Medicine. Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System. Washington, DC: The National Academies Press; 2020.
10.
Horrocks S, et al. What prevents older people from seeking treatment for urinary incontinence? A qualitative exploration of barriers to the use of community continence services. Fam Pract. 2004;21(6):689–96.PubMedCrossRef
11.
Dumoulin C, Cacciari LP, Hay-Smith EJC. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. 2018;10:CD005654.PubMed
12.
13.
Chiarelli PE, Mackenzie LA, Osmotherly PG. Urinary incontinence is associated with an increase in falls: a systematic review. Aust J Physiother. 2009;55(2):89–95.PubMedCrossRef
14.
Wagner TH, et al. Health-related consequences of overactive bladder. Am J Manag Care. 2002;8(19 Suppl):S598-607.PubMed
15.
Brown JS, et al. Urinary incontinence: does it increase risk for falls and fractures? Study of Osteoporotic Fractures Research Group. J Am Geriatr Soc. 2000;48(7):721–5.PubMedCrossRef
16.
Hung CH, Wang CJ, Tang TC, et al. Recurrent falls and its risk factors among older men living in the veterans retirement communities: a cross-sectional study. Arch Gerontol Geriatr. 2017;70:214–8.PubMedCrossRef
17.
Tinetti ME, Williams CS. The effect of falls and fall injuries on functioning in community-dwelling older persons. J Gerontol A Biol Sci Med Sci. 1998;53(2):M112–9.PubMedCrossRef
18.
Gill TM, et al. Association of injurious falls with disability outcomes and nursing home admissions in community-living older persons. Am J Epidemiol. 2013;178(3):418–25.PubMedPubMedCentralCrossRef
19.
Fischer S, et al. Estimating the long-term functional burden of osteoporosis-related fractures. Osteoporos Int. 2017;28(10):2843–51.PubMedCrossRef
20.
Singer A, et al. Burden of illness for osteoporotic fractures compared with other serious diseases among postmenopausal women in the United States. Mayo Clin Proc. 2015;90(1):53–62.PubMedCrossRef
21.
22.
Abreu HC, et al. Urinary incontinence in the prediction of falls in hospitalized elderly. Rev Esc Enferm USP. 2014;48(5):851–6.PubMedCrossRef
23.
Foley AL, et al. Association between the Geriatric Giants of urinary incontinence and falls in older people using data from the Leicestershire MRC Incontinence Study. Age Ageing. 2012;41(1):35–40.PubMedCrossRef
24.
• Gibson W, et al. The association between lower urinary tract symptoms and falls: Forming a theoretical model for a research agenda. Neurourol Urodyn. 2018;37(1):501–9. This article describes the significant association between urinary symptoms and falls in older adults, which are highly prevalent and debilitating conditions recognized as geriatric syndromes. However, the underlying mechanism is not well-understood, highlighting a potential area of future research.
25.
Sakushima K, et al. Influence of urinary urgency and other urinary disturbances on falls in Parkinson’s disease. J Neurol Sci. 2016;360:153–7.PubMedCrossRef
26.
Edwards R, Hunter K, Wagg A. Lower urinary tract symptoms and falls in older women: a case control study. Maturitas. 2015;80(3):308–11.PubMedCrossRef
27.
DuBeau CE, et al. Incontinence in the frail elderly: report from the 4th International Consultation on Incontinence. Neurourol Urodyn. 2010;29(1):165–78.PubMedCrossRef
28.
• Khanijow KD, et al. Barriers to Exercise Among Women With Urgency Urinary Incontinence: Patient and Provider Perspectives. Female Pelvic Med Reconstr Surg. 2018;24(4):301–6. Urinary incontinence has tremendous negative psychosocial impact on older women. This article describes barriers to exercise in older women with urgency urinary incontinence both from the patients and providers’ perspectives.
29.
Greer JA, et al. Urinary incontinence and disability in community-dwelling women: a cross-sectional study. Neurourol Urodyn. 2015;34(6):539–43.PubMedCrossRef
30.
Suskind AM, et al. Urinary Incontinence in Older Women: The Role of Body Composition and Muscle Strength: From the Health, Aging, and Body Composition Study. J Am Geriatr Soc. 2017;65(1):42–50.PubMedCrossRef
31.
• Meyer I, et al. Pelvic floor disorder symptoms and bone strength in postmenopausal women. Int Urogynecol J. 2020;31(9):1777–84. This study characterizes the association between urinary incontinence and bone strength, reflecting potential connective tissue pathophysiology in postmenopausal women.
32.
Bresee C, et al. Prevalence and correlates of urinary incontinence among older community-dwelling women. Female Pelvic Med Reconstr Surg. 2014;20(6):328–33.PubMedPubMedCentralCrossRef
33.
Danforth KN, et al. Physical activity and urinary incontinence among healthy, older women. Obstet Gynecol. 2007;109(3):721–7.PubMedCrossRef
34.
Tak EC, et al. Does improved functional performance help to reduce urinary incontinence in institutionalized older women? A multicenter randomized clinical trial. BMC Geriatr. 2012;12:51.PubMedPubMedCentralCrossRef
35.
Maas H, Sandercock TG. Force transmission between synergistic skeletal muscles through connective tissue linkages. J Biomed Biotechnol. 2010;2010:575672.PubMedPubMedCentralCrossRef
36.
Tuttle LJ, et al. Architectural design of the pelvic floor is consistent with muscle functional subspecialization. Int Urogynecol J. 2014;25(2):205–12.PubMedCrossRef
37.
Tuttle LJ, et al. Hip exercises improve intravaginal squeeze pressure in older women. Physiother Theory Pract. 2020;36(12):1340–7.PubMedCrossRef
38.
Tuttle LJ, DeLozier E, Harter KA, et al. The Role of the Obturator Internus Muscle in Pelvic Floor Function. J Women Health Phys Ther. 2016;40(1):15–9.CrossRef
39.
40.
Shamliyan T, et al. Benefits and harms of pharmacologic treatment for urinary incontinence in women: a systematic review. Ann Intern Med. 2012;156(12):861–74.PubMedCrossRef
41.
•• Coupland CAC, et al. Anticholinergic Drug Exposure and the Risk of Dementia: A Nested Case-Control Study. JAMA Intern Med. 2019. There is a growing evidence suggesting the association between dementia and anticholinergic drugs, which are commonly used to treat adults with urgency urinary incontinence. This article aims to assess association between cumulative anticholinergic drug exposure and risk of dementia in older adults.
42.
43.
Wagg A, et al. The efficacy and tolerability of the beta3-adrenoceptor agonist mirabegron for the treatment of symptoms of overactive bladder in older patients. Age Ageing. 2014;43(5):666–75.PubMedCrossRef
44.
45.
Sebastianelli A, et al. Systematic review and meta-analysis on the efficacy and tolerability of mirabegron for the treatment of storage lower urinary tract symptoms/overactive bladder: Comparison with placebo and tolterodine. Int J Urol. 2018;25(3):196–205.PubMedCrossRef
46.
AUGS Consensus Statement. Association of Anticholinergic Medication Use and Cognition in Women With Overactive Bladder. Female Pelvic Med Reconstruc Surg. 2017;23(3):177–8.CrossRef
47.
•• Lightner DJ, et al. Diagnosis and Treatment of Overactive Bladder (Non-Neurogenic) in Adults: AUA/SUFU Guideline Amendment 2019. J Urol. 2019;202(3):558–63. This article provides the current practice guideline for the diagnosis and treatment of overactive bladder and urgency urinary incontinence in adults.
48.
Farrell SA, Singh B, Aldakhil L. Continence pessaries in the management of urinary incontinence in women. J Obstet Gynaecol Can. 2004;26(2):113–7.PubMedCrossRef
49.
Moore KH, et al. An open study of the bladder neck support prosthesis in genuine stress incontinence. Br J Obstet Gynaecol. 1999;106(1):42–9.PubMedCrossRef
50.
Lone F, Thakar R, Sultan AH. One-year prospective comparison of vaginal pessaries and surgery for pelvic organ prolapse using the validated ICIQ-VS and ICIQ-UI (SF) questionnaires. Int Urogynecol J. 2015;26(9):1305–12.PubMedCrossRef
51.
Clemons JL, et al. Patient characteristics that are associated with continued pessary use versus surgery after 1 year. Am J Obstet Gynecol. 2004;191(1):159–64.PubMedCrossRef
52.
Sarma S, Ying T, Moore KH. Long-term vaginal ring pessary use: discontinuation rates and adverse events. BJOG. 2009;116(13):1715–21.PubMedCrossRef
53.
Nitti VW, et al. Durable Efficacy and Safety of Long-Term OnabotulinumtoxinA Treatment in Patients with Overactive Bladder Syndrome: Final Results of a 3.5-Year Study. J Urol. 2016;196(3):791–800.PubMedCrossRef
54.
Chohan N, et al. Efficacy and duration of response to botulinum neurotoxin A (onabotulinumA) as a treatment for detrusor overactivity in women. Int Urogynecol J. 2015;26(11):1605–12.PubMedCrossRef
55.
Amundsen CL, et al. OnabotulinumtoxinA vs Sacral Neuromodulation on Refractory Urgency Urinary Incontinence in Women: A Randomized Clinical Trial. JAMA. 2016;316(13):1366–74.PubMedPubMedCentralCrossRef
56.
Visco AG, et al. Anticholinergic versus botulinum toxin A comparison trial for the treatment of bothersome urge urinary incontinence: ABC trial. Contemp Clin Trials. 2012;33(1):184–96.PubMedCrossRef
57.
58.
Moossdorff-Steinhauser HF, Berghmans B. Effects of percutaneous tibial nerve stimulation on adult patients with overactive bladder syndrome: a systematic review. Neurourol Urodyn. 2013;32(3):206–14.PubMedCrossRef
59.
Burton C, Sajja A, Latthe PM. Effectiveness of percutaneous posterior tibial nerve stimulation for overactive bladder: a systematic review and meta-analysis. Neurourol Urodyn. 2012;31(8):1206–16.PubMedCrossRef
60.
Gormley EA, et al. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline. J Urol. 2012;188(6 Suppl):2455–63.PubMedCrossRef
61.
• Komesu YM, et al. Refractory urgency urinary incontinence treatment in women: impact of age on outcomes and complications. Am J Obstet Gynecol. 2018;218(1):111.e1–9. Urgency urinary incontinence is prevalent yet often difficult to treat. This study compares treatment efficacy and safety in younger versus older women with refractory urgency urinary incontinence undergoing third-line treatment.
62.
Cohen BL, et al. Predictors of response to intradetrusor botulinum toxin-A injections in patients with idiopathic overactive bladder. Adv Urol. 2009;328364.
63.
Amundsen CL, et al. Sacral neuromodulation for intractable urge incontinence: are there factors associated with cure? Urology. 2005;66(4):746–50.PubMedCrossRef
Metadata
Title
Challenges and New Insights in the Management of Urinary Incontinence in Older Women
Authors
Isuzu Meyer
Holly E. Richter
Publication date
01-06-2022
Publisher
Springer US
Published in
Current Geriatrics Reports / Issue 2/2022
Electronic ISSN: 2196-7865
DOI
https://doi.org/10.1007/s13670-022-00375-z

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