Classification

Urinary incontinence is best classified according to aetiology as shown in Table 49.6. There are a number of additional causes of urinary incontinence in elderly woman (Table 49.7), many of which can be reversed by appropriate intervention.

More recently the term Overactive Bladder (OAB) has been introduced to describe the symptom complex of urgency with, or without urge incontinence, usually with

Table 49.6 Causes of urinary incontinence in women

Urodynamic stress incontinence (urethral sphincter incompetence) Detrusor overactivity (neurogenic detrusor overactivity) Overactive bladder Retention with overflow

Fistulae - vesicovaginal, ureterovaginal, urethrovaginal, complex

Congenital abnormalities, e.g. epispadias, ectopic ureter, spina bifida occulta Urethral diverticulum

Temporary, for example, urinary tract infection, faecal impaction Functional, for example, immobility

Table 49.7 Causes of incontinence in the elderly - many of which may be transient

Infection (e.g. urinary tract infection)

Confusional states (e.g. dementia)

Faecal impaction

Oestrogen deficiency

Restricted mobility

Depression

Drug therapy (e.g. diuretics) Endocrine disorder (e.g. diabetes) Limited independence frequency and nocturia [2]. Recent epidemiological studies have reported the overall prevalence of OAB in women to be 16.9% suggesting that there could be 17.5 million women in the United States of America who suffer from the condition. The prevalence increases with age, being 4.8% in women under 25 years to 30.9% in those over the age of 65 years [17]. This is supported by recent prevalence data from Europe in which 16,776 interviews were conducted in a population based survey [42]. The overall prevalence of overactive bladder in individuals 40 years and above was 16.6% and increased with age. Frequency was the most commonly reported symptom (85%) whilst 54% complained of urgency and 36% urge incontinence. When considering management 60% had consulted a physician although only 27% were currently receiving treatment.

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