Urinary incontinence

Urinary incontinence afflicts 15-30% of elderly people living at home, one-third of those in acute-care settings, and half of those in long-term care institutions.1,2 Medically, it predisposes to perineal rashes, pressure ulcers, urinary tract infections, urosepsis, falls, and fractures. Psychosocially, urinary incontinence is associated with embarrassment, stigmatisation, isolation, depression, and with the risk of institutionalisation.3,4 And economically, the costs are startling; in the United States in 1987 over $10 billion was spent on managing incontinence,1 more than the amount spent on dialysis and coronary-artery-bypass surgery combined. Although providers and older patients often neglect incontinence or dismiss it as a normal part of ageing,3,5-7 incontinence is abnormal at any age, and it is treatable and often curable even in frail individuals.1,2,8,9 However, success requires an understanding of the impact of both normal ageing on the genitourinary system and of factors outside the urinary tract.