Urinary incontinence is a major geriatric syndrome with significant morbidity and even mortality. However, it is under-recognised and inadequately managed despite its impact and cost. Continence in the older person is maintained by the fine balance between the integrity of the lower urinary tract, the cognitive ability and motivation to keep dry, and adequate mobility and dexterity to void; impairment of any of the three can result in incontinence. The management of older persons with urinary incontinence involves, i) identifying and reversing transient incontinence, ii) excluding urinary retention, iii) deciding on the need of special tests (imaging, screening for malignancy, magnetic resonance imaging [MRI] for spinal cord, urodynamic assessment) to exclude sinister causes, and iv) deciding on the need to refer the specialist. With careful evaluation, continence in the older persons can be restored in most cases.
Urinary incontinence is the involuntary loss of urine which is objectively demonstrable and is a social or hygienic problem. Trivial as it may sound, it is in fact a major geriatric syndrome which may pose as major public health threat with increasing magnitude in this ageing society, due to its prevalence amongst older persons, its adverse impacts and the cost in dealing with this problem.
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