Summary
For persons aged 65 and over living in the community, the prevalence of urinary incontinence has been estimated at between 10 and 15%. Urinary incontinence affects up to 33% of patients in acute care hospitals and up to 60% in nursing homes.
Primary care physicians need to be aware of the reluctance of patients to discuss and reveal their lack of continence. Some estimates suggest up to one-third of patients with incontinence do not seek help.
Behavioural therapies, pharmaceutical treatments, surgery and bulking injections have all been successful in the management of urinary incontinence though there appear to be few data on their comparative effectiveness.
Behavioural therapies are generally non-invasive and often successful for patients with adequate cognitive powers. The success of behavioural therapies, as applied in nursing homes, depends on the design of the protocols and the ability of management to motivate those who implement the program.
Collagen implant treatment has shown promising results, although there is a need for data to establish long-term outcomes. Collagen implant treatment has the advantage of being a one-day procedure, and surgery is not precluded should the implantation fail.
Several surgical procedures and prostheses are available for treatment of fecal incontinence.
Urinary and fecal incontinence cause major distress for patients and have considerable cost implications for hospitals and nursing homes. Home carers have considerable difficulty coping with the incontinent elderly, which may be a contributing factor in their decision to place the elderly person concerned in institutional care.
There remains considerable scope for research on incontinence and its management, and on the costs and effectiveness of available treatments.