Genitourinary Disorders:
Urinary Incontinence: in older adults is multifactorial, resulting from interactions between LUT
abnormalities, neuro logic
... [Show More] control of voiding, meds, functional impairments, and multimorbidity.
o 15%-30% in the community
o 50% among the homebound
o 70% in nursing homes.
o More common in men
o Severity of UI increases with age.
o Urgency is the most common type of UI in older adults.
o At least half of older patients with UI wont mention it to their providers and think that it
is part of normal aging.
o Screen all patients annually for UI.
USPSTF: screen as part of an overall prevention recommendations for older
adults
WHO: routinely check for UI in older adults.
o Risk factor: falls, functional dependence, LE and UE weakness, sensory and affective
impairment, white matter signaling on MRI or CT scan brain, cognitive impairment.
Also, female gender, obesity, DM, stroke, depression, fecal incontinence,
hysterectomy.
Pts in nursing homes with UI are most likely have impaired mobility, dementia,
delirium, psychoactive meds.
Patho:
o Urge UI: inability to store urine because of uninhibited contractions of the bladder
muscle (detrusor).
o Stress UI: inability to store urine because of inadequate sphincter closure.
o Mixed: urge+stress
o Overflow incontinence: very uncommon in older adults.
o OAB: urgency, frequency, and nocturia.
o DHIC: detrusor hyperactivity with impaired contractility; in which urge UI coexists with
impaired detrusor contractility; elevated PVR.
Evaluation of UI:
o Determine which type of UI.
o Urogenital Distress Index-9: assess bothersome and QOL.
o Assess for LUT symptoms: insufficient emptying, postvoidal dribbling, slow stream,
hesitancy, frequency (can also be due to high fluid intake, caffeine, or alcohol).
o Assess functional impairment: can patient get to the toilet. Can use Timed up and GO.
o Assess for comorbidities,
o Abdominal examination is neither sensitive nor specific for detecting bladder distension.
o All women should have pelvic examination to check for vulvovaginal abnormalities.
Signs of vaginal mucosal atrophy: thinning, pallor, loss of rugae, urethral
caruncle, inflammation.
Check for organ prolapse. [Show Less]