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Incontinence

CME credit available from Harvard Medical School through April 2018.

Published Materials

The primary goal of this educational program is to help healthcare providers evaluate and manage patients with urinary incontinence.

Over 14 million older Americans have urinary incontinence, with twice as many women than men diagnosed.1 However, many patients are unwilling to discuss their symptoms, with a recent study finding that three-quarters of patients with incontinence don’t seek care.2

Figure 1: Despite the high prevalence of incontinence, most patients do not seek or receive care.2

seeking treatment for urinary incontinence

Figure 2: Patients with incontinence are at risk of increases in important clinical events.3-5

incontinence increases risk of other problems

Using a single question to ask about urinary incontinence can improve patient outcomes.6 The management of incontinence requires the diagnosis of the type of incontinence. A bladder diary can help identify the type of incontinence: stress, urgency or mixed.

Figure 3: Algorithm for detecting and addressing incontinence

detecting incontinence

Urinary incontinence is managed by behavioral and pharmacologic interventions. First-line options include behavioral interventions such as weight loss, pelvic floor muscle training and/or bladder training, while medications are reserved as a second line treatment. In mixed incontinence, treatment should be matched to the predominant symptom. While there is significantly more data available regarding treatment options for women, management of incontinence in men is similar.

Table 1. Evidence overview of interventions to treat incontinence

urinary incontinence intervention


Links for Providers
Links for Patients

Information current at time of publication, April 2015.

The content of this website is educational in nature and includes general recommendations only; specific clinical decisions should only be made by a treating physician based on the individual patient’s clinical condition.


References
  1. Centers for Disease Control & Prevention. Medicare beneficiaries suffering urinary incontinence. 2012;http://www.cdc.gov/nchs/hdi.htm. Accessed 2-11-15, 2015.
  2. Minassian VA, Yan X, Lichtenfeld MJ, Sun H, Stewart WF. The iceberg of health care utilization in women with urinary incontinence.Int Urogynecol J. 2012;23(8):1087-1093.
  3. Thom DH, Haan MN, Van Den Eeden SK. Medically recognized urinary incontinence and risks of hospitalization, nursing home admission and mortality. Age Ageing.1997;26(5):367-374.
  4. Melville JL, Delaney K, Newton K, Katon W. Incontinence severity and major depression in incontinent women. Obstet Gynecol.2005;106(3):585-592.
  5. Chiarelli PE, Mackenzie LA, Osmotherly PG. Urinary incontinence is associated with an increase in falls: a systematic review. Aust J Physiother. 2009;55(2):89-95.
  6. Wenger NS, Roth CP, Shekelle PG, et al. A practice-based intervention to improve primary care for falls, urinary incontinence, and dementia. J Am Geriatr Soc. 2009;57(3):547-555.