Urinary incontinence for the primary care physician.

This article reviews the recent data on the etiology, evaluation, and treatment of urinary incontinence in older adults. While urinary incontinence remains a major problem for older people, many of these patients never receive medical evaluation or treatment. The nonspecialist can make substantial inroads into incontinence by identifying affected patients, treating medical causes of incontinence effectively, and evaluating bladder and urethral function using simple techniques. While many patients may need referral, the cause of incontinence in most older adults can be identified and effectively treated by nonspecialists. Behavioral methods are becoming increasingly important in this effort. In office practice, up to 80% of all patients will respond with decreases in incontinence of at least 50%. Controlled studies indicate between one third and one half of nursing home patients will be equally improved. Consequently, there is good reason for substantial optimism with this problem.