Incont Pelvic Floor Dysfunct 2008; 2(2):63-66 Review

Urinary Incontinence in

Der-Sheng Han, M.D., Yen-Ho Wang, M.D.1 Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation1, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

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SP Review

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Reversible causes of ÇêçãÉ=çê=ëíêçâÉ=ïáíÜ=äáãÄ=ïÉ~âåÉëë=íóéáÅ~ääó=Ü~îÉ=ÇáÑÑáÅìäíáÉë=áå=íÜáë ~êÉ~=xOVzK /Dementia Infection (UTI) bs^ir^qflk Atrophic urethritis and vaginitis Pharmaceuticals Psychiatric disorders (, alcoholism) håçïáåÖ=íÜÉ=Å~ìëÉë=çÑ=rf=áë=íÜÉ=âÉó=ëíÉé=íçï~êÇ=ëìÅÅÉëëÑìä Excess fluid (hyperglycemia, hypercalcemia, , , , ã~å~ÖÉãÉåíK=qÜÉ=Å~ìëÉë=çÑ=rf=áå=ÇÉãÉåíá~=~êÉ=ìëì~ääó=ãìäíáéäÉK=qÜÉ alcohol, congestive heart failure, edema) Ä~ëáÅ=Éî~äì~íáçå=áåÅäìÇÉë=~=ãÉÇáÅ~ä=ÜáëíçêóI=éÜóëáÅ~ä=Éñ~ãáå~íáçåI Restricted mobility éçëíîçáÇ=êÉëáÇì~ä=EmsoF=îçäìãÉ=ãÉ~ëìêÉãÉåíI=~åÇ=ìêáå~äóëáë=xNOzK Stool impaction (constipation)

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qÜáë=íÉÅÜåáèìÉ=áë=ëìáí~ÄäÉ=Ñçê=é~íáÉåíë=~ÄäÉ=íç=ÑÉÉä=~å=ìêÖÉ=ëÉåë~íáçå ~åÇ=íÜÉ=ÖÉåÉê~ä=ÜÉ~äíÜ=çÑ=é~íáÉåíëK=cìåÅíáçå~ä=ëí~íìë=~åÇ=~ÅíáîáíáÉë=çÑ ~åÇ=êÉèìÉëí=íçáäÉíáåÖ=~ëëáëí~åÅÉK=qÜÉ=Å~êÉÖáîÉê=ãìëí=çÄëÉêîÉ=Å~êÉJ Ç~áäó=äáÑÉ=~êÉ=ÅçåëáÇÉêÉÇ=ÑáêëíI=~åÇ=áåÅçåíáåÉåÅÉ=áíëÉäÑ=áë=äÉëë=áãéçêí~åíK Ñìääó=Ñçê=ëáÖåë=çÑ=åÉÉÇ=íç=îçáÇI=ëìÅÜ=~ë=êÉëíäÉëëåÉëëI=~åñáçìë=ÄÉÜ~îáçêI jìäíáÇáëÅáéäáå~êó=íÉ~ãJïçêâ=áë=ìëì~ääó=åÉÉÇÉÇ=íç=êÉ~ÅÜ=íÜÉ=ÄÉëí ÅêóáåÖI=ï~åÇÉêáåÖI=éêÉëëìêÉÇ=ëéÉÉÅÜI=~åÇ=íìÖÖáåÖ=çå=íÜÉ=íêçìëÉêëK çìíÅçãÉëK fÑ=é~íáÉåíë=Å~å=ÖáîÉ=ÅìÉë=Ñçê=îçáÇáåÖI=íÜÉ=Å~êÉÖáîÉê=ëÜçìäÇ=ÖáîÉ=~ éçëáíáîÉ=êÉëéçåëÉK obcbobk`bp PK _ä~ÇÇÉê=íê~áåáåÖW=fíë=~áã=áë=íç=íÉ~ÅÜ=éÉçéäÉ=íç=êÉëáëí=íÜÉ=ìêÖÉ=íç=îçáÇ ~åÇ=Öê~Çì~ääó=Éñé~åÇ=íÜÉ=áåíÉêî~ä=ÄÉíïÉÉå=îçáÇáåÖëK=fí=~äëç=ÅçåJ 1. Richter RW: Medical diagnosis and workup of Alzheimer's disease. ëáëíë=çÑ=~ÅíáîÉ=êÉÜ~Äáäáí~íáçå=~åÇ=ÉÇìÅ~íáçå=íÉÅÜåáèìÉë=xPRzK In: Richter RW, Richter BZ, eds., Alzheimer's disease: A physician's QK mÉäîáÅ=ãìëÅäÉ=êÉÜ~Äáäáí~íáçå=EéÉäîáÅ=ãìëÅäÉ=ÉñÉêÅáëÉI=ÄáçÑÉÉÇÄ~ÅâI guide to practical management. Totowa, Humana Press 2004, pp ÉäÉÅíêáÅ~ä=ëíáãìä~íáçåFW=^äíÜçìÖÜ=íÜÉëÉ=íÉÅÜåáèìÉë=~êÉ=ìëÉÇ=áå=é~J 75-87. 2. Herbert LE, Scherr PA, Bienias JL, Bennett DA, Evans DA: íáÉåíë=ïáíÜ=ëíêÉëë=áåÅçåíáåÉåÅÉI=íÜÉêÉ=áë=äáííäÉ=Ç~í~=íç=ëìééçêí=íÜÉáê Alzheimer's disease in the US population: Prevalence estimates ìëÉ=áå=é~íáÉåíë=ïáíÜ=ÇÉãÉåíá~=xPPzK using the 2000 census. Arch Neurol 2003; 60:1119-1122. RK bÇìÅ~íáçåW=qÜÉ=éìÄäáÅ=ëÜçìäÇ=ÄÉ=áåÑçêãÉÇ=íÜ~í=rf=áë=åçí=áåÉîáí~ÄäÉ=çê 3. Alzheimer's Disease International: Dementia in the Asia Pacific ëÜ~ãÉÑìäK=rf=áë=íêÉ~í~ÄäÉI=~åÇI=áÑ=åçíI=áí=áë=ã~å~ÖÉ~ÄäÉK=m~íáÉåí=ÉÇìJ region: The epidemic is here. Http://www.tada2002.org.tw, 2007. Å~íáçå=ëÜçìäÇ=ÄÉ=áåÇáîáÇì~äáòÉÇI==~åÇ=ëÜçìäÇ=áåîçäîÉ=Å~êÉÖáîÉêëK 4. Ballard C, Lowery K, Powell I, O'Brien J, James I: Impact of behav-

SR Review

ioral and psychological symptoms of dementia on caregivers. Int 23. O'Donnell BF, Drachman DA, Barnes HJ, Peterson KE, Swearer Psychogeriatr 2000; 12(Suppl):93-107. JM, Lew RA: Incontinence and troublesome behaviors predict insti- 5. American Psychiatric Association: Diagnostic and statistical manual tutionalization in dementia. J Geriatr Neurol 1992; 5:45- of mental disorders. Washington DC, American Psychiatric 52. Association, 2000. 24. Zorn BH, Montgomery H, Pieper K, Gray M, Steers WD: Urinary 6. Souder E, Chastain JR, Williams RD: Dementia in the new incontinence and depression. J Urol 1999; 162:82-84. millennium. Medsurg Nurs 2002; 11:61-69. 25. Nuotio M, Tammela TL, Luukkaala T, Jyiha M: Urgency and urge 7. National Institute of Neurological Disorders and Stroke. The incontinence in an older population: Ten-year changes and their dementia: Hope through research. Http://www.ninds.nih.gov/disor- association with mortality. Aging Clin Exp Res 2002; 14:412-419. ders//detail_dementias.htm, 2007. 26. Brocklehurst JC, Dillane JB: Studies of the female bladder in old 8. Peterson RC: Aging, mild cognitive impairment, and Alzheimer's age II: Cystometrograms in 100 incontinent women. Gerontol Clin disease. Neurol Clin 2000; 18:789-806. (Basel) 1966; 8:306-319. 9. Sadik K, Wilcock G: The increasing burden of Alzheimer disease. 27. Williams ME, Gaylord SA: Role of functional assessment in the Alzheimer Dis Assoc Disord 2003; 17(Suppl 3):75-79. evaluation of urinary incontinence. J Am Geriatr Soc 1990; 38:296- 10. Alzheimer's Association: Stages of Alzheimer's disease. Http://www. 299. alz.org/alzheimers_disease_stages_of_alzheimers.asp, 2007. 28. Resnick NM, Yalla SV: Detrusor hyperactivity with impaired con- 11. Abrams P, Cardozo L, Fall M, et al: The standardization of terminol- tractile function. An unrecognized but common cause of inconti- ogy of lower urinary tract function: Report from the standardization nence in elderly patients. JAMA 1987; 257:3076-3081. Sub-committee of the International Continence Society. Neurourol 29. Dubeau CE: The aging lower urinary tract. J Urol 2006; 175:S11- Urodyn 2002; 21:167-178. S15. 12. Erdem N, Serels S: Understanding and managing elderly patients 30. Fowler CJ: Integrated control of lower urinary tract - clinical with and urge urinary incontinence. Http://www. perspective. Br J Pharmacol 2006; 147(Suppl 2):S14-S24. geri.com/geriatrics/data/articlestandard/geriatrics/022005/141788/ 31. Bengtson J, Chapin MD, Kohli N, Loughlin KR, Seligson J, Gharib article.pdf, 2007. S: Urinary incontinence: Guide to diagnosis and management. Http:/ 13. Skelly J, Flint AJ: Urinary incontinence associated with dementia. J /www.guideline.gov/summary/summary.aspx?doc_id=6188&nbr= Am Geriatr Soc 1995; 43:286-294. 003987&string=incontinence. 2004. Brigham and Women's Hospital, 14. Campbell AJ, Reinken J, McCosh L: Incontinence in the elderly: 2007. Prevalence and prognosis. Age Ageing 1985; 14:65-70. 32. Gill SS, Mandani M, Naglie G et al: A prescribing cascade involving 15. Ouslander JG, Zarit SH, Orr NK, Muira SA: Incontinence among cholinesterase inhibitors and drugs. Arch Intern Med elderly community-dwelling dementia patients. Characteristics, 2005; 165:808-813. management, and impact on caregivers. J Am Geriatr Soc 1990; 33. Yap P, Tan D: Urinary incontinence in dementia-A practical 38:440-445. approach. Aust Fam Physician 2006; 35:237-241. 16. Del-Ser T, Munoz DG, Hachinski V: Temporal pattern of cognitive 34. Resnick NM, Yalla S: Evaluation and management of urinary decline and incontinence is different in Alzheimer's disease and dif- incontinence. In: Walsh PC, Retik AB, eds., Campbell's . fuse Lewy body disease. Neurology 1996; 46:682-686. Philadelphia, W. B. Saunders, 1998, p1045. 17. Nuotio M: Urgency and urge incontinence in the older population. 35. Fantl J, Newman DK, Colling J: et al. Overview: Urinary Inconti- Prevalence, associated factors and prognosis. University of nence in Adults: Clinical Practice Guideline Update. Http://www. Tampere, Finland. Thesis/Dissertation, 2003. ahcpr.gov/clinic/uiovervw.htm, 1996. Agency for Health Care Policy 18. Hannestad YS, Rortveit G, Sandvik H, Hunskaar S: Norwegian and Research, US Department of Health and Human Services. 2007. EPINCONT study. of Incontinence in the County of 36. Tong YC: Global view on urinary and fecal incontinence. Incont Pelvic Nord-Trondelag: A community-based epidemiological survey of fe- Floor Dysfunct 2007; 1:85-88. male urinary incontinence. J Clin Epidemiol 2000; 53:1150-1157. 37. Anderson RU, Mobley D, Blank B, Saltzstein D, Susset J, Brown 19. Stenzelius K, Mattiasson A, Hallberg IR, Westergren A: Symptoms JS: Once daily controlled versus immediate release chlo- of urinary and fecal incontinence among men 75+ and women in ride for urge urinary incontinence. OROS Oxybutynin Study Group. relations to health complaints and quality of life. Neurourol Urodyn J Urol 1999; 161:1809-1812. 2004; 23:211-222. 38. Wagg A, Cohen M: Medical therapy for the overactive bladder in 20. Wagner TH, Hu TW, Bentkover J, et al: Health-related consequences the elderly. Age Ageing 2002; 31:241-246. of overactive bladder. Am J Manag Care 2002; 8(Suppl 19):S598- 39. Gitlin LN, Corcoran MA: Appendix B. Examples of environmental S607. strategies for targeted management areas. In: Gitlin LN, Corcoran 21. Brown JS, Vittinghoff E, Wyman JF, et al: Urinary incontinence: Does MA, eds., Occupational therapy and dementia care. Bethesda, it increase risk for falls and fractures? Study of Osteoporotic Frac- American Occupational Therapy Association, Inc., 2005, pp 243- tures Research Group. J Am Geriatr Soc 2000; 48:721-725. 280. 22. Stewart WF, Van Rooyen JB, Cundiff GW, et al: Prevalence and 40. Brink CA: Absorbent pads, garments, and management strategies. burden of overactive bladder in the United States. World J Urol 2003; J Am Geriatr Soc 1990; 38:368-373. 20:327-336.

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