Urinary Incontinence in Older Adults

By Lacey Salberg, PT, DPT, Outreach Physical Therapist

Is urinary incontinence (UI) a health problem that Physical Therapists can address? The answer is yes! While UI may be a common symptom among older people, it is not an inevitable part of aging. According to a 2015 systematic review by Stenzelius et al., the prevalence of UI is ~30-40% among persons over 65 years of age living in their own homes. The consequences of urinary incontinence are vast — including decreased quality of life, associated urinary infections, dependency, sleep disturbances, and low sense of dignity. Because of the rapidly aging population in the USA, there are more people than ever who face a risk of UI and its associated psychosocial and economic burdens. Despite the consequences, many individuals do not seek help for their symptoms due to embarrassment or lack of awareness about treatment options.

Stenzelius’s systematic review included 23 studies, with a total of 13 used for final analysis. Its purpose was to evaluate the effectiveness of conservative interventions on urinary leakage episodes and quality of life in older and frail older persons. The interventions that showed significant impact on these two factors were pelvic floor muscle exercise, physical training in combination with ADL training, prompted voiding, attention training and “help to toilet.” Patient education helped to decrease the frequency of micturition during the day, but not at night. It also had a positive (yet not significant) effect on people’s ability to find toilets and the frequency of changing clothes and protective pads. None of the included studies reported any adverse events.

As Physical Therapists, we are experts on the human movement system and possess the unique skill set to address this widely prevalent health issue. We also often have ample time and the strong patient rapport needed to address these topics with empathy and sensitivity. Pelvic floor dysfunction is indeed within our scope of practice, whether it is cueing someone on how to appropriately activate their pelvic floor, setting up bladder diaries and voiding schedules, or decreasing barriers to commodes/toilets. When evaluating patients, it is important to consider the entire patient and to remember that anatomy does not end below the belt. For more information on how to treat concepts related to the pelvic floor, visit leading bodies such as the APTA and the Herman & Wallace Institute.

Stenzelius, K., Molander, U., Odeberg, J., Hammarström, M., Franzen, K., Midlöv, P., Samuelsson, E., & Andersson, G. (2015). The effect of conservative treatment of urinary incontinence among older and frail older people: a systematic review. Age and ageing, 44(5), 736–744. https://doi.org/10.1093/ageing/afv070