Evaluation and management of urinary incontinence in older patients.

The training of health care providers in the diagnosis and management of urinary incontinence is inadequate, and evaluation and management skills are less than optimal. Urinary incontinence volume measurement is difficult to perform accurately in elderly long-term-care inpatients. After incontinence has been noted, the physician needs to select the appropriate studies to determine the cause and choose the correct treatment. Otherwise, treatable causes such as outlet obstruction or fecal impaction may be missed. Subsequent management includes scheduled visits to the toilet, treatment of impaired mobility, use of easily identified and accessible toilet facilities, reevaluation of the need for restraints and side rails, and, if appropriate, the use of drugs to treat the incontinence. Many elderly incontinent patients who are treated in the outpatient setting can be cured or substantially improved.