A careful history by the doctor and bedside investigation of urine flow (urodynamics) are necessary:
The patient empties their bladder and then, lying on the examination table with a bedpan underneath them, is asked to cough. Loss of urine indicates stress incontinence. The patient is then catheterized and urine drained. If there is more than 100 cc, the person has overflow incontinence. A 50 cc syringe is then attached to the catheter and the bladder is filled with normal saline. The patient is asked to indicate when the first urge to urinate is felt. If this occurs before 300 cc or if it is accompanied by immediate, vigorous movement of the bubble in the syringe, the diagnosis is urge incontinence. When 400 cc of saline has been instituted into the bladder, the catheter is removed and the person is asked to cough again. Loss of urine = stress incontinence. The patient is then asked to void into a container. If greater than 100 cc, then overflow incontinence is diagnosed.
Management of Incontinence
Table 1 below provides a useful summary of the treatments for various types of incontinence.
Finally, remember that many older persons develop DHIC (detrusor hypercontractibility and impaired contraction), a combination of urge and neurogenic incontinence. Treatment depends on needs of patient, e.g., if being wet during the day is unacceptable, then oxybutynin is given in the morning and bethanechol in the evening.
Urinary incontinence is a straightforward condition, its cause easily identified and treated. Treatment can have a major impact on the older person's quality of life. Proactive preventive Kegel exercises may be helpful.