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Incontinence in the elderly, 'normal' ageing, or unaddressed pathology?

Nature Reviews Urology volume 14, pages 440–448 (2017)Cite this article

Subjects

Key Points

  • Lower urinary tract symptoms (LUTS), including incontinence, are highly prevalent among both community-dwelling and institutionalised older adults, with the prevalence increasing with older age

  • Age-related physiological changes in both the lower urinary tract and the CNS might contribute to this rise

  • The degree to which these changes are related to pathology or to 'normal ageing', however this is defined, is unclear

  • Data from animal and human models, both cross-sectional and longitudinal, would support the idea that LUTS in older people reflect pathology, not an inevitable part of the ageing process

  • LUTS in older adults are amenable to treatment, and active case-finding and appropriate investigation can lead to significant improvements in quality of life

Abstract

The prevalence of urinary incontinence and other lower urinary tract symptoms (LUTS) increases in association with increasing age. This effect is more noticeable in men after the seventh decade of life and, in women, postmenopausally. However, the changes in the lower urinary tract, peripheral nervous system and central nervous system that underpin this observation are both multifactorial and inadequately understood; much debate exists regarding whether these observed changes are pathological or are a part of the 'normal' ageing process; with both health professionals and older people often holding the view that incontinence is an expected part of normal ageing. Here we aim to summarize the current level of knowledge regarding the physiological and hormonal changes that take place during the ageing process and discuss whether the occurrence of urinary incontinence or other LUTS in later life better reflect part of the 'normal' ageing process or the presence of unaddressed pathology.

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Figure 1: Changes in LUT function associated with ageing.
Figure 2: White matter hyperintensities.

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  1. Division of Geriatric Medicine, Department of Medicine, University of Alberta, 1–198 Clinical Sciences Building, 11350–11383 Avenue, Edmonton, T6G 2P4, Alberta, Canada

    William Gibson & Adrian Wagg

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W.G. declares that he has acted as a consultant of Astellas. A.W. declares that he has acted as a consultant of, or speaker for, Astellas, Pfizer and SCA AB.

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Gibson, W., Wagg, A. Incontinence in the elderly, 'normal' ageing, or unaddressed pathology?. Nat Rev Urol 14, 440–448 (2017). https://doi.org/10.1038/nrurol.2017.53

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