It is a common disorder in older people; It is estimated that close to 15% of the population over 65 years of age in the community and more than 50% of institutionalized people present it (in fact, it is the second reason for institutionalization). It is more frequent in women than in men and, contrary to what is usually assumed, it is not exclusive to deteriorated or highly disabled people, but also appears in people with good mental function and who are independent.
Although in itself it is not a serious health problem, it is true that its presence entails serious management problems, limits autonomy, deteriorates personal image, alters the social life of the people who suffer from it and significantly impairs the quality of life. In addition, it contributes to the development of pressure ulcers , urinary tract infections and depression . Due to its frequency and repercussion, urinary incontinence is one of the main geriatric syndromes and should be actively sought and studied in the comprehensive geriatric assessment.
There is no doubt that aging conditions a series of changes both at the level of the nervous system (central, autonomic, sympathetic and parasympathetic) and its innervation, as well as at the level of the lower urinary tract (bladder, urethra) and the genital system (prostate, vagina). ), which may interfere with the normal performance of the micturition act, having its origin at different levels: lower urinary tract, nervous system responsible for the control and coordination of micturition, mechanism of urine production, perception of micturition desire or ability to access the bathroom and carry out the basic activities of daily living.
Contrary to what one may think, urinary incontinence is not normal with aging, but rather a problem caused by some type of medical or functional disorder. Its assessment and treatment are very simple and effective, with rates of cure or improvement up to 75% of cases. When cure is not possible, it can be treated in ways that increase the well-being of the patient, facilitate the work of caregivers, and minimize costs and complications. One of the factors that largely determines the prognosis of urinary incontinence is the motivation and attitude of the professionals. The appropriate approach is to promote continence and treat incontinence based on its causes and not just avoid wetting clothes and bedding with the use of absorbents.
It is known that for every recognized case in primary care there are 20 cases that are not. Other studies show that almost two thirds of patients suffer from incontinence for more than 2 years before consulting a specialist for the first time and that only one third of incontinence cases are investigated. There are several reasons that can explain this:
- Too often, urinary incontinence is considered, both by professionals and by the patients or family members, a normal and inevitable consequence of aging or something specific to women.
- There is a widespread belief that it is more of a nuisance than a real health problem.
- Patients may have little confidence that the problem will be resolved by the healthcare team, fear troublesome diagnostic studies, or be ashamed to acknowledge the problem.
- There is a great lack of knowledge about the diagnosis and treatment on the part of health professionals, which generates a certain rejection of them. Nursing staff refer to having little time to preserve continence and express enormous difficulties in supervising incontinence records. There are often problems in ensuring that centers have enough staff to establish continence protocols.
- The care and techniques that are known to be effective are applied infrequently and little is explained to caregivers for their completion.