Up to 30% of older adults are concerned about urinary incontinence, an involuntary loss of urine that can be socially restricting and cause problems with hygiene. If the patient reports incontinence, ask if the patient is leaking small amounts of urine due to increased intra-abdominal pressure from coughing, sneezing, laughing, or lifting. Or following an urge to void, is there an involuntary loss of large amounts of urine? Is there a sensation of bladder fullness, frequent leakage, or voiding of small amounts but difficulty emptying the bladder?
Bladder control involves complex neuroregulatory and motor mechanisms. Several central or peripheral nerve lesions affecting S2 to S4 can affect normal voiding. Does the patient sense when the bladder is full? And when voiding occurs? There are five broad categories of incontinence, including functional and mixed incontinence.
In addition, the patient's functional status may affect voiding behaviors even when the urinary tract is intact. Is the patient mobile? Alert? Able to respond to voiding cues and reach the bathroom? Is alertness or voiding affected by medications?
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