Urinary Incontinence in Dementia

Urinary incontinence (UI) in dementia is a common problem which can lead to comorbidities, lower quality of life, and great economic cost. It usually emerges at the stage of moderate dementia. The prevalence rate of UI is 4 times more common in people with dementia than in those without, and is higher in the older population. UI is related to pressure ulcers, urinary tract infection, falls, fractures, low quality of life, earlier institutionalization, and increased risk of suicide and mortality. Functional incontinence and detrusor overactivity are the main causes of UI in dementia. The chain of continence, including sensory function, high cortical function, the sacral micturition reflex, accessibility to toilets and a friendly environment, and manual dexterity, is the key concept of continence. A complete valuation consists of a medical history, physical examination, postvoid residual volume measurement, and urinalysis. Reversible causes are corrected first. Management should be individualized. The pharmacological options include anticholinergics, antidepressants or antipsychotics, estrogen, alpha-blockers, antibiotics, and laxatives. Behavior treatment includes timed voiding, prompted voiding, bladder training, pelvic muscle rehabilitation, education, environmental alteration, adequate hydration, therapeutic exercise, and continence aids. Multidisciplinary team-work is usually needed to reach the best outcomes.

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