**7.1.2 Physical examination**

122 Urinary Incontinence

Nowadays, there are several evidences about the need of the early detection of UI in older persons, especially in the frail elderly, due to the low index consultation (about 30-50 % of patients), as well as the number of elderly people that received an effective treatment, in spite of the valid alternatives. In this sense, the Assessing Care of Vulnerable Elders, the Fourth Consultation on Incontinence, and the Guidelines on UI recently published by the European

It is very important to highlight that the extent of the clinical approach and the diagnostic process in the frail elderly incontinent is not well established. In general, healthy older persons should receive the same diagnostic schedule as younger patients. By contrast, in frail older persons an individual assessment is required, and it should include: medical and functional status; the incontinence's impact; the preferences of the patient; the life's

Currently, it is accepted that the clinical assessment of the elderly incontinent has two

Basic step the basic step should be done in every incontinent patient and the general practitioner can successfully do it, with several main objectives: to detect transient causes of incontinence; to exclude serious underlying diseases; to identify patients who need further

Basic step has included different components of the clinical assessment, all of them very





**7. Clinical approach of the urinary incontinence in the frail elderly** 

Association of Urology recommends its assessment (Grade A) (DuBeau et al, 2010).

expectancy and also the true chances to improve after a wide evaluation.

different steps, one basic and another further.

evaluation and finally to decide the appropriate treatment.

important to know the characteristics of the incontinent frail elderly.

Medical history with the follow components (Abrams et al, 2010):

negative effects on continence (diuretics, psychotropics)

**7.1 Basic step** 

Basic step should include:

alcoholic drinks).

cognition).

**7.1.1 Medical history** 

The physical examination should include an abdominal (for excluding a distended bladder or a pelvic mass), rectal (for evaluating the sphincter tone, the prostate size, the presence of impaction faecal) a basic neurological exam (especially gait and signs of focal lesions), a genital and pelvic examinations (cough stress test, prolapse evaluation).

The International Continence Society recommends also a post-void residual volume (PVR) measurement by a non-invasive method before to start medical or surgical treatment (Grade C of recommendation), although there are no evidence-based criteria for a high volume (DuBeau et al, 2010; Abrams et al, Markland et al, 2011). In general, PVR greater than 150- 200 ml is considered significant in frail older patients.

### **7.1.3 Basic investigations**

Urine analysis should be done in all the incontinent frail patients, and it can be very useful to detect or rule out infection or hematuria. Although, results should be interpreted with caution due to the high percentage of asymptomatic bacteriuria in the older population (at least 20%). So, it is necessary to be sure of the relation between an abnormal urine analysis and the urinary symptoms (urgency, frequency, dysuria), in order to accept the clinical diagnosis of urinary infection instead of asymptomatic bacteriuria.

Other laboratory tests (thyroid hormones, vitamin B12 or vitamin D levels) require an individualized justification.
