From the Guidelines
Urinary incontinence in elderly females should be managed through a combination of behavioral, pharmacological, and surgical approaches, prioritizing lifestyle modifications and non-invasive treatments first, as recommended by the most recent guidelines 1.
Initial Management
Start with lifestyle modifications including:
- Scheduled voiding every 2-3 hours
- Pelvic floor exercises (Kegel exercises) performed 3 sets of 10 contractions daily
- Fluid management by limiting intake to 1.5-2 liters daily with reduced evening consumption
- Weight loss if overweight
- Avoiding bladder irritants like caffeine, alcohol, and spicy foods
Pharmacological Treatment
For urge incontinence, consider antimuscarinic medications such as:
- Oxybutynin (5mg 2-3 times daily)
- Solifenacin (5-10mg once daily)
- Mirabegron (25-50mg once daily) For stress incontinence, duloxetine (40mg twice daily) may be considered.
Additional Treatments
Topical estrogen (such as vaginal estradiol cream 0.5-1g daily for 2 weeks, then twice weekly) can improve tissue quality in the urogenital area. Absorbent products provide immediate management while pursuing treatment. For persistent cases, specialized options include:
- Pessaries
- Botulinum toxin injections
- Surgical interventions like midurethral slings or artificial urinary sphincters
These treatments work by addressing the underlying causes of incontinence, including weakened pelvic floor muscles, detrusor overactivity, or hormonal changes affecting urethral tissue integrity, as discussed in recent studies 1.
From the FDA Drug Label
1 INDICATIONS AND USAGE
1.1 Adult Overactive Bladder (OAB) Mirabegron Monotherapy Mirabegron extended-release tablets are indicated for the treatment of OAB in adult patients with symptoms of urge urinary incontinence, urgency, and urinary frequency.
Treatment of Urinary Incontinence in Elderly Female: Mirabegron is indicated for the treatment of overactive bladder (OAB) in adult patients with symptoms of urge urinary incontinence, urgency, and urinary frequency 2.
- The majority of patients in the clinical trials were Caucasian (94%) and female (72%) with a mean age of 59 years (range 18 to 95 years) 2.
- Mirabegron 25 mg and 50 mg were effective in treating the symptoms of OAB within 8 weeks and 4 weeks, respectively, and the efficacy was maintained through the 12-week treatment period 2.
- Key Points:
- Mirabegron is used to treat OAB symptoms, including urge urinary incontinence.
- It is effective in adult patients, including elderly females.
- The recommended doses are 25 mg and 50 mg once daily.
From the Research
Treatment Options for Urinary Incontinence in Elderly Females
- Pelvic floor exercises are a recommended first-line treatment for urinary incontinence in women, including elderly females, with studies showing up to 70% improvement in symptoms of stress incontinence 3.
- Supervised pelvic floor muscle training programmes, led by specialist physiotherapists or continence nurses, have been shown to be more effective than unsupervised or leaflet-based care 3.
- Pharmacological therapies are also available for the treatment of urinary incontinence in elderly females, with the choice of medication depending on the specific type of incontinence 4.
- Lifestyle and behavioral modifications, such as fluid management and bladder training, may also be recommended as initial treatments for urinary incontinence in elderly females 5, 6.
- Urologic referral may be necessary for complex cases or when initial treatment measures fail 5.
Factors Associated with Treatment
- Women with more severe and longer-term urinary incontinence are more likely to receive treatment, with odds ratios of 3.1 and 1.9, respectively 7.
- Women with mixed or urgency urinary incontinence are more likely to receive treatment than those with stress urinary incontinence, with odds ratios of 2.5 and 3.0, respectively 7.
- Despite the availability of effective treatments, only approximately 1 in 9 older women with self-reported urinary incontinence undergo treatment within a year of reporting symptoms 7.
Diagnosis and Assessment
- A thorough medical history and physical examination are essential for diagnosing the type of urinary incontinence and determining the most effective treatment plan 4, 6.
- Simple laboratory tests and urodynamic testing may also be useful in the evaluation of urinary incontinence in elderly females 4.
- Assessment of urinary incontinence in older women should extend beyond the genitourinary tract, considering factors such as mobility, fluid balance, and cognition 6.