Urinary incontinence (UI), the involuntary loss of urine, has a prevalence of 25%–45% in women. Only approximately 34% of incontinent women have UI to such a degree that they viewed it as a significant bother. Frequent or severe UI can have a devastating impact on people's lives, leading to social withdrawal and depression and contributing to the decision to go into a nursing home. Leaking small amounts can often be managed by wearing pads and has only a modest impact on quality of life. UI is approximately half as common in men compared with women.
UI prevalence increases with age as shown in Figure 26.1. At the age of 60 years approximately 14.8% of women have moderate-to-severe incontinence, but this increases to 20.2% by 70 years and to 27.5% by 85 years. The loss of continence will not always occur with aging. Many specific age-related changes, such as functional impairments in mobility, dexterity, cognition, and reduction in bladder capacity, contribute to UI. Other established risk factors that are not age-related include obesity and parity. The strongest single risk factor in men other than age is prostatectomy or transurethral resection.
An estimated 60% of people with UI who are identified through surveys have not reported their UI to a health care provider, perhaps because they are embarrassed or believe nothing can be done to help. This is unfortunate, because UI is curable in many and can be managed in most cases. Health care providers, therefore, should specifically ask about incontinence.