Urinary Incontinence Revisited: George Kuchel & Alison Huang

GeriPal - A Geriatrics and Palliative Care Podcast

I have to start with the song. On our last podcast about urinary incontinence the song request was, “Let it go.” This time around several suggestions were raised. Eric suggested, “Even Flow,” by Pearl Jam. Someone else suggested, “Under Pressure,” but we’ve done it already. We settled on, “Oops…I did it again,” by Britney Spears.

In some ways the song title captures part of the issue with urinary incontinence. If only we lived in a world in which much of urinary incontinence was viewed as a natural part of aging, the normal response wasn’t embarrassment and shame, but rather an ordinary, “Oops…I did it again.” And if only we lived in a world in which this issue, which affects half of older women and a third of older men, received the research and attention it deserves. We shouldn’t have therapeutic nihilism about those who seek treatment, yet urinary incontinence is woefully understudied relative to its frequency and impact, and as we talk about on the podcast, basic questions about urinary incontinence have yet to be addressed. I don’t see those perspectives as incompatible.

Today we talk with George Kuchel and Alison Huang about:

• Urinary incontinence as a geriatric syndrome and relationship to frailty, disability, and cognitive decline

• Assessment of incontinence: the importance of a 48 hour voiding diary, when to send a UA (only for acute changes)

• How the assessment leads naturally to therapeutic approaches

• Non-pharmacologic approaches including distraction, scheduled voiding, and pelvic floor therapy

• “Last ditch” pharmacologic treatments.

• Landmark studies by Neil Resnick and Joe Ouslander.

Enjoy!

-@AlexSmithMD