Reversible Causes of Incontinence in Older Adults

Dr. Neil M. Resnick, a geriatric medicine specialist at the University of Pittsburgh, emphasizes that urinary incontinence (UI) in older adults is often reversible and should be managed primarily by primary care physicians. Many cases are caused or worsened by conditions outside the bladder, best addressed in general practice. He developed the mnemonic DIAPERS to remember seven reversible causes: Delirium, Infection, Atrophic urethritis/vaginitis, Pharmaceuticals, Excess urine output, Restricted mobility, and Stool impaction. Treating these factors can cure about one-third of elderly patients and improve outcomes in many others.

UI is never a normal part of aging, though age-related changes—such as decreased bladder sensation, reduced contractility, prostate enlargement, and weaker sphincters—predispose to it. Over one-third of older adults experience UI, leading to complications such as skin breakdown, infections, falls, depression, and high healthcare costs, which exceed those of major surgeries. Yet, fewer than 20% report symptoms due to stigma, underscoring the importance of proactive screening.

Dr. Resnick detailed management strategies for each DIAPERS category, from addressing delirium and treating UTIs appropriately, to using topical estrogen for atrophic changes, adjusting problematic medications, moderating fluid intake, improving mobility, and relieving stool impaction. Persistent UI after addressing these causes usually stems from either storage problems (overactive detrusor, stress incontinence) or emptying problems (underactive detrusor, urethral obstruction).

By systematically applying DIAPERS, physicians can significantly improve patients’ quality of life, reduce morbidity, and often avoid unnecessary surgical interventions.

Jancin, B. (2018, August 24). In geriatric urinary incontinence, think DIAPERS mnemonic. Internal Medicine News. MDedge. Retrieved from https://www.mdedge.com/internalmedicinenews/article/173368/geriatrics/geriatric-urinary-incontinence-think-diapers-mnemonic