Clinical approach to urinary incontinence: A comparison between internists and geriatricians

Abstract

To compare the initial approach and pattern of practice betweeninternists and geriatricians in treating urinary incontinence. Aretrospective chart review of 300 consecutive charts of elderly patientsover the age of 65, seen by either internists (IM) or Geriatricians(GERI) for urinary incontinence at the Cleveland Clinic Florida wasperformed. The clinical approaches to the management of urinaryincontinence were compared between IM and GERI groups by using aStudent's t test. The mean age for these patients was 77y for the IMgroup and 79y for the GERI group. Majority of patients suffered from twochronic illnesses. We found that geriatricians performed more initialwork up such as urodynamic testing before referring, while internistsobtained more referrals to gynecologist with special interest inurologic disorders (currently called urogynecologist) without initialworkup. IM and GERI groups equally prescribed medications forincontinence. However, the GERI group recommended Kegel exercises morefrequently. This study showed that geriatricians manage urinaryincontinence more extensively by performing more initial work upincluding urodynamics and providing initial behavioral therapy (Kegelexercise and toilet schedule) before referring to specialists. Perhapsgeriatricians feel more comfortable treating urinary incontinence asshown by their lower frequency of referrals and are therefore morecomfortable than internists at addressing this medical issue. On thecontrary, the internist did the initial evaluation but preferred to geta referral perhaps due to less familiarity with urinaryincontinence.