urinary incontinence in older women; Incontinence and anal fissure
Incontinence, the involuntary loss of faecal material  or urine  affects all ages with more occurrence in women than men [3, 4], thus this page on urinary incontinence in older women . Over 200 million people worldwide suffer from incontinence . In 2005 over 2 million Australian were urinary incontinent while over 1 million were faecal incontinent . The data reported by  has increased as at 2010 to almost 5 million patient suffering from incontinence and the data is projected to increase by 2030 as shown in the Figure below .
Furthermore, incontinence prevalence has been reported higher compared to chronic diseases such as arthritis, anxiety disorders, hypertension, diabetes and asthma . In relative to these chronic diseases there is limited data for incontinence because less than half of the affected patient neither seek medical aid nor report due to the embarrassment attached to the condition [2, 4, 5, 8]
Moreover, incontinence is responsible for higher degree of social isolation , depression [2, 3, 9], loss of productivity , unemployment [4, 10], anxiety [9, 11] and diminish in quality of life (QOL) [2, 5, 10, 12]. In addition, incontinence also poses high economic burden [4, 8]. The cost of treatment and care of incontinence patient is on the high side with institutionalisation of the patients compounding the cost [12, 13]. The annual cost of taking care of patients with urinary incontinence (UI) in the USA was estimated to be approx. $8.6 billion in the community and $3.8 billion in nursing homes . It cost Australia 42.9 billion AUD in 2010 to take care of incontinence  with personal expenditure for purchase of continence pads around $191.2 million; an approximate value of $9,014 per person .
Apart from incontinence, anal fissure (AF), characterised by a tear in the anorectum compartment creates a state of discomfort [14, 15]. Unlike incontinence, AF affects all age group (prevalent in the young and adult) with equal incidence in both sexes . Poh et al. reported that 10% of all operations in colorectal units and 6.2% to 15% of all visits in Australia hospital are associated with AF . AF is associated with high faecal mass, hypertonia of the IAS, anal trauma, diarrhoea, constipation, ischemia of the anoderm and obesity [15-18]. In addition, certain sports (mountain biking), vaginal parity and sexual abuse of anus have been considered as risk factor for AF .
A graph showing the prevalence of urinary incontinence in older women in Australia in 2010 and expected increase till 2030. Modified from . Incontinence is prevalence among people living in the Australian community and it is a major factor contributing to the isolation of aged in residential age care (RAC). Incontinence in Australia is projected to increase by 2030 as the generation of the baby boomer ages.
Urinary incontinence in older women bibliography
1. Whitehead WE et., Non surgicalal. Fecal incontinence in US adults: epidemiology and risk factors. Gastroenterology 2009, 137:512-517, 517 e511-512.
2. Berghmans LC et.,al. Conservative treatment of urge urinary incontinence in women: a systematic review of randomized clinical trials. BJU international 2000, 85:254-263.
3. Khandelwal C et.,al. Diagnosis of urinary incontinence. American family physician 2013, 87:543-550.
4. Athanasopoulos A et.,al. Pharmacotherapy of urinary incontinence. International Urogynecology Journal 2009, 20:475-482.
5. Sievert K-D et.,al. Can we prevent incontinence? ICI-RS 2011. Neurourology and urodynamics 2012, 31:390-399.
6. Chiarelli P et.,al.: Estimating the prevalence of urinary and faecal incontinence in Australia: systematic review. Australasian Journal on Ageing 2005, 24:19-19.
7. Australia CFo: The economic impact of incontinence in Australia. Continence Foundation of Australia/Deloitte Access Economics 2011:1-72.
8. Visser E et.,al. The effect of systematic screening of older women for urinary incontinence on treatment uptake: the URINO trial. Maturitas 2013, 74:334-340.
9. Townsend MK et.,al. Risk factors for fecal incontinence in older women. The American journal of gastroenterology 2013, 108:113-119.
10. Markland AD et.,al. Incontinence. Medical Clinics of North America 2011, 95:539-554.
11. Fraser MO et.,al. Neural control of the urethra and development of pharmacotherapy for stress urinary incontinence. BJU Int 2003, 91:743-748.
12. Wald A: Faecal Incontinence in the Elderly: Epidemiology and Management. Drugs & Aging 2005, 22:131-139.
13. Shah BJ et.,al. Fecal incontinence in the elderly: FAQ. The American journal of gastroenterology 2012, 107:1635-1646.
14. Poh A et.,al. Innovations in chronic anal fissure treatment: A systematic review. World journal of gastrointestinal surgery 2010, 2:231-241.
15. Madalinski MH: Identifying the best therapy for chronic anal fissure. World journal of gastrointestinal pharmacology and therapeutics 2011, 2:9-16.
16. Herzig DO et.,al. Anal Fissure. Surgical Clinics of North America 2010, 90:33-44.
17. Zaghiyan KN et.,al.: Anal fissure. Clinics in colon and rectal surgery 2011, 24:22-30.
18. Non-surgical therapy for anal fissure. Cochrane database of systematic reviews (Online) 2012, 2:CD003431.