Urinary Incontinence Daniel Bundrick RPh VP of Pharmacy Services Agape Pharmacy

Objectives Define urinary incontinence Know the types of urinary incontinence Understand risk factors for urinary incontinence Exercises and behavioral methods Drug treatments Other options

Urinary Incontinence Defined as ‘involuntary leakage of urine,’ incontinence is not a normal result of aging. It can be embarrassing and frustrating, but there are ways to treat it.

Bladder Anatomy Urination is controlled by the detrusor muscle, which expels urine from the bladder; the internal urethral sphincter, which works by an involuntary process; and the external urethral sphincter, which is voluntary.

Types of Urinary Incontinence Incontinence can occur for a number of reasons, which often affect the way it is treated. Improper function of the urethra, the detrusor muscle, or both can be a cause, or problems such as dementia and limited mobility can result in incontinence simply because patients can’t reach the bathroom. Often these problems can occur together.

Stress Incontinence People with stress incontinence often experience leakage during exertion, such as sneezing or exercising. This occurs because the sphincter that closes off the urethra is not strong enough to resist extra pressure.

Stress Incontinence: Risk Factors Women Pregnancy Childbirth Menopause Cognitive impairment Obesity Age Men Lower urinary tract injury Cognitive Impairment Surgery Example: prostatectomy

Urge Incontinence Patients experience frequency and urgency Frequency-more than 8 bathroom trips per day Urgency-Sudden need to urinate, often difficult to delay Also known as bladder overactivity, for most patients it is unclear what causes these symptoms

Urge Incontinence: Risk Factors Advanced age Neurologic disease, such as stroke Bladder outlet obstruction Example: benign prostatic hyperplasia (BPH)

Functional Incontinence This refers to patients who have functional urinary tracts, but due to limited mobility or cognitive function, cannot reach the bathroom in time to urinate. This problem can often be solved simply by providing a bedside urinal or commode.

Treatment Treatment is often selected in a stepwise manner, starting with non-drug therapies, moving on to drug therapy, and if unresolved and intolerable to the patient, surgical and other options.

Non-Drug Treatments Bladder training: methods such as delaying urination and double voiding improve urge control Other methods: Scheduled bathroom trips, generally every 2-4 hours Regulating fluid intake- Do not limit to the extent that dehydration occurs

Non-Drug Treatments, cont’d. Other methods include weight loss and exercise, as well as pelvic floor muscle exercises. These consist in squeezing the muscles used to stop urine flow and holding for about 3 seconds, then repeating.

Drug Treatment: Anticholinergics Most effective drugs for urge incontinence Equal effectiveness among these drugs Include: Ditropan® Available as generic-oxybutynin Detrol ® Enablex ® Vesicare ® Sanctura ®

Anticholinergics: Side Effects and Doses Potential Side Effects Constipation Dry mouth Drowsiness Blurred Vision Avoid in narrow angle glaucoma and gastric retention All available in once daily dosage forms Vesicare ®, Detrol ®, Ditropan ®, Sanctura ® also in immediate release, multiple daily dose forms Oxybutynin available in brand gel, patch, and syrup dosage forms Patches now available over the counter (OTC)

Drug Treatment: Estrogens Helpful for stress incontinence in women Improves urinary sphincter tone Topical products are recommended, since systemic treatment may produce serious side effects

Drug Treatments: Alpha Agonists Used for stress incontinence Work to improve sphincter tone NOT indicated in certain conditions: Narrow-angle glaucoma, hypertension, and others Include: Pseudoephedrine Phenylephrine

Other Options Surgery can resolve some cases of stress incontinence when other interventions fail In some patients, catheters are an appropriate option

Additional Considerations If you suffer from urinary incontinence, it is important to keep your skin clean and dry to prevent irritation, but avoid overwashing, as this may remove natural defenses against infection.

Additional Considerations If you experience nighttime frequency, make sure you have a clear path to the bathroom, and consider a night light to prevent falls. Bathroom renovations may solve some functional incontinence issues.

Conclusion Urinary incontinence can be a serious hindrance to everyday life It is not an unavoidable result of aging, but can result from a number of causes There are many treatment options available Your doctor can help choose the right treatment to regain bladder control

Additional Resources Mayo Clinic- Urinary Incontinence Urinary Incontinence: MedlinePlus