1. Urinary Incontinence Daniel Bundrick RPh VP of Pharmacy Services Agape Pharmacy

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

3. 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.

4. 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.

5. 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.

6. 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.

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

8. 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

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

10. 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.

11. 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.

12. 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

13. 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.

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

15. 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)

16. 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

17. 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

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

19. 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.

20. 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.

21. 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

22. Additional Resources Mayo Clinic- Urinary Incontinence
Urinary Incontinence: MedlinePlus