Urinary Incontinence

Darrell Hulisz, RPh, PharmD
Published Online: Friday, August 1, 2003

What Is Urinary Incontinence?
Urinary incontinence (UI) is the loss of normal control over urination. If you have UI, you are not alone. About 13 million Americans experience this condition. Some patients experience symptoms such as having an urge to urinate or to urinate frequently. This is called overactive bladder. UI is the most distressing form of overactive bladder, since it involves an actual unintended leakage of urine. The good news is that UI can be treated. Because it is an embarrassing condition, many patients do not discuss their symptoms with others and may not even tell their doctor. If you suffer from UI, please read on. Your pharmacist can help you understand this condition, what makes it better or worse, and how you can have better control over your bladder. The pharmacist also can give you information about medications to treat this condition.

What Are the Different Types of Urinary Incontinence?

Stress Incontinence
This form of UI is most common in women over age 50. With stress incontinence, urine leaks out during lifting, exercise, coughing, sneezing, or laughing. Relaxed pelvic muscles that may have been stretched or torn during childbearing cause it. This type of incontinence also may be related to decreases in estrogen levels after menopause.

Overflow Incontinence
This form of UI is more common in older men, especially men with an enlarged prostate gland. It results in constriction of the tube through which urine drains from the bladder. Urine may then leak from a bladder that does not completely empty, resulting in a constant dripping of urine and straining during urination. Older men with this form of UI should receive medical attention, because prostate gland enlargement sometimes is serious, especially if it is caused by a tumor.

Urge Incontinence
Urge incontinence also is more common in elderly people. It occurs when you lose the ability to hold urine once you have the urge to urinate. The need to urinate comes before you make it to the bathroom. Some medical conditions may cause urge incontinence?such as a bladder infection. It also may occur in patients with diseases that affect the nervous system, such as stroke, Parkinson?s disease, and multiple sclerosis.

Functional Incontinence
Functional incontinence is similar to urge incontinence. It occurs when you have normal control over bladder function, but you cannot get to the bathroom on time because of a disabling medical condition, such as severe arthritis or Alzheimer?s disease.

Iatrogenic Incontinence
The word iatrogenic means a condition that is caused by a medication or treatment. Some drugs and chemicals worsen incontinence, but they may not necessarily be the direct cause. These substances include alcohol, caffeine, diuretics, and lithium.

As you can see, both men and women may experience UI. Not all patients have just a single type of UI. Some patients may experience what is known as "mixed incontinence." This is a combination of stress and urge incontinence. It is more common in women.

How Is Urinary Incontinence Treated?
The exact treatment prescribed by your doctor may vary, depending on the type and/or cause of UI. For example, if you have stress incontinence, pelvic muscle exercises (called Kegel exercises) may help you gain better bladder control. Kegel exercises involve tightening and relaxing the pelvic muscle, with the goal of holding each contraction for 10 to 15 seconds. You should start gradually, with the eventual goal of doing the maneuver 20 times, 3 to 4 times daily. You can practice these exercises anytime, while lying, standing, or sitting. Your doctor or another health care professional, such as a physical therapist, can help you learn the technique and plan a pelvic muscle-strengthening program. For more information on how to conduct these exercises, you may find this Internet site helpful: www.kegel-exercises.com.

Another method of treating UI involves bladder training. You teach yourself to empty the bladder on schedule rather than waiting until you feel the urge. It also may be beneficial for you to stop drinking beverages 2 to 4 hours before going to bed, particularly if you experience leakage or accidents during the night.

A device known as a pessary is an option. It is similar to the outer ring of a diaphragm. A pessary is inserted up and around a woman?s cervix. It gives support to the pelvic muscles and helps prevent stress incontinence.

Also remember that your pharmacist can assist you in selecting incontinence pads. They are available in various sizes and degrees of absorbency, to aid in absorbing urine.

What Medications Are Available to Treat Urinary Incontinence?
Medications known as anticholinergic drugs, such as oxybutynin (Ditropan and Ditropan-XR [extended release]) and tolterodine (Detrol and Detrol-LA [long acting]) are the most widely used drugs for UI. They are also the most effective. These medications inhibit the involuntary contractions of the bladder and increase the capacity of the bladder to store urine. They also delay the initial urge to urinate. The newest formulations of these drugs are long-acting and need only be taken once daily. Although these drugs are effective in most patients with UI, you may experience some side effects, especially when you begin treatment. These side effects include dry mouth, constipation, drowsiness, and dry eyes. Rarely, patients may experience other side effects, such as rapid heartbeat and blurry vision. Dry mouth and other side effects typically are less pronounced with the long-acting versions of these medications. Your doctor may need to adjust the dose of your medication in order to find the lowest dose that helps you maintain bladder control and does not produce bothersome side effects. Other medications such as propantheline (Pro-Ban-thine), and dicyclomine (Bentyl) are sometimes used as alternative treatments. They have effects similar to anti-cholinergic drugs. If you are a postmenopausal woman with UI, your doctor may consider prescribing hormone therapy with estrogen (especially if you have other menopausal symptoms, such as hot flashes and vaginal dryness). Be sure to discuss the advantages and disadvantages of estrogen with your doctor or pharmacist.

Addition Resources

American Urological Association
1120 North Charles Street
Baltimore, MD 21201
410-727-1100
www.auanet.org  www.drylife.org

American Foundation for Urologic Disease
1128 North Charles Street
Baltimore, MD 21201
800-242-2383 or 410-468-1800
www.afud.org

Simon Foundation for Continence
PO Box 835
Wilmette, IL 60091
800-237-4666
www.simonfoundation.org

National Association for Continence
PO Box 8306
Spartanburg, SC 29305-8306
800-BLADDER
www.nafc.org



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