- In evaluating urinary incontinence (UI), drug-induced or drug-aggravated etiologies must be ruled out.
- Accurate diagnosis and classification of UI type are critical to the selection of appropriate pharmacotherapy.
- Goals of treatment for UI are reduction of symptoms, minimization of adverse effects, and improvement in quality of life.
- Nonpharmacologic, nonsurgical treatment is the first-line therapy for several types of UI, and should be continued even when drug therapy is initiated.
- Anticholinergic/antimuscarinic agents are first-line therapies for urge incontinence. Choice of agent should be based on patient characteristics (e.g., age, comorbidities, concurrent medications, and ability to adhere to the prescribed regimen).
- Mirabegron, a β3-adrenergic agonist, can be considered as an alternative in patients who failed to achieve optimal efficacy or cannot tolerate adverse effects of anticholinergics.
- Duloxetine (approved in Europe only), α-adrenergic receptor agonists, and topical (vaginal) estrogens (alone or together) are the drugs of choice for urethral underactivity (stress incontinence).
- Assessment of patient outcomes should include efficacy, adverse effects, adherence, and quality of life.
- Management of UI should target individualized goals, which may change over time. If therapeutic goals are not achieved with a given agent at optimal dosage for an adequate duration of trial, consider switching to an alternative agent.
On completion of the chapter, the reader will be able to:
Differentiate the types and prevalence of urinary incontinence (UI) between genders and the changes that occur with aging.
Explain the pathophysiology of the major types of UI (urge, stress, overflow, and functional).
Identify the signs and symptoms of the major types of UI encountered in clinical setting.
Compare the differences in clinical presentation between stress (SUI) and urge urinary incontinence (UUI).
List the classes of medications that can cause or contribute to UI.
List the treatment goals for a patient with UI.
Identify the criteria for selecting nonpharmacologic treatment for patients with UI.
Describe nonpharmacologic treatment options based on incontinence type, gender, or other patient characteristics.
Compare and contrast anticholinergics/antimuscarinics for the treatment of UUI or overactive bladder (OAB).
Evaluate the role of mirabegron for the treatment of UUI or OAB in an individual patient.
Evaluate the roles of α-adrenoceptor agonists, duloxetine, vaginal estrogens, cholinomimetics, and tricyclic antidepressants for the treatment of UI in an individual patient.
Describe each individual agent for UI in terms of mechanism of action, treatment outcomes, adverse effects, and potential drug–drug interactions.
Identify factors that guide drug selection for an individual patient.
Prepare an individualized treatment plan for a patient to optimize efficacy and tolerability.
Prepare a monitoring plan for a patient based on patient-specific factors.
Describe nonpharmacologic treatment approaches (including surgery) for UI.
Formulate appropriate counseling information for patients receiving drug therapy for UI.
Urinary incontinence (UI) is defined as involuntary leakage of urine.1 It is frequently accompanied by other bothersome lower urinary tract symptoms, such as urgency, increased daytime frequency, and nocturia. It is a common yet underdetected and underreported health problem that can significantly ...