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CHAPTER SUMMARY FROM THE PHARMACOTHERAPY HANDBOOK
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For the chapter in the Wells Handbook, please go to Chapter 81. Urinary Incontinence.
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KEY CONCEPTS
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 treatment for several types of UI, and should be continued even when drug therapy is initiated.
Antimuscarinic agents are second-line treatments for urge incontinence. Choice of agent should be based on patient characteristics (eg, age, comorbidities, concurrent medications, and ability to adhere to the prescribed regimen).
Mirabegron, a β3-adrenergic agonist, is another second-line treatment for urge incontinence, and can be considered in patients who failed to achieve optimal efficacy or cannot tolerate adverse effects of antimuscarinic agents.
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.
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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 among the most common medical condition occurring in humans and yet it is an underdetected and underreported health problem that can significantly affect quality of life. Patients with UI may have depression as a result of the perceived lack of self-control, loss of independence, and lack of self-esteem, and they often curtail their activities for fear of an “accident.” UI may also have serious medical and economic ramifications for untreated or undertreated patients, including perineal dermatitis, worsening of pressure ulcers, urinary tract infections, and falls.
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This chapter highlights the epidemiology, etiology, pathophysiology, treatment of stress, urge, mixed, and overflow UI in men and women.
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UI is highly prevalent, and the impact of this condition is substantial, crossing all racial, ethnic, and geographic boundaries. In addition, lower urinary tract symptoms (eg, urgency, urinary frequency, and nocturia) associated with overactive bladder (OAB) are also quite debilitating.2 Several studies have objectively shown that UI is associated with reduced levels of social and personal activities, increased psychological distress, and overall decreased quality of life as measured by numerous indices.3 The condition can affect people of all age groups, but the peak incidence of UI, at least in women, appears to occur around the age of menopause, with a ...