Medication therapy management (MTM) providers should screen for medications that may contribute to urinary incontinence.
A combination of behavioral and drug therapies is the mainstay of treatment of urinary incontinence. Adherence to behavioral therapies should be assessed at each MTM encounter.
Medications for urinary incontinence are often difficult to tolerate because of the anticholinergic effects; elderly patients may be particularly susceptible to these adverse effects.
MTM providers should work with the patient and the prescriber to find the most acceptable regimen and help manage the adverse effects of medications for urinary incontinence.
INTRODUCTION TO INCONTINENCE
The simplistic definition of urinary incontinence (UI) is involuntary loss of urine.1-3 The exact prevalence of urinary incontinence is difficult to determine, but it is estimated that 22% of American adults suffer from some type of incontinence. UI is more common in women than in men. Data suggest that about one-quarter of young women, half of all postmenopausal women, and three-quarters of elderly women in nursing homes have some form of UI. Only 9% of men, regardless of age, have some variation of UI.1,2
The lower urinary tract includes the bladder, urethra, urinary sphincter, and surrounding connective tissue, nerves, and blood vessels. Under normal circumstances, the bladder detrusor muscle relaxes during filling and contracts during emptying, while the urinary sphincter contracts during filling to prevent urine leakage and relaxes during emptying. These actions are mediated by the parasympathetic nervous system. Acetylcholine activity at muscarinic receptors throughout the urinary tract mediates urinary function. Usually, the bladder and sphincter work in unison. However, if anything disrupts this balance, then UI may result (see Table 28-1). Medications that influence the function of the lower urinary tract are presented in Table 28-2, and reversible causes of UI are outlined in Figure 28-1. There are several different types of UI; urge incontinence is the most common.
TABLE 28-1Differentiating Bladder Overactivity from Urethral Underactivity |Favorite Table|Download (.pdf) TABLE 28-1 Differentiating Bladder Overactivity from Urethral Underactivity
|Symptoms ||Bladder Overactivity ||Urethral Underactivity |
|Urgency (strong, sudden desire to void) ||Yes ||Not common |
|Frequency with urgency ||Yes ||Rarely |
|Leaking during physical activity (eg, coughing, sneezing, lifting) ||No ||Yes |
|Amount of urinary leakage with each episode of incontinence ||Large if present ||Usually small |
|Ability to reach the toilet in time following an urge to void ||No or just barely ||Yes |
|Nocturnal incontinence (presence of wet pads or undergarments in bed) ||Yes ||Rare |
|Nocturia (waking to pass urine at night) ||Usually ||Seldom |
TABLE 28-2Medications that Influence Lower-Urinary-Tract Function