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LEARNING OBJECTIVES

  1. Describe the physical and psychosocial consequences of urinary incontinence.

  2. Describe medications used in the treatment of urinary incontinence, including serotonin-norepinephrine reuptake inhibitors, β-3 agonists, and anticholinergic medications.

  3. Formulate a comprehensive clinical plan including nonpharmacologic and pharmacologic therapy for a patient with urinary incontinence or vulvodynia.

INTRODUCTION

This chapter covers two genitourinary conditions commonly experienced by women, urinary incontinence (UI), and vulvodynia. Other related conditions, such as vaginal atrophy (Chapter 12) and sexually transmitted and female infectious diseases (Chapter 29), are discussed elsewhere in the book.

EPIDEMIOLOGY

Reports of the incidence and prevalence of UI demonstrate considerable variability across various studies due to differences in the populations studied and the definition of UI used. Regardless, UI is a common problem for women (used as an inclusive term of all gender identities and sex minorities). Data from the National Health and Nutrition Examination Survey (NHANES) suggest that the prevalence of UI in women aged 20 years or older is slightly more than 50% compared to approximately 15% in men.1 Prevalence increases with age, as more than 40% of women and up to 35% of men age 80 years and older report UI.2 Women typically report stress incontinence symptoms as being most common, followed by urge incontinence, whereas men most frequently cite urge incontinence and bladder outlet obstruction symptoms.1

Despite a high prevalence, UI frequently goes unreported due to patients' reluctance to discuss their symptoms. Only about 25% of women with UI will seek care and fewer than 50% of those seeking care will receive treatment.3

Patient Case (Part 1)

T.K. is a 61-year-old woman who presents to the urology clinic for a joint consult with the continence care nurse and the clinical pharmacist for an assessment of UI.

Chief Concern: “Since starting on furosemide for my leg edema I have these urges to go the bathroom but frequently I am not able to get to the toilet in time. I do not even want to go out anymore, not even to visit my family. I am so embarrassed when I wet my pants.”

History of Present Illness: T.K. has experienced UI for about 35 years beginning shortly after delivery of her third child. Since menopause, approximately 6 years ago, she reports more episodes of incontinence. Initially, T.K. would experience leaking urine only when she coughed or laughed, but her symptoms have gradually worsened over the years such that she now loses urine when she lifts up heavy items, such as grocery bags, her dog, or grandchildren.

T.K. currently uses incontinence absorbent products to manage her symptoms, which she finds prevents urine from staining her clothing and furniture. She worries about odor and has curtailed many of her social and volunteer activities because of this. She even considered missing her granddaughter's graduation from junior high school ...

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