|
Monday, September 6, 2010
Incontinence
Click here to go directly to Drug Review Urinary incontinence affects millions of Americans. It is a condition that can be embarrassing and can negatively impact an individual's quality of life. Urinary incontinence was thought to be the result of the aging process, but it is actually the result of an underlying reversible condition. Thus, understanding incontinence is important since it may improve an individual's quality of life.
Normal Bladder FunctionThe bladder serves as a reservoir for urine, a waste product produced by the kidneys. Urine is contained in the bladder by constriction of a muscle called the urethral sphincter. It is stored until the volume reaches a capacity which is too large for the bladder to retain. At this point, the contractile muscle of the bladder, the detrusor, creates a pressure exceeding the force of the sphincter muscle. The pressure difference generated by the detrusor muscle empties the bladder. When either of these muscles are not fully functional, urinary incontinence may result. Urinary incontinence can be classified into four types, each with specific causes and treatments. However, it is common for a person to experience more than one type of incontinence at the same time.:
Overflow IncontinenceOverflow incontinence develops when the detrusor muscle fails to contract, thus causing the bladder to overfill. On the other hand, overflow incontinence can also result from urinary obstruction which is very common in older males with benign prostatic hypertrophy. Overflow incontinence is characterized by the loss of small amounts of urine. Some causes include: prostatic hypertrophy, stricture of the urethral sphincter, diabetic neuropathy, and fecal impaction. The most common complaint associated with overflow incontinence is the "leakage" or "dribbling" of small amounts of urine. Since this form of incontinence is often related to an obstruction, removal of the obstruction will sometimes correct the problem. In the case of prostatic hypertrophy, the use of medications such as Hytrin (Terazosin) may lessen or even eliminate symptoms without the need for surgical intervention. If symptoms cannot be reversed, then the use of an absorptive/protective undergarment is recommended. Please refer to the selection chart for the appropriate product.
Urge IncontinenceUrge incontinence occurs when the detrusor muscle contracts in spasms, or with lack of control. This is often caused by neurological impairment, and is commonly associated with Alzheimer's disease, Parkinson's disease, brain tumors, or spinal cord injuries. As opposed to overflow incontinence, urge incontinence usually results in complete emptying of the bladder. Urge incontinence can be managed with medications. The most effective medication is Ditropan (Oxybutinin). A newer drug, Detrol (Tolterodine), is as effective as Ditropan yet it is much more expensive. Nonetheless, regardless of Detrol's expense, it is still considered an acceptable form of treatment for urge incontinence. Other medications for urge incontinence include: Pro-Banthine (Propantheline), Bentyl (Dicyclomine), and Urispas (Flavoxate). Traditional antidepressants like tricyclic antidepressants can also be used. They include: Tofranil (Imipramine), Elavil (Amitriptyline), and Sinequan (Doxepin). However, these agents are not well tolerated in the elderly due to their strong anticholinergic side-effects which may cause delirium, constipation, dry mouth, sedation, cardiac arrhythmias, among other adverse effects. Since large volumes of urine result from urge incontinence, a specific type of undergarment is needed. Please refer to the selection chart for the appropriate product.
Stress IncontinenceStress incontinence is common in the elderly, especially females. It is most commonly associated with pelvic or urethral muscle weakness. Stress incontinence is characterized by the loss of small amounts of urine resulting from coughing, laughing, sneezing, lifting heavy objects, or bending over; all of which increase intra-abdominal pressure. Increasing intra-abdominal pressure puts pressure on the bladder, thus triggering stress incontinence. Medications useful in the management of stress incontinence usually constrict the urethral sphincter. These medications include: Sudafed (Pseudoephedrine), Ephedrine, and Phenylpropanolamine. Use of these medications may not be advised in some individuals since they may increase blood pressure or interact with currently prescribed medications. Some doctors prescribe Estrogen therapy which increases urethral muscle tone that usually declines during menopause. Although a recent NIH study, July 2002, found an increased risk of breast cancer, heart attacks and strokes in those using combination estrogen/progestin therapies, the study did not evaluate topical estrogen creams and only evaluated one strength combination product, that being Prempro/Premphase 0.625mg/2.5mg. Also, the arm of the study which used estrogen alone in study participants did not show an increased risk of breast cancer, heart attack, stroke or venous thromboembolism. Hence, there is no evidence which leads to a conclusion that estrogen alone, especially topical estrogen, or lower-dose oral estrogen alone therapy is contraindicated. Thus, those with atrophic vaginitis, which contributes to or causes stress incontinence may continue to use estrogen alone for effective therapy Regardless, we still recommend discussing the risks versus benefits with your physician. Use of both an estrogen product and a product like Sudafed (pseudoephedrine) has been proven to be most effective at managing stress incontinence in elderly women. Since small amounts of urine are excreted, resulting of stress incontinence, a specific type of incontinence product is needed. Please refer to the selection chart for the appropriate product.
Functional IncontinenceFunctional incontinence occurs when toileting habits become improper, usually resulting from severe cognitive or physical impairment. It is best managed with behavioral techniques, which require the assistance of others to re-establish proper habits. Behavioral techniques are too involved to cover in the scope of this article. It is important to speak with a physician about treatments for this type of incontinence.
Medications That Aggravate IncontinenceThere are medications that may worsen urinary incontinence. They include: tricyclic antidepressants (i.e. Tofranil, Elavil, Sinequan), Norpace (Disopyramide), Cogentin (Benztropine), Artane (Trihexyphenidyl), diuretics (i.e. Furosemide, Hydrochlorothiazide), Hytrin (Terazosin), Minipress (Prazosin), Cardura (Doxazosin), alcohol, caffeine, sedatives, decongestants, and muscle relaxants. If you are on one of these medications and incontinence is a problem, consult your physician. Interestingly, a few drugs that can worsen incontinence ( Hytrin and tricyclic antidepressants), are also used to manage certain types of incontinence (overflow incontinence and urge incontinence, respectively). Hytrin, may cause overflow incontinence by relaxing the sphincter muscle which allows urine to flow out of the bladder with minimal pressure applied. Normally, Hytrin is used to manage overflow incontinence in males with prostatic hypertrophy. Antidepressants have anticholinergic activity which inhibits the detrusor muscle from contracting; thus, leading to an accumulation of urine in the bladder. Caffeine, alcohol, and diuretics such as Lasix (Furosemide) and Hydrochlorothiazide can increase the amount of urine, thus facilitating urgency and frequency. Sedatives and psychopharmacologic agents may lead to overflow incontinence. Decongestants may cause difficulty urinating, and thus overflow incontinence. Alpha-adrenergic receptor blockers like Minipress and Cardura can contribute to the development of stress incontinence. Incontinence is a condition that affects several million Americans. For many, it is a socially embarrasing and limiting condition. However, by understanding more about incontinence, it can be controlled or perhaps eliminated altogether. We hope this review has provided you with information to help you become informed about the treatment options for urinary incontinence.
Drugs Used To Manage Overflow Incontinence
* This drug is effective in managing overflow incontinence, primarily in males.
Drugs Used To Manage Urge Incontinence
Drugs Used To Manage Stress Incontinence
* These drugs are effective in managing stress incontinence in women only. 2/05/2000 |
|
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
 |
 |
|||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Moisture Barrier
Mesh Pants
Latex Examination Gloves, Aloe Powder Free
