Urge Incontinence Management
A.Basmadjian, N. Nazarian, N.R. Florea
USC School of Pharmacy
What is Urge Incontinence?
Urge incontinence is the involuntary leakage of urine. It is often referred to as an overactive bladder or detrusor instability. In urge incontinence the bladder muscle (detrusor) contracts when it shouldn't. When this occurs, urine leaks out through the sphincter muscles, holding the bladder closed. Although this is a common condition that can virtually affect anyone, women and older adults are at higher risk of developing it.1
In most instances, urge incontinence tends to be more of an inconvenience than anything else and usually does not require a doctor’s attention. However, if you find that it is significantly impairing daily activities and affecting your lifestyle, we recommend consulting a doctor to discuss possible options to help manage your condition.1
Even though urge incontinence tends to become a more chronic state, it never usually accompanies any severe complications. Thus patients usually do not seek medical advice or attention. Despite tolerance of this condition, we encourage patients to see a doctor to make sure an infection, bladder stones, or inflammation is not the cause of the incontinence. Beware that urge incontinence can also become very bothersome both physically and emotionally, and thus there is no need to passively tolerate this condition. There are ways to treat urge incontinence, so visit Choice Care today to evaluate your options.1
Is there anything I can do to help manage my situation?
1. Diet
Limiting the intake of alcohol, caffeine and other irritating foods that are acidic, spicy or high in sugar can reduce bladder irritation and help improve your symptoms.
2. Kegel Exercises
An option for treatment of urge incontinence prior to trying pharmacologic medications.
These exercises strengthen the muscles involved in urination, mainly the pelvic floor muscles.1
3. Bladder Retraining
○Retraining your bladder can strengthen the muscles involved with urination.
○For example, urinating at only specific scheduled times each day, is one way to retrain your bladder. This may not be easy at first and you may go every hour at first but you will be able to increase the wait time by half hour intervals until you can make it to three or four hours without leakage.1
If you find that you are unsuccessful after implementing all the aforementioned methods, the next approach would be pharmacological management. For peri-or post-menopausal women with either stress or urge incontinence, a trial of topical vaginal estrogen therapy is suggested. Available preparations include creams, rings, and tablets. Oral estrogen therapy is not recommended for urge incontinence. 2
Other options available are three classes of medications: antimuscarinic (anticholinergic) agents, beta adrenergic therapy, and alpha blockers (for men).3 The choice of therapy depends mainly on the side effect profile.
●Antimuscarinics (anticholinergics)
○Treatment options:
■Oxybutynin
■Tolterodine
○Side Effects - All of these may limit drug tolerability and dose escalation
■Dizziness
■Drowsiness
■Dry mouth
■Constipation
■Dry Eyes
○Due to their side effects, antimuscarinics may not be a great choice for the elderly who have high risk of fall. 3
●Beta Adrenergic Therapy (Beta 3 adrenergic agonist)
○Treatment options:
■Mirabegron
○Benefit
■This is a great option for patients who can not tolerate or do not respond to antimuscarinic medications or are at risk of central nervous system side effects.
○Side Effects
■Hypertension - not recommended for patients with severe uncontrolled hypertension4
■UTI
■Headaches
■Nasopharyngitis
●Alpha Blockers (For Men)
○Treatment options:
■Tamsulosin
■Alfuzosin
■Terazosin
■Doxazosin
○Side Effects
■Orthostatic Hypotension
■Dizziness 6
What Choice Care Offers?
Our team of healthcare professionals at Choice Care take urge incontinence very seriously. We strongly encourage you to come in today for a consultation to evaluate all your options for management. Beware that the prevalence of urge incontinence increases with age, and the condition affects women more than men, along with about 30% of the elderly population. 5 Leaving it untreated only puts you at risk for complications such as cellulitis, pressure ulcers, urinary tract infections, falls with fractures, sleep deprivation, social withdrawal, depression, and sexual dysfunction. In addition, urinary incontinence impairs quality of life, and can affect your emotional well-being, social functioning, and general health.
Our physicians can screen for and diagnose for urinary incontinence, along with prescribing appropriate treatments. In addition, our medication management team led by pharmacists, provides a great resource to help keep you on track with your prescribed treatment regimen and manage any side effects that accompany certain treatments. Contact us if you would like to come in for a consultation.
