aware
WELL Duquesne University Mylan School of Pharmacy
UPDATE from the Center for Pharmacy Care
Summer 2005
Urinary Incontinence Embarrassing Yet Treatable
U
rinary incontinence is defined as the involuntary loss of bladder control. The condition occurs in at least 1 of 10 people age 65 or older and can be very distressing to those afflicted with the problem and to their caregivers. Symptoms of urinary incontinence include a strong desire to urinate regardless of whether the bladder is full, urinating more than once every two hours or more than seven times per day, getting up to urinate more than twice during sleep, bedwetting, or painful urination. Urinary tract infections, constipation and vaginal infections or irritation are common causes of short-term urinary incontinence. Medications, such as diuretics, anti-anxiety agents, tranquilizers, antidepressants, hypnotics, laxatives and antibiotics can result in the development of this condition. Caffeine and smoking have been shown to increase the risk
Upcoming Events
of incontinence while alcohol also may be a contributing factor. Long-term incontinence can be related to weak or overactive bladder muscles, blockage from an enlarged prostate, damage to nerves that control the bladder, or diseases such as arthritis. Urinary incontinence is divided into four major types – stress, urge,
overflow and mixed incontinence. Some consider functional incontinence to be a fifth type. This disorder develops due to a secondary disease state, such as osteoarthritis, that prevents the patient from reaching the bathroom in time.
Lifestyle Changes Symptoms of urinary incontinence can be reduced by the institution of various changes in daily habits and lifestyle. These subtle changes in diet, fluid intake, etc., may result in significantly reduce the severity of incontinence. Some suggested methods include: • Avoiding heavy lifting • Biofeedback/behavioral treatment • Decreasing the use of caffeinated and carbonated drinks • Limiting the use of sugar, honey, corn syrup and chocolate
• • • • •
Maintaining a healthy weight Reducing intake of alcohol Restricting fluid intake after 6:00 pm Seeking treatment for persistent cough Smoking cessation
Mark Your Calendar CENTER FOR PHARMACY CARE WELLNESS MONDAY • May 16, June 13, July 11, August 8 Location: 320 Bayer, 9:00 a.m.-1:00 p.m. BLOOD PRESSURE SCREENING
All events will be held in the Center for Pharmacy Care, Room 320 Bayer Learning Center, unless otherwise noted.
• June 1 & 15, July 6 & 20, August 3 & 17 Location: Union Concourse, 3rd Floor, 11:00 a.m.-1:00 p.m. BLOOD PRESSURE/STROKE SCREENING • May 18 Location: Union Concourse, 3rd Floor, 11:00 a.m.-1:00 p.m.
CHRONIC PAIN INITIATIVE Duquesne University participates in the Chronic Pain Initiative, which provides support and informational resources for families and caregivers of those who are suffering from pain. If you have questions about chronic pain, call x5874 for a confidential referral. ATTENTION LIGHTEN-UP PARTICIPANTS! If you would like to continue with regular weigh-ins, please feel free to come to Wellness Mondays.
TOBACCO CESSATION PROGRAM
CENTER FOR PHARMACY CARE – Wellness Mondays
The Center for Pharmacy Care offers a five-week tobacco cessation program. Any employee or student interested in joining a group to quit tobacco should call x5874. Dates will be determined after sign-up.
The Center offers the following complimentary screenings on Mondays by appointment: bone density, body composition analysis, facial skin analysis & cholesterol screening. Please call 412-396-5874 for an appointment.
www.duq.edu
Urinary Incontinence–Embarrassing Yet Treatable Stress Incontinence Stress incontinence is most common in younger and middle-age women and may develop during menopause. It is characterized by urine leakage when pressure is placed on the bladder. Problems commonly occur during exercise, coughing, sneezing, laughing, or lifting heavy objects. Childbirth can damage pelvic muscles and cause stress incontinence. Common non-drug treatments to regain bladder control are Kegel (pelvic muscle) exercises, placement of a pessary (vaginal insert or urethral plug), or an implant injected around the urethra to add bulk and prevent leakage.
Urge Incontinence (Overactive Bladder)
Urge incontinence, also known as “overactive bladder,” is characterized by a strong, sudden urge to urinate and an inability to get to the toilet quickly enough. In some cases, patients can leak urine with no urge or warning. It is often caused by hyperactivity of the bladder muscles linked to conditions such as dementia, Parkinson’s disease, multiple sclerosis, spinal cord injury, etc. Other risk factors include aging, obstruction of urine flow, inconsistent emptying of the bladder and a diet high in bladder irritants. Some substances that irritate the bladder include coffee, tea, cola, chocolate and acidic fruit juices. Treatment involves strengthening pelvic muscles through Kegel exercises, electrical stimulation devices and placement of a pessary. Collagen injections into the tissue surrounding the urethra may improve the ability to retain urine. Additionally, drugs can reduce excessive and uncoordinated contraction of the bladder muscles.
spinal cord injury. Surgery may correct urine obstruction. Pharmacological treatment is limited to medications that treat benign prostatic hyperplasia (BPH), hypertension, or alopecia. While BPH is a condition that occurs only in men, these medications have also been successfully used in women.
Mixed Incontinence Mixed incontinence is typically a combination of urge and stress incontinence. Treatment usually focuses on the more severe symptoms.
Pharmacotherapy of Urinary Incontinence The names and dosages of drugs that treat urinary incontinence are included in the table below. Most of these drugs produce limited adverse effects. The most common adverse reactions from drugs used to treat urge incontinence are dry mouth, blurred vision, constipation, drowsiness, or dizziness. Drugs prescribed for the management of overflow incontinence can produce drowsiness, dizziness, headache, or nausea.
DRUGS FOR TREATING URINARY INCONTINENCE TYPE
DRUG – DOSE – COMMENTS
Stress
• duloxetine (Yentreve®) – to be approved by the FDA in 2005 • estrogen – various preparations, including vaginal suppositories; recent studies question the benefit of estrogens in urinary incontinence • pseudoephedrine – 15-30 mg three times a day
Urge
• darifenacin (Enablex®) – 7.5 mg once daily • oxybutynin (Ditropan®) – 5 mg two or three times a day (5-30 mg daily if using extended release Ditropan XL®); also available as Oxytrol® patch (applied twice weekly) • solifenacin (Vesicare®) – 5 mg once daily • tolterodine (Detrol®) – 1-2 mg twice a day (2-4 mg once daily if using extended release Detrol LA®) • trospium (Sanctura®) – 20 mg twice a day
(Overactive Bladder)
Overflow (These drugs are not FDA labeled for treatment of incontinence)
• alfuzosin (Uroxatral®) • doxazosin (Cardura®) • dutasteride (Avodart®) • finasteride (Proscar®) • tamulosin (Flomax®) • terazosin (Hytrin®)
– – – – – –
10 mg once daily 1-8 mg once daily 0.5 mg once daily 5 mg once daily 0.4-0.8 mg once daily 1-20 mg once daily
Overflow Incontinence Overflow incontinence occurs when small amounts of urine leak from a bladder that is always full and cannot be completely emptied. The most common cause of overflow incontinence is anatomical obstruction of urine flow due to an enlarged prostate, fecal impaction, cancer, or changes in the pelvic floor. Overflow incontinence also can be due to poor bladder contractility caused by neuropathy due to diabetes, vitamin B-12 deficiency, or
Newsletter Contributors John G. Lech, Pharm.D. Kathryn A. Bayer, Pharm.D. Candidate Jennifer R. Snyder, Pharm.D. Candidate
For additional information please visit the following Web sites: • www.urologyhealth.org
• www.medlineplus.org
• www.intellihealth.com
• www.kidney.niddk.nih.gov
A publication of the Duquesne University Mylan School of Pharmacy Center for Pharmacy Care & Pharmaceutical Information Center (PIC) Additional information on any of the topics discussed may be obtained from the Pharmaceutical Information Center by calling 412-396-4600 or sending an e-mail to pic@duq.edu. Questions about screenings or programs: Christine O’Neil, Pharm.D, B.C.P.S. 412-396-6417 5/05 304640 CG