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Download DRUGS THAT MAY CAUSE OR WORSEN URINARY INCONTINENCE
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URINARY INCONTINENCE For Practicing Physicians TAKE HOME MESSAGES 1. Determine whether the incontinence is transient or persistent. 2. Identify treatable causes, such as infections, delirium, drugs, fecal impaction, and fluid overload. 3. Mixtures of types of persistent incontinence are frequent in the elderly; treatment is best addressed initially with consideration of degree of “nuisance”. 4. Stress and urge incontinence should be approached first with behavioral interventions. 5. It is essential to perform a post void residual to determine retention, as overflow can be confused clinically with urge. Management is totally different in these two types of incontinence. 6. “Overactive bladder syndrome” can occur with and without losses of urine; both forms are treated the same as urge incontinence. 7. Questions of incontinence should be included in review of systems as patients may not report these problems spontaneously. 8. Depression and self-isolation may result from incontinence. 9. Newly occurring incontinence may be a manifestation of other conditions, not necessarily of the GU tract. 10.Physiologic aging changes are in part responsible for the increased prevalence of incontinence in the elderly. 11.Referral of patients with incontinence to specialists should be done selectively, depending on the degree of difficulty of the problem and the level of need of the patient. 12.Continence products are variable in size, capacity, fit and difficulty of use; hence, selection of most suitable products is best done by trial. TYPES OF URINARY INCONTINENCE CAUSED OR AGGRAVATED BY MEDICATIONS Type of Drug Examples Effects STRESS INCONTINENCE Alpha blockers doxazosin, prazosin tamsulosin, terazosin Relax the urinary sphincter and urethra; can cause incontinence when coughing, straining, sneezing, lifting heavy objects, or putting any other pressure on the abdomen (stress incontinence) Angiotensin-converting inhibitors (ACE-I) benazepril, captopril, enalapril, lisinopril Can cause cough and worsen stress incontinence enzyme OVERFLOW INCONTINENCE Alpha-adrenergic agonists nasal decongestants: pseudoephedrine Tighten the urinary sphincter; can cause containing urine to be retained in the bladder and uncontrollable leakage of small amounts of urine (overflow incontinence) Antidepressants amitriptyline doxepin Interfere with bladder contraction and worsen constipation; can cause urine to be retained in the bladder and overflow incontinence Other highly anticholinergic agents Amantidine benztropine chlorpheniramine dicyclomine diphenhydramine hydroxyzine phenothiazines promethazine propantheline thioridazine Interfere with bladder contraction and worsen constipation; can cause urine to be retained in the bladder and overflow incontinence. Calcium channel blockers (nondihydropyridines) diltiazem, verapamil Opioids morphine, codeine, oxycodone, oxycontin Interfere with bladder contraction and worsen constipation due to reduced smooth muscle contractility; can cause urine to be retained in the bladder and overflow incontinence Interfere with bladder contraction and worsen constipation; can cause urine to be retained in the bladder and overflow incontinence MIXED URGE & FUNCTIONAL INCONTINENCE Antipsychotics haloperidol risperidone olanzapine Can slow mobility (functional incontinence) and cause abrupt urge to urinate followed by uncontrollable loss of urine (urge incontinence) Sedating Agents diazepam, flurazepam carisoprodol , chlorzoxazone, metaxalone, cyclobenzaprine orphenadrine May cause confusion and alter the person’s ability to respond to (functional incontinence) and/or recognize the urge to void.(urge incontinence) Alcohol beer, wine, liquor Increases urination by increasing urine production, may also affect a persons awareness of the need to void. Caffeine coffee, cola, tea , some nonprescription headache meds Increases urination by increasing urine production Diuretics furosemide, thiazides Increase urination by increasing urine production. This is particularly relevant in older persons and/or in those with already impaired incontinence. OTHER MEDICATIONS THAT MAY CAUSE OR WORSEN URINARY INCONTINENCE Type of Drug Examples Effects Alcohol Beer, wine, liquor Increases urination by increasing urine production Alpha agonists Pseudoephedrine, nasal decongestants Tighten the urinary sphincter; can cause containing urine to be retained in the bladder and uncontrollable leakage of small amounts of urine (overflow incontinence) Alpha blockers Doxazosin, prazosin, tamsulosin, terazosin Angiotensin converting inhibitors (ACE-I) Anticholinergics Benazepril, captopril Relax the urinary sphincter and urethra; can cause incontinence when coughing, straining, sneezing, lifting heavy objects, or putting any other pressure on the abdomen (stress incontinence) Can cause cough and worsen stress incontinence enzyme Antidepressants Antihistamines Antipsychotics Caffeine Calcium channel blockers Diuretics Opioids Sedatives Benztropine, dicyclomine, loperamide Amitriptyline, desipramine, nortriptyline Chlorpheniramine, diphenhydramine Haloperidol, risperidone, thioridazine, thiothixene Coffee, cola, tea , some nonRx headache remedies Diltiazem, verapamil Furosemide, thiazides Morphine Diazepam, flurazepam, lorazepam Interfere with bladder contraction and worsen constipation; can cause urine to be retained in the bladder and overflow incontinence Interfere with bladder contraction and worsen constipation; can cause urine to be retained in the bladder and overflow incontinence Interfere with bladder contraction and worsen constipation; can cause urine to be retained in the bladder and overflow incontinence Can slow mobility and cause abrupt urge to urinate followed by uncontrollable loss of urine (urge incontinence) Increases urination by increasing urine production Interfere with bladder contraction and worsen constipation; can cause urine to be retained in the bladder and overflow incontinence Increase urination by increasing urine production Interfere with bladder contraction and worsen constipation; can cause urine to be retained in the bladder and overflow incontinence Can slow mobility and worsen urge incontinence VISIT FORM: URINARY INCONTINENCE Reason for Visit: Bothersome problem with urinary incontinence History of Present Illness: 1. Results of dip UA: Blood: Leukocyte esterase: Nitrite: Neg Neg Neg Tr + Tr + Pos ++ ++ YES NO YES NO YES NO 4. Problem using/getting to the toilet………. If YES, explain:_____________________________ _________________________________________ +++ +++ 5. Prior prostate surgery (if male)…………… 2. Duration of symptoms: _______ weeks/months/years 3. Characteristics of voiding: Sudden urge to void (urge)……………... Loss with cough/laugh/bend (stress)….. Continuous leakage……………………... Other, specify: ____________________ Examination: 1. 2. Genital/ Pelvic: Rectal: YES NO YES NO 6. Prior treatment: Timed toileting………………..…………… Medications, specify: ________________ Pelvic/Kegel's exercises (if female)………. Pessary (if female)………………………… Other, specify: _____________________ Female Male Uterine prolapse………… Cystocele………………… Urine loss with cough…… 1. Prostate: Enlargement…….…….… Mass…………………….. Fecal impaction…………. Decreased rectal tone….. 2. Rectal: Fecal impaction…………. Decreased rectal tone….. Diagnosis/Treatment Plan: Lab/Tests: Impression: Send urine for C&S Bladder US with PVR (Normal <100 ml) Other:__________________ UI, type: Stress Urge Functional Overflow Mixed UI, prostate-related Urinary tract infection Other: _____________________________________________ Treatment: Patient education handout: “Pelvic exercises” “Bladder retraining” Other behavioral treatment: ____________________________ Medication for UI: ____________________________________ If behavioral treatment unsuccessful: For urge/mixed and if PVR <100 ml: For stress: oxybutynin 2.5-5mg BID-TID, or pseudoephedrine 15-30 mg TID oxybutynin XL 5-20 mg qd, or tolterodine 2 mg BID Medication for UTI: ___________________________________ x 7-10 days Gynecology consult Urology consult Other:___________________________________________________________________________________________ Provider’s Signature______________________________________________ Date of Visit______________ Patient Name: ____________________________ Med. Rec. # ______________________________
