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Introduction to urinary incontinence

By Carl Booth and Debbie Pascoe

Urinary incontinence is common and troublesome (particularly in women and the elderly), and there is a considerable reduction in the quality of life of patients with this condition. Many patients hesitate to seek medical advice due to embarrassment and they attempt to manage the problem by using incontinence pads, restricting their fluid intake or adjusting their lifestyles, even though many cases of urinary incontinence can be cured or significantly improved with appropriate treatment.

Accurate assessment and diagnosis of the cause of incontinence is vital for treatment success, with drugs representing only one treatment option for this condition.1

Epidemiology

Estimating the true prevalence of bladder problems is difficult and even the most conservative estimate, which suggests that 10 per cent of the population are affected by urinary incontinence, probably does not reflect the full extent of the problem.2 It appears that half as many men as women experience bladder dysfunction, with a proportion as high as 50 per cent of women over 18 years experiencing mild stress incontinence.3 Anatomical differences mean that men tend to suffer more from urge incontinence, whereas women tend to suffer with stress incontinence (see Table 1, p65).

A review of published literature indicates that the mean prevalence of incontinence in those aged 30–60 is 25 per cent in women and 6 per cent in men while in those under the age of 30, it is 16 per cent in women and 8 per cent in men.4 In the elderly, the prevalence of bladder control problems is reported to be as high as 30 per cent, increasing to 50 per cent in patients who are resident in nursing homes.5 Normal ageing is not a cause of urinary incontinence, but age-related changes in lower urinary tract function predispose older patients to urinary incontinence (due to anatomical or physiological insults to the lower urinary tract, and systemic disturbances).

It is now thought that urinary incontinence occurs more frequently in white women than in black women.6 This may represent a difference in the rates of genuine stress incontinence and may be related to a shorter urethra, weaker pelvic floor muscles and a lower positioned bladder neck in white women.

Physiology

Urinary incontinence is a disorder of the reservoir function of the lower urinary tract, which consists of the bladder, urethra and sphincter muscles, and has been defined as the involuntary loss of urine which is objectively demonstrable, and which has become a social or hygienic problem.7

Download the attached PDF to read the full article.

Citation: Hospital Pharmacist URI: 10975340

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