Managing Adult Bladder Control Problems
TL;DR: By providing education and counseling, pharmacists can help raise awareness of the management of bladder control problems and have an excellent opportunity to make a positive impact on the care of people affected by bladder control issues.
Abstract: Objective To review the impact, pathophysiology, types, and treatment strategies for adult bladder control problems. Data Sources Articles published from January 1983 through July 2001 identified through a Medline search using the terms urinary incontinence, overactive bladder, voiding dysfunction, stress urinary incontinence, urge incontinence, and overflow incontinence. Additional references were identified from the bibliographies of retrieved articles. Data Synthesis Bladder control problems, including overactive bladder, stress urinary incontinence, and overflow incontinence, affect millions of adults in the United States. Such problems can result in a myriad of physical, psychological, and functional difficulties. Most patients with bladder control problems have a favorable response to therapy; however, the majority of affected people fail to seek treatment and rely upon absorbent products and coping strategies to manage their condition. Treatment for bladder control problems includes behavioral modifications, strengthening exercises, avoidance of triggering factors, pharmacotherapy, and, in some cases, surgery. Global treatment strategies should include screening for bladder control problems to assist in the identification of sufferers who could benefit from therapy. Pharmacists have an excellent opportunity to make a positive impact on the care of people affected by bladder control problems. Conclusion Bladder control problems are not a normal part of aging and most patients respond well to treatment. By providing education and counseling, pharmacists can help raise awareness of the management of bladder control problems.
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TL;DR: The evidence supports surgery as initial therapy and as a secondary form of therapy after failure of other treatments for stress urinary incontinence, and retropubic suspensions and slings are the most efficacious procedures for long-term success (based on cure/dry rates).
682 citations
TL;DR: To determine if urge urinary incontinence is associated with risk of falls and non‐spine fractures in older women, a large number of studies have found that it is not.
Abstract: OBJECTIVE: To determine if urge urinary incontinence is associated with risk of falls and non-spine fractures in older women.
METHODS: Type and frequency of incontinent episodes were assessed by 6049 community-dwelling women using a self-completed questionnaire. Postcards were subsequently mailed every 4 months to inquire about falls and fractures. Incident fractures were confirmed by radiographic report. Logistic and proportional hazard models were used to assess the independent association of urge urinary incontinence and risk of falling or fracture.
RESULTS: The mean age of the women was 78.5 (± 4.6) years. During an average follow-up of 3 years, 55% of women reported falling, and 8.5% reported fractures. One-quarter of the women (1493) reported weekly or more frequent urge incontinence, 19% (1137) reported weekly or more frequent stress incontinence, and 708 (12%) reported both types of incontinence. In multivariate models, weekly or more frequent urge incontinence was associated independently with risk of falling (odds ratio = 1.26; 95% confidence interval (CI), 1.14-1.40) and with non-spine nontraumatic fracture (relative hazard 1.34; 95% CI, 1.06-1.69; P = .02). Stress incontinence was not associated independently with falls or fracture.
CONCLUSIONS: Weekly or more frequent urge incontinence was associated independently with an increased risk of falls and non-spine, nontraumatic fractures in older women. Urinary frequency, nocturia, and rushing to the bathroom to avoid urge incontinent episodes most likely increase the risk of falling, which then results in fractures. Early diagnosis and appropriate treatment of urge incontinence may decrease the risk of fracture. J Am Geriatr Soc 48:721–725, 2000.
532 citations
TL;DR: The results indicate that urinary incontinence is common among middle-aged women and that few seek treatment suggests a need for more information about women's attitudes toward incontinentity and more attention to this problem by health care providers.
502 citations
TL;DR: A review of the literature was undertaken to investigate the degree to which differences in definitions of incontinence, age, and gender of the populations studied, response rates, measurement techniques, or location could explain differences in reported prevalences.
Abstract: OBJECTIVES: Prevalence estimates for urinary incontinence among community-dwelling adults vary from 2 to 55%. A review of the literature was undertaken to investigate the degree to which differences in definitions of incontinence, age, and gender of the populations studied, response rates, measurement techniques, or location could explain differences in reported prevalences.
DESIGN: A literature search was conducted to locate all studies published in English reporting the prevalence of urinary incontinence in a population-based sample of adults.
MEASUREMENT: Information was abstracted for study size, response rate, type of survey, definition of urinary incontinence, and prevalence of incontinence by age group and gender. Prevalence by type of incontinence was also abstracted where available. Stratification was used to obtain prevalence estimates specific for age, gender, and frequency of incontinence. Data were examined for associations between prevalence and survey type, response rate, year, and location of survey.
RESULTS: A total of 21 studies met inclusion criteria. Stratification of reported prevalence by frequency, gender, and age substantially reduced the variation in prevalence estimates. For older women, the estimated prevalence of urinary incontinence ranged from 17 to 55% (median = 35%, pooled mean = 34%), and for daily incontinence it ranged from 3 to 17% (median = 14%, pooled mean = 12%). For older men, incontinence prevalence was estimated to be 11 to 34% (median = 17%, pooled mean = 22%), and 2 to 11% reported daily incontinence (median = 4%, pooled mean = 5%). Within studies, the prevalence of any incontinence was 1.3 to 2.0 times greater for older women than for older men. Among middle-aged and younger adults, prevalence of incontinence ranged from 12 to 42% (median = 28%, pooled mean = 25%) for women and from 3 to 5% (median = 4%, pooled mean = 5%) for men. The ratio of prevalence of any incontinence for women to men in this age group ranged from 4.1 to 4.5. Stress incontinence predominated in younger women, whereas urge and mixed incontinence predominated in older women. There was a tendency for studies using in-person interviews to report higher prevalences.
CONCLUSIONS: An accurate estimate of the prevalence of urinary incontinence depends on specifying the definition of incontinence and the age and gender groups of interest.
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