2. Definition
• “Involuntary loss of urine or stool in
sufficient amount or frequency to
constitute a social and/or health problem.
• A heterogeneous condition that ranges in
severity from dribbling small amounts of
urine to continuous urinary
incontinence…”
3. Prevalence
• Affects up 20% of community-dwelling
older individuals
• Affects up to 50 % of nursing home
residents
• Increases gradually during youth
• Peaks around middle age
• Steadily increases in the elderly
4. Prevalance of UI among women
EPINCONT Study [n=27.936]
Hannestad et al, J Clin Epidemiol 2003;53:1150-1157
9. Stress
• Leakage with increase in intra-abdominal
pressure
• Urethral sphincter malfunction (intrinsic weakness) /
bladder neck hypermobility
• Associated with weakening of pelvic floor muscle
• Loss of small to moderate amount of urine
• No evidence of urgency or nocturia
10. Urge
• Voiding dysfunction associated with involuntary loss of
urine
• Detrusor overactivity
• Urgency
• Frequency
• Night time voiding
• Most common in older women
11. Overflow
• Involuntary loss of urine due to distention of the
bladder
• Filling occurs to the stretch limit of the bladder
• Underactive detrusor with/without bladder outlet
obstruction
• Large PVR >400cc
• Dribbling, frequency
• High rates of infections
21. Pharmacological Treatment
• Anticholinergics=detrusor underactivity, may cause
retention
• Cholinergics=detrusor overactivity, may cause frequency
• Alpha agonists=outlet overactivity, may cause retention
• Alpha blockers=outlet underactivity, may cause stress
incontinence
25. Physiology of Stress
Incontinence
1. Urethral sphincter fails to protect against
loss of urine
– Intrinsic weakness
– Failure to contract
2. Urethral hypermobility
3. Coexist together
26. Pharmacological Treatment of
Stress Incontinence
1. Phenylpropanolamine hydrochloride /pseudoephedrine
/midodrine
• Reduction in pad changes
• Reduction in incontinence episodes
• Improvement in subjective symptoms
2. Duloxetine (Cymbalta)
• Inhibitor of serotonin/norepinephrine reuptake
• Increases serotonin/norepinephrine levels in the sacral
spinal cord
• Increased contraction of urethral sphincters during urine
storage phase of micturition cycle
27. Physiology & Pharmacological
Treatment for Overactive Bladder
1. Neurogenic
– Cause-enhanced bladder C-fiber sensory input
– Abnormal atropine-resistant parasympathetic transmission
– Acetylcholine mediates detrusor contraction
2. Anticholinergic versus placebo control
– 41% experienced a cure or improvement in urinary
incontinence, improvement in leakage episodes/24 hours,
number of voids in 24 hours, volume at first contraction
29. Muscarinic Receptors Antagonists
• Detrusor contraction –mediated by M3 muscarinic
receptors
• Mainstay of treatment
• Choose an agent that is selective for the bladder