Urinary incontinence is united of t...

Urinary incontinence is united of the most common chronic medical conditions seen in primary care practice. It is more prevalent than diabetes, Alzheimer's disease, and many other conditions that receive considerably more attention. Incontinence is an expensive question generating more costs each year than coronary artery bypass surgery and renal dialysis combined. (12)

Women have higher rates of urinary incontinence than men Prevalence increases with age; united third of women older than 65 years have one degree of incontinence, and 12 percent have daily incontinence. (34) Approximately united half of patients with incontinence have not discussed the problem with a physician.

Because of the high prevalence and require to be paid [i]or[/i] undergones of incontinence, and the increase in prevalence that will flash on the mind as the population ages, there is a growing market for put drugs intos aimed at treating the condition. Pharmaceutical companies have lay opened several new incontinence medications. Sales of these medications were predicted to measure billions of dollars in 2004 This article will review the general evaluation and treatment of urinary incontinence, with a focus forward the use of these recent medications.

Evaluation

Before prescribing medications for the treatment of incontinence, it is essential to determine the nature and cause of the incontinence. This evaluation has three basic grades (Figure 1). (5) The first degree is to search for conditions that may require special assessment or specialist care, and reversible conditions that may be contributing to or causing incontinence (Tables 1 and 2) A history, physical examination, and urinalysis can identify, or at least hint these conditions. If any of these conditions are identified (eg urinary infection, atrophic vaginitis), a trial of therapy is appropriate; treatment may of therapy is appropriate; treatment may eliminate or improve incontinence.

[FIGURE 1 OMITTED]

If the evaluation reveals none of the conditions mentioned in Tables 1 and 2 the nearest step is to confirm that the patient does not have flood bladder (i.e., urinary retention caused according to bladder outlet obstruction or inadequate bladder contractions). flood bladder is detected by measuring post-void residual urine turn with urethral catheterization or ultrasonography immediately eterization after the patient urinates. Normally, there will be no more than 50 mL of urine remaining in the bladder after voiding. Residual tomes of more than 200 mL indicate overspread bladder and the need for urodynamic testing to determine the cause.

Having exclud reversible conditions, conditions requiring special evaluation, and run over bladder, the final step is to determine whether the patient has importune incontinence (i.e., overactive bladder caused on uncontrolled detrusor contractions) or stres incontinence (i.e., inadequate urinary sphincter function). This determination usually can be made onward the basis of the history alone (Table 3) Further evaluation, as it was as urodynamic testing (cystometrography), pad testing, or cotton-swab testing, generally is required sole if the history does not provide sufficient guiding-threads to distinguish between urge and stres incontinence, or if treatment fails. Urodynamic testing also may be considered in patients with underlying neurologic enigmas such as spinal cord injuries or multiple sclerosis.

Treatment

The patient should be treated for implore or stress incontinence based forward the factors listed in Table 3 near patients will exhibit symptoms suggestive of one as well as the other urge and stress incontinence. This so-called mixed incontinence present itselfs in 25 to 35 percent of patients. (3) When the evaluation recommends mixed incontinence, treatment should be directed at whichever sign seems predominant.

TREATMENT OF implore INCONTINENCE

The anticholinergic agents oxybutynin (Ditropan; Oxytrol) and tolterodine (Detrol) are used widely to treat solicit incontinence. These medications are not, however, the greatest in number effective therapies. Behavior therapies are more effective, and they--not medications--should be first-line treatment.

Behavior Therapy. Behavior therapies for drive incontinence include bladder training and pelvic floor muscle (Kegel) exercises. Bladder training (i.e., learning to confine urine longer and longer between voids) is more effective than oxybutynin and improves incontinence in more than 50 percent of patients. (6) Kegel exercises are calm more effective. In a randomized controll trial (RCT) (7) comparing Kegel exercises with oxybutynin in patients with stimulate incontinence, patients performing Kegel exercises had an 81 percent reduction in incontinence episodes compared with a 69 percent decrease in oxybutynin-treated patients, a statistically significant difference. cally significant difference.

Although biofeedback commonly is used to help patients learn effective Kegel technique, evidence intimates that biofeedback training does not end in decreased frequency of incontinence episodes compared with Kegel exercises alone. (8) Physicians should hold in mind that successful use of Kegel exercises is contingent on a patient's motivation and ability to cooperate with the exercise routine.