Wise Words – Incontinence

Submitted by Dr Becky Wise

Incontinence is life altering and can be psychologically devastating. Folks who live with this condition often end up not wanting to leave home, and therefore become less social and therefore depressed, or stressed which can lead to a chain reaction of other illnesses and diseases.

use-the-bathroom-WEBIncontinence has several types: Male vs. Female, Urinary (bladder) vs. Fecal (colon), mild to severe. I will focus on Urinary Incontinence here – which can be broken down further into Functional, Overflow, Stress, Urge, or Mixed.

The first of these, Functional Urinary Incontinence, has little to do with the bladder itself, but instead is the inability to get to the toilet due to cognitive, psychological, physical or environmental barriers. Stress Incontinence is when a “leakage” occurs due to a physical stress on the abdomen from a cough, sneeze, laughing, exercise, obesity, etc. Urge Incontinence is a sudden and severe feeling of bladder fullness and is usually associated with a subsequent large-volume leak. It is exacerbated by position changes, quick change in temperature, or sensory stimulation by flowing water.

Stress or Urge incontinence are most often seen in women who are pregnant or have had children. Overflow is a problem where there is urine retention or bladder overfilling due to anatomy, nerve, or medication related issues. This is commonly seen in men with prostate issues. Finally, mixed incontinence is just as it sounds – a combination of problems noted above.

The causes for incontinence can be trauma (like childbirth, surgery or a car accident), age-related muscle tone decrease or nerve dysfunction, urinary tract infection, cognitive decline, psychological decline (including depression), endocrine disorders (diabetes, edema), reduced mobility, stool impaction, or even from medications. The medications implicated in causing incontinence or making it worse include caffeine, alcohol, antidepressants, cough and cold remedies, allergy medications, insomnia medications or other sedatives, NSAIDs like ibuprofen or naproxyn, muscle relaxers, narcotic pain relievers, hypertension medications (ACE Inhibitors like lisinopril or enalapril and diuretics like HCTZ or furosemide), or lithium.

Additional issues that may arise as a result of incontinence include skin irritation, depression/anxiety, constipation, and weight loss. The symptoms of incontinence and any of these subsequent issues must be openly and honestly discussed with the health care team to provide proper treatment and management. Treatment depends on how severe the symptoms are. If they are mild and/or intermittent, a “watchful waiting” strategy is recommended. Lifestyle modifications and setting up a voiding schedule every 2-3 hours are recommended. The doctor may recommend pelvic floor exercises (Kegels) or biofeedback techniques. For moderate to severe issues, medication may be required.

Medications for incontinence include BPH medications for men like Flomax (tamsulosin) or Proscar (finasteride). In fact, Flomax can also be ordered for women if there is an obstruction. Otherwise, medications are Enablex (darifenacin), Toviaz (fesoterodine), Myrbetriq (mirabegron), Ditropan/Oxytrol (oxybutynin), Detrol (tolterodine), Vesicare (solifenacin), or Sanctura (trospium). The most common side effects of all these medications include dry mouth, dry eyes, constipation, and somnolence. They interact with many other medications as well, so finding the right one might take some trials.

If the medications don’t work, a physician could order nerve stimulation treatments, catheterization, or even cystoplasty (bladder reconstruction), urinary diversion, or urostomy (requiring an external collection bag). Regardless of the reasons for the incontinence or the severity, talk to your physician or pharmacist about what treatments are best for you. Be open and honest and take their advice so you can continue to live an active life of participation in your favorite activities.

For further information:

Be Well, Be Wise
Dr.BeckyBe Well, Be Wise,


Dr. Rebecca Wise

Wise Words…. is a general medical information column from Dr Rebecca Wise. Dr. Wise has a master’s degree in education as well as her doctorate in pharmacy. She is an assistant professor and ambulatory care specialist at a Medication Therapy Management (MTM) clinic in Erie, PA.

Soon to be released is Dr Becky’s new website which will address women’s issues, watch for it: www.WiseWordsforWomen.com

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