Anticholinergic Therapy of Urinary Incontinence and Urinary Frequency Associated With the Elderly

Abstract

Pharmacotherapy with anticholinergic agents was studied in a total of 80 patients aged 65 years or older with chief complaints of urinary frequency (4 patients) and/or ugency incontinence (76 patients). The subjects were 45 men and 35 women at the age ranging between 65 and 92 (mean 73.7). The patients received anticholinergic agents (terodiline hydrochloride 24 mg/day, oxybutynin hydrochloride 6 mg/day, propantheline bromide 60 mg/day separately or in combination) for more than two weeks. Subjective symptoms and objective findings were assessed before and after the administration. In addition, according to the result of Hasegawa's dementia rating scale the patients were divided into dementia group and non-dementia group for further evaluation of the study drugs. As a result, cystometrogram revealed significant increase of maximum bladder capacity in either dementia group or non-dementia group. There was no significant difference in rate of objective improvement between both groups. On the other hand, rate of subjective improvement was significantly higher in non-dementia group (40%) than in dementia group (15%). As mentioned above, improvement of cystometrogram findings was not associated with improvement of subjective symptoms in the demented patients. This suggests that the major cause of incontinence in demented patients is not the bladder dysfunction but the specific conditions of demented patients such as agnosia and apraxia.

Treatment of urinary incontinence with anticholinergics in patients taking cholinesterase inhibitors for dementia

“…The literature also fails to support a long‐held notion that dementia‐associated incontinence is exclusively or primarily caused by detrusor hyperreflexia. In those who have detrusor hyperreflexia, immobility and dementia severity play a major role in the development of incontinence 12 , 13 . In addition, outlet obstruction and stress incontinence are other lower urinary tract etiologies 14 of incontinence in the population with dementia.…”