Prevalence of commonly prescribed medications potentially contributing to urinary symptoms in a cohort of older patients seeking care for incontinence

Abstract

BackgroundSeveral medication classes may contribute to urinary symptoms in older adults. The purpose of this study was to determine the prevalence of use of these medications in a clinical cohort of incontinent patients.MethodsA cross-sectional study was conducted among 390 new patients aged 60 years and older seeking care for incontinence in specialized outpatient geriatric incontinence clinics in Quebec, Canada. The use of oral estrogens, alpha-blocking agents, benzodiazepines, antidepressants, antipsychotics, ACE inhibitors, loop diuretics, NSAIDs, narcotics and calcium channel blockers was recorded from each patient’s medication profile. Lower urinary tract symptoms and the severity of incontinence were measured using standardized questionnaires including the International Consultation on Incontinence Questionnaire. The type of incontinence was determined clinically by a physician specialized in incontinence. Co-morbidities were ascertained by self-report. Logistic regression analyses were used to detect factors associated with medication use, as well as relationships between specific medication classes and the type and severity of urinary symptoms.ResultsThe prevalence of medications potentially contributing to lower urinary tract symptoms was 60.5%. Calcium channel blockers (21.8%), benzodiazepines (17.4%), other centrally active agents (16.4%), ACE inhibitors (14.4%) and estrogens (12.8%) were most frequently consumed. Only polypharmacy (OR = 4.9, 95% CI = 3.1-7.9), was associated with medication use contributing to incontinence in analyses adjusted for age, sex, and multimorbidity. No associations were detected between specific medication classes and the type or severity of urinary symptoms in this cohort.ConclusionThe prevalence of use of medications potentially causing urinary symptoms is high among incontinent older adults. More research is needed to determine whether de-prescribing these medications results in improved urinary symptoms.

The Problem of Polypharmacy in Female Patients with Overactive Bladders – Cross-Sectional Study in a Specialist Outpatient Department

“…It is of interest, however, that 57 % of the patients did indeed take drugs that could trigger or at least promote incontinence. The study of Kashyap et al revealed a similar result whereby the prevalence of drug consumption with an impact on the lower urinary tract amounted to 61% [6]. This means that more than half of the patients regularly took one or more drugs that could, on their own, be the sole reason for their incontinence.…”

“…The quality of life of the afflicted persons is appreciably impaired and therapy for overactive bladder syndrome leads to a significant improvement in the quality of life [5]. Polypharmacy is one of the reversible causes of overactive bladder [6]. We speak of polypharmacy when five or more drugs are taken regularly [7].…”

“…Especially elderly persons require polypharmacy [9]. The "overactive bladder" syndrome is defined by the symptom complex pollakiuria (≥ 8 micturitions/24 hours with a normal amount of urine [up to 2.8 l/24 h]), imperative need to urinate (sudden onset of need to urinate accompanied with the danger of involuntary leakage), nocturia (the awakening from sleep at night to pass urine) as well as premicturitional urine leakage (leakage of urine prior to intended urination) [6,10,11]. The clinical picture of overactive bladder can, but need not, be accompanied with incontinence [10].…”

Expert Panel Recommendations on Lower Urinary Tract Health of Women Across Their Life Span

“…Medications that interfere with cerebral processing of bladder function and/or have cholinergic effects on the smooth muscles, such as antidepressants, antipsychotic, and sleep medications, can exacerbate UI. 37 …”

How to treat the frail elderly: The challenge of multimorbidity and polypharmacy

“…Potential mechanisms include an increase in urine production (e.g., loop diuretics), interference with sphincter function (e.g., alpha-blocking agents), disruption of detrusor contractility (e.g., anticholinergic medication) and interference with cerebral control of micturition (e.g., sedative/hypnotic medication such as benzodiazepines). 4 Drug-drug interactions may also cause pharmacokinetic or pharmacodynamic alterations, leading to unexpected toxicity or therapeutic failure.…”