J Korean Med Assoc.  2015 Oct;58(10):886-891. 10.5124/jkma.2015.58.10.886.

Urinary incontinence and overactive bladder

Affiliations
  • 1Department of Urology, Cheil General Hospital & Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea. jtandro@cgh.co.kr

Abstract

The overactive bladder (OAB) and incontinence may occur at any age but are more common in the elderly. These lower urinary tract symptoms are associated with reduced quality of life and morbidity. Urinary incontinence is a significant symptom that affects social life and incurs economic costs. Most patients do not seek treatment because of embarrassment and misperception of the normal consequences of the aging process. Most elderly patients have several comorbidities, and polypharmacy is common. Modifying lifestyle and behavior may prevent urinary incontinence. Muscarinic receptor antagonists are the most commonly used drug, and are well-tolerated, safe, and effective in elderly patients with OAB. However, the selection of an optimal agent must be considered carefully in elderly patients. Surgical treatment may also be indicated in some patients. Anti-incontinence procedures like the mid-urethral sling operation or the Burch procedure are appropriate in stress urinary incontinence. Botulinum toxin A injection in the bladder may have a useful effect in refractory OAB patients. The management of OAB/incontinence in the elderly often poses significant management challenges. With a variety of drugs and procedures, however, physicians can optimize OAB/incontinence treatment for elderly patients.

Keyword

Aged; Urinary incontinence; Urinary bladder, overactive

MeSH Terms

Aged
Aging
Botulinum Toxins
Comorbidity
Humans
Life Style
Lower Urinary Tract Symptoms
Polypharmacy
Quality of Life
Receptors, Muscarinic
Suburethral Slings
Urinary Bladder
Urinary Bladder, Overactive*
Urinary Incontinence*
Botulinum Toxins
Receptors, Muscarinic

Reference

1. Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, Monga A, Petri E, Rizk DE, Sand PK, Schaer GN. International Urogynecological Association. International Continence Society. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2010; 29:4–20.
Article
2. Abrams P, Andersson KE, Birder L, Brubaker L, Cardozo L, Chapple C, Cottenden A, Davila W, de Ridder D, Dmochowski R, Drake M, Dubeau C, Fry C, Hanno P, Smith JH, Herschorn S, Hosker G, Kelleher C, Koelbl H, Khoury S, Madoff R, Milsom I, Moore K, Newman D, Nitti V, Norton C, Nygaard I, Payne C, Smith A, Staskin D, Tekgul S, Thuroff J, Tubaro A, Vodusek D, Wein A, Wyndaele JJ. Members of Committees. Fourth International Consultation on Incontinence. Fourth International Consultation on Incontinence Recommendations of the International Scientific Committee: Evaluation and treatment of urinary incontinence, pelvic organ prolapse, and fecal incontinence. Neurourol Urodyn. 2010; 29:213–240.
Article
3. Minassian VA, Drutz HP, Al-Badr A. Urinary incontinence as a worldwide problem. Int J Gynaecol Obstet. 2003; 82:327–338.
Article
4. Irwin DE, Milsom I, Hunskaar S, Reilly K, Kopp Z, Herschorn S, Coyne K, Kelleher C, Hampel C, Artibani W, Abrams P. Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study. Eur Urol. 2006; 50:1306–1314.
Article
5. Lee YS, Lee KS, Jung JH, Han DH, Oh SJ, Seo JT, Lee JG, Park HS, Choo MS. Prevalence of overactive bladder, urinary incontinence, and lower urinary tract symptoms: results of Korean EPIC study. World J Urol. 2011; 29:185–190.
Article
6. Stewart WF, Van Rooyen JB, Cundiff GW, Abrams P, Herzog AR, Corey R, Hunt TL, Wein AJ. Prevalence and burden of overactive bladder in the United States. World J Urol. 2003; 20:327–336.
Article
7. Brown JS, McGhan WF, Chokroverty S. Comorbidities associated with overactive bladder. Am J Manag Care. 2000; 6:11 Suppl. S574–S579.
8. Wagner TH, Hu TW, Bentkover J, LeBlanc K, Stewart W, Corey R, Zhou Z, Hunt T. Health-related consequences of overactive bladder. Am J Manag Care. 2002; 8:19 Suppl. S598–S607.
9. Brown JS, Vittinghoff E, Wyman JF, Stone KL, Nevitt MC, Ensrud KE, Grady D. Urinary incontinence: does it increase risk for falls and fractures? Study of Osteoporotic Fractures Research Group. J Am Geriatr Soc. 2000; 48:721–725.
10. Zorn BH, Montgomery H, Pieper K, Gray M, Steers WD. Urinary incontinence and depression. J Urol. 1999; 162:82–84.
11. Weiss JP, Blaivas JG. Nocturnal polyuria versus overactive bladder in nocturia. Urology. 2002; 60:5 Suppl 1. 28–32.
Article
12. Brading AF. A myogenic basis for the overactive bladder. Urology. 1997; 50:6A Suppl. 57–67.
Article
13. Caulfield MP, Birdsall NJ. International Union of Pharmacology. XVII. Classification of muscarinic acetylcholine receptors. Pharmacol Rev. 1998; 50:279–290.
14. Scarpero HM, Dmochowski RR. Muscarinic receptors: what we know. Curr Urol Rep. 2003; 4:421–428.
Article
15. Voytas J. The role of geriatricians and family practitioners in the treatment of overactive bladder and incontinence. Rev Urol. 2002; 4:Suppl 4. S44–S49.
16. Shaw C, Tansey R, Jackson C, Hyde C, Allan R. Barriers to help seeking in people with urinary symptoms. Fam Pract. 2001; 18:48–52.
Article
17. Ouslander JG. Management of overactive bladder. N Engl J Med. 2004; 350:786–799.
Article
18. Frewen W. Role of bladder training in the treatment of the unstable bladder in the female. Urol Clin North Am. 1979; 6:273–277.
Article
19. Fantl JA, Wyman JF, McClish DK, Harkins SW, Elswick RK, Taylor JR, Hadley EC. Efficacy of bladder training in older women with urinary incontinence. JAMA. 1991; 265:609–613.
Article
20. Tsao JW, Heilman KM. Transient memory impairment and hallucinations associated with tolterodine use. N Engl J Med. 2003; 349:2274–2275.
Article
21. Van Kerrebroeck P, Kreder K, Jonas U, Zinner N, Wein A. Tolterodine Study Group. Tolterodine once-daily: superior efficacy and tolerability in the treatment of the overactive bladder. Urology. 2001; 57:414–421.
Article
22. Zinner NR, Mattiasson A, Stanton SL. Efficacy, safety, and tolerability of extended-release once-daily tolterodine treatment for overactive bladder in older versus younger patients. J Am Geriatr Soc. 2002; 50:799–807.
Article
23. Yamada S, Maruyama S, Takagi Y, Uchida S, Oki T. In vivo demonstration of M3 muscarinic receptor subtype selectivity of darifenacin in mice. Life Sci. 2006; 80:127–132.
Article
24. Kay G, Crook T, Rekeda L, Lima R, Ebinger U, Arguinzoniz M, Steel M. Differential effects of the antimuscarinic agents darifenacin and oxybutynin ER on memory in older subjects. Eur Urol. 2006; 50:317–326.
Article
25. Dubeau CE, Kraus SR, Griebling TL, Newman DK, Wyman JF, Johnson TM 2nd, Ouslander JG, Sun F, Gong J, Bavendam T. Effect of fesoterodine in vulnerable elderly subjects with urgency incontinence: a double-blind, placebo controlled trial. J Urol. 2014; 191:395–404.
Article
26. White WM, Pickens RB, Doggweiler R, Klein FA. Short-term efficacy of botulinum toxin a for refractory overactive bladder in the elderly population. J Urol. 2008; 180:2522–2526.
Article
27. Karram MM, Bhatia NN. Management of coexistent stress and urge urinary incontinence. Obstet Gynecol. 1989; 73:4–7.
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