The Pharmacist September/October 2018 - Page 44

CLINICAL Advising on urinary incontinence Patients can be embarrassed about this common condition, but community pharmacists can play a big part in dispelling their fears, writes Deborah Evans rinary incontinence is the unintentional passing of urine and is a common problem thought to affect around six million people in the UK. In the UK, one older person in four is affected by urinary incontinence, and an estimated 30-60% of those in institutional care suffer from the condition. Half of the female population will experience urinary incontinence at some time in their lives with 6% of younger women (15 to 44 years old) experiencing symptoms. One study has shown that 32% of women have experienced symptoms of urinary incontinence in the previous 30 days and yet only one in five affected will seek help. While urinary incontinence is often considered a female problem, this is only partly true. In younger age groups, more women than men experience this condition because of the effects of childbirth and the menopause. However, the differences are equalised around the age of 70 as a result of men experiencing urinary retention from prostate gland enlargement as they age. U Common causes of urinary incontinence Urinary incontinence can occur when the normal process of storing and passing urine is disrupted. This can happen for a number of reasons, with certain factors increasing the likelihood of incontinence developing; advancing age is the biggest risk factor. 44 | The Pharmacist | September/October 2018 Stress incontinence occurs when the pressure inside the bladder as it fills becomes greater than the strength of the urethra to stay closed. Additional pressure to the bladder such laughing or sneezing can then cause urine to leak. Weak or damaged pelvic floor muscles or an inadequate urethral sphincter can result in the urethra opening when it shouldn’t. These problems can be caused by: • Damage during childbirth, particularly a vaginal delivery. • Increased pressure on the abdomen, for example during pregnancy or if obese. • Surgical damage to the bladder or nearby area caused, for example, during a hysterectomy or removal of the prostate 32% of women have experienced symptoms of urinary incontinence in the previous 30 days and yet only one in five affected will seek help gland in men (prostatectomy). • Birth defects such as a defective bladder or sphincter. • Neurological conditions that affect the brain and spinal cord, such as Parkinson’s disease, multiple sclerosis, stroke and spinal cord injury. • Certain connective tissue disorders. • Menopause, where the reduction in oestrogen results in the bladder becoming lax. • Some medicines. Urge incontinence is the urgent and frequent need to pass urine, which can be caused by a problem with the detrusor muscles in the walls of the bladder. These muscles relax to allow the bladder to fill with urine and contract when going to the toilet to let urine out. If these muscles contract too often then this creates an urgent need to go to the toilet – this is known as an overactive bladder. Frequent contraction of the detrusor muscles can be caused by: • Drinking too much alcohol or caffeine. • Poor fluid intake, which causes strong, concentrated urine to collect, irritating the bladder. • Constipation. • Conditions such as urinary tract infections and bladder tumours. • Neurological conditions. • Some medicines. Overflow incontinence (also called chronic urinary retention) is often caused by a blockage or obstruction of the bladder. The bladder fills as normal but cannot empty completely because of an obstruction causing pressure to build up behind it, causing leaking around the blockage. An obstruction can be the result of an enlarged prostate gland in men, bladder stones and constipation. Total incontinence occurs when the bladder cannot store any urine at all. This results in large amounts of urine being passed constantly or passed occasionally with frequent leaking. It can be caused by birth defects, spinal cord injury and bladder fistulas. How can pharmacists help identify people who need help? Urinary incontinence can result in significant suffering, including psychological problems and social isolation, sexual issues, lack of sleep due to nocturia, constipation from limiting fluid intake and falls and fractures in older people who have to rush to the toilet. It is likely to be under-reported as it is an embarrassing problem to many women and men. One study of adults with symptoms of an overactive bladder found that: • 54% reported that they were bothered by their symptoms. • Of this group, 73% of women used a coping mechanism (such as physiotherapy or exercise, absorbent pads or limiting fluid intake). • Of these, 69% of women initiated