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Query: UMLS:C0042024 (incontinence)
 13,409 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Aging is associated with many changes that may predispose an individual to urinary incontinence. An appropriate pharmacologic treatment plan depends on identification of the type of incontinence and minimization of aggravating factors. Stress incontinence is caused by incompetence of the internal urethral sphincter and is most common in postmenopausal women. This type of incontinence may respond to estrogen therapy and/or alpha-adrenergic agonists. Urge incontinence may occur in both men and women as a result of inappropriate detrusor muscle contraction. This condition may be treated with estrogens, anticholinergics or smooth muscle relaxants. Hypertonicity of the detrusor muscle, usually secondary to a neurologic problem, leads to overflow incontinence. Although overflow incontinence is difficult to control, cholinergic agonists and beta-adrenergic blockers may be helpful. Finally, any obstruction of bladder outflow may cause overflow incontinence and is best treated by amelioration of the cause. However, alpha-adrenergic blockers and 5-alpha reductase inhibitors may be useful in selected cases.
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PMID:Pharmacotherapy of urinary incontinence. 910 89

Urinary incontinence is common in the elderly, affecting 6-8% of people over 64 years in the community and up to 31% in hospital and long-term care. It is possible to establish the diagnosis clinically in most incontinent patients with the likelihood of improving symptoms in the majority. Treatment of patients with urinary incontinence requires attention to general and specific measures. General measures include moderation of fluid intake to about 1.5 litres/day, reduced intake of caffeine-rich drinks, treatment of aggravating conditions such as urinary infection, oestrogen deficiency, increased solute load as in diabetes mellitus and uraemia, and drugs like diuretics, sedatives and antidepressants. Specific measures include pelvic floor exercises, vaginal cones, interferential therapy and oestrogens for patients with stress incontinence. Bladder retraining and anticholinergic drugs are for patients with urge incontinence, and alpha-blockers and 5-alpha reductase inhibitors for patients with overflow incontinence due to prostatic hyperplasia.
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PMID:Management of urinary incontinence in the elderly. 914 9

Benign prostatic hyperplasia is a common condition affecting older men. Typical presenting symptoms include urinary hesitancy, weak stream, nocturia, incontinence, and recurrent urinary tract infections. Acute urinary retention, which requires urgent bladder catheterization, is relatively uncommon. Irreversible renal damage is rare. The initial evaluation should assess the frequency and severity of symptoms and the impact of symptoms on the patient's quality of life. The American Urological Association Symptom Index is a validated instrument for the objective assessment of symptom severity. The initial evaluation should also include a digital rectal examination and urinalysis. Men with hematuria should be evaluated for bladder cancer. A palpable nodule or induration of the prostate requires referral for assessment to rule out prostate cancer. For men with mild symptoms, watchful waiting with annual reassessment is appropriate. Over the past decade, numerous medical and surgical interventions have been shown to be effective in relieving symptoms of benign prostatic hyperplasia. Alpha blockers improve symptoms relatively quickly. Although 5-alpha reductase inhibitors have a slower onset of action, they may decrease prostate size and alter the disease course. Limited evidence shows that the herbal agents saw palmetto extract, rye grass pollen extract, and pygeum relieve symptoms. Transurethral resection of the prostate often provides permanent relief. Newer laser-based surgical techniques have comparable effectiveness to transurethral resection up to two years after surgery with lower perioperative morbidity. Various outpatient surgical techniques are associated with reduced morbidity, but symptom relief may be less durable.
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PMID:Diagnosis and management of benign prostatic hyperplasia. 1853 71

Five-alpha reductase inhibitor may be underused and their value underappreciated in nursing home residents with enlarged prostates due to BPH. Initiation of a 5-alpha reductase inhibitor with an alpha-1 selective blocker may reduce the occurrence of acute urinary retention, decrease the risk of developing incontinence, and avoid or significantly delay the need for surgical intervention in this highly vulnerable male population.
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PMID:Opportunity to optimize management of benign prostatic hyperplasia. 2105 17

Lower urinary tract symptoms (LUTS) after urethral stricture repair are not uncommon. Urgency has been reported in 40% of men and urge incontinence in 12% of men after anterior urethroplasty. De novo urgency and urge incontinence is seen in 9 and 5% of men, respectively, after urethroplasty. Once a complication of urethroplasty (such as recurrent urethral stricture or diverticulum) has been excluded as a cause, evaluation of LUTS in such patients should focus on differentiating bladder dysfunction (overactive bladder, underactive bladder), from other outlet obstruction (such as benign prostatic obstruction), dysfunctional voiding, or medical causes (such as nocturnal polyuria). Management of overactive bladder may include behavioural modification, physical therapy, anticholinergic and/or beta-3 agonist medications, intravesical onabolulinum toxin, sacral neuromodulation or peripheral tibial nerve stimulation. Definitive treatment for underactive bladder is limited. Treatment of benign prostatic obstruction may include alpha-blocker and/or 5-alpha reductase inhibitor medication, or surgery to cavitate the prostate. Minimally invasive prostatic procedures are also an option. Although management of LUTS for patients after urethral stricture repair can usually proceed similarly as for patients without prior history of urethral reconstruction, special consideration and alterations in management need to be made when instrumenting the urethra, as the urethral lumen may be narrower in these patients.
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PMID:Incidence and Management of Lower Urinary Tract Symptoms After Urethral Stricture Repair. 2871 63