URINARY

INCONTINENCE:
OVERVIEW
By: MediHelp App
Clinical Guidelines Section
This is a part of MediHelp App’s Clinical
Pharmacy Section ---> Guidelines.

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Definition
Urinary incontinence is the
involuntary loss of bladder control,
leading to the accidental leakage of
urine. It can result from various
underlying causes, affecting
individuals of any age, though it is
more common in older adults.
Physiology
Normally urine is formed in the
kidney and flows down the
ureters into the bladder which
due to the detrusor muscle &
epithelium lining can stretch
and expand into the abdomen to
store 750 mls of urine (less in
women).
Physiology
The involuntary internal
sphincter muscle opens when the
bladder is half full,
The second muscle is under
voluntary control (that’s why you
can stop urine mid-stream which
called Kegel’ exercises).
Micturition Part 1

Stretch receptors send signal to

both micturition reflex in the
spine, and the voluntary control
section in the brain. if the
micturition reflex is unopposed
by the voluntary control,
Micturition happens. as shown by
the left side of the drawing..
Micturition Part 2

Otherwise the voluntary part

(pontine storage center) overrides
the spinal cord reflex.
When you need to urinate the
Pontine Micturition Center
activates the spinal cord reflex.
hence Micturition happens.
 Main Types of Urinary Incontinence
Urge Incontinence Stress Incontinence Overflow Incontinence

Known as This happens when When the bladder

overactive bladder, pressure on the doesn't empty
it's a sudden, intense bladder increases properly, leading to
urge to urinate due to coughing, frequent or
followed by sneezing, or constant dribbling
involuntary loss of exercising, leading to of urine.
urine. leaks.
 Urge Incontinence
This is due the detrusor
muscle randomly contracting
which leads to sudden
urination, and is more
frequent at night.
 Treatment of Urge Incontinence
Oxybutynin Tolterodine Solifenacin

Dose (Adults) IR: 5 mg Dose (Adults) IR: 2 mg PO Dose (Adults): 5 mg PO qDay,

PO twice/three times q12hr; may lower dose to may increase to 10 mg/day if
daily; not to exceed 5 mg 1 mg twice daily based on well tolerated
PO four times daily response and tolerability Dose (Child > 2 years): 9 to
15 kg: 2 mL PO qDay initially;
Dose (≥5 years) IR: 5 mg not to exceed 4 mL/day
PO q12hr; may be Children: Not
increased to 5 mg PO recommended Dose (Child > 2 years): >15 to
q8hr 30 kg: 3 mL PO qDay initially;
not to exceed 5 mL/day
Treatment of Urge Incontinence
Indicated for overactive bladder (OAB) with
symptoms of urge urinary incontinence,
urgency, and urinary frequency

Dose (Adults): 25 mg PO qDay.

25 mg dose is typically effective within 8

weeks.
Stress Incontinence
This is due to increased
pressure on the bladder either
transient as sneezing or
coughing. Or long term as
pregnancy.
It causes weak stream of urine
to break through.
 Stress Incontinence Treatment
Kegels: Strengthening the Avoiding irritants: Similar to urge
muscles that support the bladder incontinence, avoiding caffeine,
and urethra can reduce or stop acidic foods, and alcohol can help.
leakage.
 Stress Incontinence Treatment

There are no approved medications to

specifically treat stress incontinence in
the United States. However, the
antidepressant duloxetine (Cymbalta) is
used for the treatment of stress
incontinence in Europe.
Overflow Incontinence
This is due to ineffective bladder
emptying either due to weak detrusor
muscle, or blockage by BPH, etc. This
cause the bladder to overflow with
urine and weak stream of urine
comes out.
Also cause difficulty to start a
stream of urine.
 Treatment of Overflow Incontinence

Addressing the issue causing the

overflow incontinence as the
blockage in the urethra or the
weak detrusor muscle.
 Treatment of Overflow Incontinence
Tamsulosin Alfuzosin Doxazosin

Bladder Outlet Benign Prostatic Dose (Adults) IR: 1 mg PO

Hyperplasia: qDay; may titrate by doubling
Obstruction (Off-label): daily dose at 1-2 week
Relief of symptoms 10 mg PO qDay taken
after same meal intervals to maximum 8
0.4 mg PO qDay mg/day
Prostatic cancer should be Prostatic cancer should be Risk of orthostatic
ruled out before therapy ruled out before therapy hypotension (dose
is initiated is initiated dependent)
Treatment of Overflow Incontinence
Indicated for overactive bladder (OAB) with
symptoms of urge urinary incontinence,
urgency, and urinary frequency

Dose (Adults): 25 mg PO qDay.

25 mg dose is typically effective within 8

weeks.
 Other type of Urinary
Incontinence
Functional incontinence: Occurs when
physical or mental impairments make it
challenging to reach the toilet in time.
Mixed incontinence: A mix of different
types, often stress and urge incontinence
together.
Thank you
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