Old bedridden persons in particular often suffer from urinary incontinence in addition to other complaints. The administration of medication can be supplemented with targeted pelvic floor or bladder training. As Dr. med. Cristina Mitrache, Basel, and Dr. med. Markus Gnädinger, Steinach, showed at this year’s KHM Congress, a combination treatment is often useful.
Basically, urinary incontinence correlates with three factors:
- Age: Among persons over 95 years of age, 73.3% are incontinent; among those under 65 years of age, only 26.5% are incontinent.
- Brain diseases: 76.7% of patients with dementia suffer from incontinence.
- Immobility: 82.1% of bedridden patients show symptoms of incontinence.
Other risk factors include a high number of births (>3 births) and illness. Not only gynecological or urological conditions such as atrophy, recurrent urinary tract infections (UTI) or prostatic hyperplasia/carcinoma, but also diseases with polyuria, e.g. diabetes mellitus/insipidus, hypercalcemia, polydipsia, or those affecting the central nervous system such as hydrocephalus, Parkinson’s syndrome, multiple sclerosis and, indeed, dementia. Constipation, for example, stagnation of feces in the colon (coprostasis), also increases the risk. “The use of medications, especially sedatives, antidepressants, neuroleptics, anticholinergics, Parkinson’s medications, alpha-adrenergics, diuretics, as well as Ca antagonists should be reduced in the presence of incontinence,” said Cristina Mitrache, MD, senior physician at the University Center for Geriatric Medicine, Basel.
Forms of therapy
In most cases, urinary incontinence and hyperactive bladder have several causes, therefore therapy combinations increase the success of treatment. In the longer term, primary therapy must be followed by long-term prophylaxis. In case of poor results with conservative therapy, a urodynamic examination can be performed after three months. Further clarifications should only take place if concrete indicators are available (Table 1).
For unstable overactive bladder, pharmacotherapies with Detrusitol® (caution: may worsen dementia symptoms in brain-diseased patients), Spasmo-Urgenin Neo®, Emselex®, Vesicare
®
, Urispas® are recommended.
Urge incontinence or mixed incontinence with predominant urge form can be reduced with drug therapies (oxybutinin, tolterodine, or trospium) in 59-71% of cases. The cure rates are 17-23%. Pelvic floor training achieves similarly good results (reduction up to 80%). Targeted bladder training leads to a reduction in >35% of patients and in some cases even to a cure after six months. It is particularly suitable for seniors with preserved cognitive functions.
Stress incontinence or mixed incontinence with predominant stress form can be reduced very well by pelvic floor training (in women best combined with biofeedback): Up to 95% or 87% of cases show improvement. Electrical stimulation, on the other hand, does not provide any additional benefit in women. 64% of patients benefit from drug therapies with estrogens and duloxetine.
Finally, pharmacotherapies for residual urine formation were presented. Effective medications, according to Dr. Mitrache, are Pradif®, Xatral Uno® or Ubretid®.
Source: “Incontinence in old age”, seminar at the 15th Continuing Education Conference of the College of Family Medicine (KHM), June 20-21, 2013, Lucerne.
