A pharmacist's guide to care of adult patients presenting with lower urinary tract symptoms.

Abstract

Lower urinary tract symptoms (LUTS) are associated with a broad range of conditions that are a result of dysfunction in either urine storage or voiding.1 Voiding dysfunction involves symptoms resulting from the bladder outlet or urethral pathology and this includes symptoms related to the prostate. Storage dysfunction involves urinary incontinence and is categorized into 3 conditions: stress urinary incontinence, urgency and mixed urinary incontinence. Overactive bladder is also a type of storage dysfunction and is characterized as a sense of urgency that may or may not be associated with urgency incontinence.1,2 Approximately 3.3 million (10%) Canadians have incontinence.1 Furthermore, a survey conducted in 2008 found that of Canadians aged 18 years and older, 57% of female respondents and 43% of male respondents had at least 1 lower urinary tract symptom.3 Although urinary symptoms are commonly experienced by adult Canadians, very few adults consult a health care professional for support. As few as 20% of adults with any type and frequency of LUTS reported seeking help, and for those adults with daily LUTS, only 50% reported consulting with a physician.4-6 The main barriers to seeking support from a health care professional were found to be a misunderstanding that these symptoms are a normal part of aging, a lack of awareness of available treatment options and a feeling of embarrassment.4 It is important to overcome these barriers and identify LUTS early because these symptoms significantly affect patients’ physical and mental well-being.7,8 A recent trial found that older women who were actively approached by their physician to receive incontinence treatment had improved symptoms and fewer incontinence episodes compared with women who were treated only when they sought physician care on their own.9 Because pharmacists are generally believed to be the most accessible and among the most trusted health care professionals10 and pharmacies are a major source of continence products, community-based pharmacists have the greatest opportunity to identify patients with LUTS and initiate appropriate interventions. Current LUTS identification, assessment and treatment guidelines are targeted to family physicians and specialists, so there is a need for evidence-based management recommendations to community pharmacists that will allow them to identify, assess, treat or refer to other care providers when approached by a patient with bothersome LUTS. Furthermore, with the expanding scope of pharmacist practice, a guide tailored to the pharmacist will help delineate the potential pharmacist intervention as part of a collaborative primary care team. The purpose of this project was to adapt a guide for Canadian community pharmacists who screen for or are sought out by community-dwelling adults with bothersome LUTS.