Abstract
BackgroundSeveral medication classes may contribute to urinary symptoms in older adults. The purpose of this study was to determine the prevalence of use of these medications in a clinical cohort of incontinent patients.MethodsA cross-sectional study was conducted among 390 new patients aged 60 years and older seeking care for incontinence in specialized outpatient geriatric incontinence clinics in Quebec, Canada. The use of oral estrogens, alpha-blocking agents, benzodiazepines, antidepressants, antipsychotics, ACE inhibitors, loop diuretics, NSAIDs, narcotics and calcium channel blockers was recorded from each patient’s medication profile. Lower urinary tract symptoms and the severity of incontinence were measured using standardized questionnaires including the International Consultation on Incontinence Questionnaire. The type of incontinence was determined clinically by a physician specialized in incontinence. Co-morbidities were ascertained by self-report. Logistic regression analyses were used to detect factors associated with medication use, as well as relationships between specific medication classes and the type and severity of urinary symptoms.ResultsThe prevalence of medications potentially contributing to lower urinary tract symptoms was 60.5%. Calcium channel blockers (21.8%), benzodiazepines (17.4%), other centrally active agents (16.4%), ACE inhibitors (14.4%) and estrogens (12.8%) were most frequently consumed. Only polypharmacy (OR = 4.9, 95% CI = 3.1-7.9), was associated with medication use contributing to incontinence in analyses adjusted for age, sex, and multimorbidity. No associations were detected between specific medication classes and the type or severity of urinary symptoms in this cohort.ConclusionThe prevalence of use of medications potentially causing urinary symptoms is high among incontinent older adults. More research is needed to determine whether de-prescribing these medications results in improved urinary symptoms.
Highlights
Several medication classes may contribute to urinary symptoms in older adults
The use of oral estrogens, alpha-blocking agents, sedative-hypnotics, antidepressants, antipsychotics, ACE inhibitors, loop diuretics, non-steroidal anti-inflammatory agents (NSAIDS) and calcium channel blockers have all been implicated to some degree in the onset or exacerbation of urinary symptoms [8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23]
Three hundred and ninety men and women consented to enroll in the study over a four year time period, representing approximately forty percent of all new patients
Summary
Several medication classes may contribute to urinary symptoms in older adults. The purpose of this study was to determine the prevalence of use of these medications in a clinical cohort of incontinent patients. The use of oral estrogens, alpha-blocking agents, sedative-hypnotics, antidepressants, antipsychotics, ACE inhibitors, loop diuretics, non-steroidal anti-inflammatory agents (NSAIDS) and calcium channel blockers have all been implicated to some degree in the onset or exacerbation of urinary symptoms [8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23]. Active medication potentially exert direct effects on the lower urinary tract system by causing relaxation of striated pelvic floor muscles and interfering with afferent sensory messages from the bladder, or even indirectly through their effect on mobility and toileting ability. Acetylcholinesterase inhibitors can precipitate de novo urgency incontinence via enhanced cholinergic activity in the bladder
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