INCONTINENCE

Watson Pharmaceuticals, Inc., which is headquartered in Corona, Ca., announced the results of its Phase III study for incontinence using its Oxytrol (TM) transdermal oxybutnin patch at the 22nd Annual Scientific Meeting of the American Urogynecologic Society in Chicago. The study involved patients at 40 medical centers in the U.S. and was conducted by the Transdermal Oxybutin Study Group led by Dr. G. Willy Davilla.

According to their press release " The 3.9 mg/day transdermal oxybutynin group had significantly greater improvements compared with placebo (p^ 0.05) in the median number of incontinence episodes per week, median change in micturition (urination) frequency per day, increase in urine volume per urination, and scores on incontinence questionnaires." Itching at the patch site and dry mouth were the most common adverse reaction found among the 520 patients in the study group. The groups consisted of 520 patients receiving either a placebo, 1.3 mg/day, 2.6 mg/day or 3.9 mg/day.

Approximately 17 million Americans suffer from overactive bladder. It is found in both women and men with the highest occurrence being found in women of post-menopausal age. More than 90% of the patients in the study group were female with the average age of the participants being about 61 years of age.

Incontinence is a word that many people associate with the aging process. Incontinence is not a natural part of the aging process. It can happen at any age and may be due to any one of the following causes:

• Urinary tract infection
• Vaginal infection or irritation
• Constipation
• Effects of medicine
• Weakness of the muscles that hold the bladder in place
• Weakness of the bladder itself
• Weakness of the urethral sphincter muscles
• Overactive bladder muscles
• Blocked urethra (maybe caused by an enlarged prostate)
• Hormone imbalance in women
• Neurological disorders
• Immobility

Lets first examine the bodily processes involved in urination so that we can better understand what can go wrong. By in-taking food and water the body must have a mechanism to expel what has been absorbed or the body would explode. The kidneys filter out waste products from the body fluids and produce urine. Urine travels down tubes called ureters into a muscular sac called the urinary bladder, which stores the urine. Urine travels out of your bladder through a tube called the urethra. You release urine by relaxing the urethral sphincter and contracting the bladder muscles. The urethral sphincter is a group of muscles that tightens to hold urine in and loosens to let it out.

Incontinence has been broken into 3 main types:

• Urge Incontinence-People with urge incontinence lose urine as soon as they feel a strong need to go to the bathroom. You may have urge incontinence when you can't get to the bathroom fast enough, when you have the urge to go even after drinking only a small amount of water or even when you hear water running. This type of incontinence is also exemplified by having the urge to go to the bathroom even though you just went a short time before.
• Stress Incontinence-People with stress incontinence lose urine when they exercise or move in a certain way. If you have stress incontinence, you may leak urine when you sneeze, cough or laugh, when you move suddenly or when you exercise. In addition to the aforementioned causes, mental stress may be a factor in stress incontinence.
• Overflow Incontinence- People with overflow incontinence may feel that they never completely empty their bladder. If you have overflow incontinence, you may also lose small amounts of urine during the day and night. You may be getting up often during the night to go to the bathroom. You often feel as if you have to empty your bladder but you can't do it. You may pass only a small amount of urine buy feel as if your bladder is still partly full. You may spend a long time at the toilet but produce only a weak, dribbling stream of urine.

Once you have determined that you have a urinary problem for yourself or a loved one how do you go about dealing with the issue? The starting point should be to inform your health professional that you have the problem. Some of us may be too embarrassed to tell anyone about it, but the problem will not go away by itself. Your doctor will ask you to keep a record of when you encounter the problem. You will probably have a physical examination and urine test. These tests will help you determine the cause of your problem and the best treatment to deal with it.

After the type and cause of the urinary incontinence has been determined the treatment can follow. Basically there are 3 methods of treatment. They are as follows:

• Behavioral Techniques-You can be taught techniques to control your bladder and sphincter muscles. Bladder training is used for urge incontinence and also possibly for stress incontinence. A technique called prompted voiding, which calls for urinating on a schedule may be used. The patient will go to the bathroom at certain timed intervals whether or not the individual had the urge to go or not at that time. Another methodology used is called distraction. Trying to get the patient to think about something else besides his urination problem can be quite successful. Pelvic muscle exercises called Kegel exercises are used for stress incontinence. The Kegel exercises help to strengthen weak muscles around the bladder.
• Medication-The most common types of medicine treat infection, replace hormones, stop abnormal bladder muscle contractions, or tighten sphincter muscles. Use only medications that have been recommended by your health professional.
• Surgery-Can be used for example if there is some tissue causing a blockage. It is also a technique that is used if the pelvic muscles have been severely weakened or to enlarge a small bladder so it can hold more urine. It may also be used for women who have stress incontinence caused by the bladder neck being improperly positioned.

The following are the tests most frequently given to diagnose urinary incontinence:

1. Blood tests-Examine blood for levels of various chemicals
2. Cystoscopy-Looks for abnormalities in bladder and lower urinary tract.
3. Post-void residual (PVR) measurement-Measures how much urine is left in the bladder after urinating by placing a small soft tube into the bladder or by using ultrasound.
4. Stress test-Looks for urine loss when stress is put on bladder muscles usually by coughing, lifting or exercise.
5. Urinalysis-Examines urine for signs of infection, blood, or other abnormality.
6. Urodynamic testing-examines bladder and urethral sphincter function (may involve inserting a small tube into the bladder; x-rays also can be used to see the bladder).

FOR AN INFORMATIVE AND PERSONAL ARTICLE ON PRACTICAL SUGGESTIONS WHEN SELECTING A NURSING HOME SEE OUR ARTICLE "Selecting a Nursing Home"

Much of the information for this article was obtained from The U.S. Department of Health and Human Services-Agency for Health Care Policy and Research Publication No.96-0684

By Allan Rubin
updated October 28, 2001

http://www.therubins.com

To e-mail: rehabstrat1@aol.com or rubin@brainlink.com

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