Magazine article Drug Topics

Dealing with Incontinence

Magazine article Drug Topics

Dealing with Incontinence

Article excerpt

Revised guidelines from the Agency for Health Care Policy & Research (AHCPR) on the treatment of urinary incontinence include a new chapter on treating chronic urinary incontinence in long-term care and home care settings. Developed by an interdisciplinary panel of experts, including a pharmacist, the update reflects changes in the field that have occurred since the original guidelines were released in 1992.

Christopher Keeys, Pharm.D., president, Clinical Pharmacy Associates, Calverton, Md., served on the panel that developed the guidelines. He sees three roles for all pharmacists, not just consultant pharmacists, in the management of urinary incontinence: patient assessment; intervention and education.

"Before we deal with treatment," Keeys said, "we need to look at risk factors for urinary incontinencethings that predispose a patient to urinary incontinence." For example, patients may be unable or unwilling to reach a toilet. "You see that in someone who is delirious or who has an illness that impairs the patient's ability to ambulate," Keeys said. The guidelines note that physical and chemical restraints and drugs that cause sedation can prevent a person from getting to the toilet.

"There are a whole lot of contributing factors that we are advising [caregivers] to evaluate for a patient with urinary incontinence," Keeys said. "For a pharmacist, it's things like looking at drugs that increase urine production, such as diuretic therapy," he said. "Or it could be as simple as someone having an excess intake of dietary substances that increase urine production, such as caffeinated beverages," Keeys added.

When assessing patients with urinary incontinence, he said pharmacists need to look at the problem a couple of different ways. "We're talking about reasons why a patient couldn't make it to the toilet on time; we're talking about reasons why urine production might be increased and what might be done to improve that," he said. "We're talking about drugs that interfere with the normal neurophysiologic function of the bladder and with the process of urinating," he said. "All of these would fall into patient assessment."

From a treatment standpoint, the guidelines cover several different approaches, including behavioral modifications, pharmacologic therapy, and surgery.

Behavioral modification includes such initiatives as providing the patient with a walker to make it easier to reach the toilet or arranging "scheduled toileting" every few hours with or without the help of a caregiver. …

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