Urinary incontinence secondary to drugs

Paliperidone Palmitate-induced Urinary Incontinence: A Case Report

Urinary incontinence, although rarely reported, is one of the most important adverse effects of antipsychotic medication. It can be an embarrassing, distressing, and potentially treatment-limiting. Several antipsychotics, including both typical and atypical varieties, are known to induce urinary incontinence. Many antipsychotic drugs target the neural pathways controlling continence by binding to receptors of some neurotransmitters such as serotonin, dopamine, acetylcholine, and adrenaline. Pharmacological management of incontinence should be considered if there is a risk of cessation of the antipsychotic therapy or any decline in patients’ compliance. Amitriptyline, desmopressin, ephedrine, and anticholinergics such as oxybutynin and trihexyphenidyl are the most frequently used agents to treat incontinence. We think that the frequency of incontinence is higher than reported in the literature, and that follow-up routines should include a form of standardized screening for all possible adverse effects, including incontinence, of any given antipsychotic. In this article, we report a case of urinary incontinence as an adverse effect of paliperidone palmitate use during maintenance therapy in a patient with schizophrenia.

Urinary incontinence and diarrhoea associated with the switch from oral to injectable risperidone

OBJECTIVE

Urgency, urinary incontinence and bowel disturbances are distressing side effects that have been observed during treatment with risperidone and other antipsychotics probably due to the receptor affinity profile. This occurrence can lead to poor compliance and therefore impair clinical outcome.

METHOD

We report the case of a 50 year-old lady, who experienced urinary incontinence and diarrhoea, when switching from oral to injectable risperidone, which ceased when discontinuing the drug. Results and conclusions It should be taken into account that some side effects can be revealed when switching from oral to depot formulations due to non-compliance to orals; nevertheless dose-dependent mechanisms and individual metabolic variability must be considered when observing idiosyncratic reactions to drugs.

Antipsychotic-induced urinary dysfunction: anticholinergic effect or otherwise?

Although urinary difficulties such as incontinence (UI) and retention (UR), reported with both typical and atypical antipsychotics, have been hypothesised as being a form of extrapyramidal side effects or due to anticholinergic side effects, we believe this may not be the case. We report here a male patient with bipolar disorder who developed urinary difficulties with antipsychotics, both typical and atypical, and in whom only aripiprazole seemed to work. We also hypothesise on the possible mechanisms of adverse urinary effects of antipsychotics.

[The medication-induced dysfunction of the urinary bladder]

Bladder dysfunction can result from pathological changes in the bladder itself, of its central neurological regulation, (BPS), or of non-urological diseases such as diabetes or heart failure. Medication-induced bladder dysfunction can mostly be treated by simple changes in the pharmacological therapy. Bladder dysfunction can be induced pharmacologically by activating or inhibitory influences on adrenergic, sympathetic, beta-receptor-induced relaxation of the detrusor, alpha-receptor-induced contraction of the bladder neck, or cholinergic, parasympathetic, muscarinic receptor-induced contraction of the detrusor. Diuretics can increase urine production, thus possibly leading to incontinence. If incontinence occurs in patients, treatment should be stopped if possible and additional pharmacological therapy should not be started before medication-induced bladder dysfunction is excluded.

The relationship between comprehensive functional assessment and optimal pharmacotherapy in the older patient

Older patients hospitalized for treatment of an acute medical illness will have improved outcomes when approached in a comprehensive fashion focusing on the physical, social, and emotional aspects of life. When used by an interdisciplinary team, comprehensive functional assessment can address social, biomedical, nutrition, continence, mobility, pharmacotherapy, and psychological issues to enhance patient care. Although the appropriate use of medications is often cited as an important part of medical care for the older person, it has not been defined for this group of patients. This article outlines steps pharmacists can take to achieve optimal pharmacotherapy in older patients. Prior to attending a team conference, the pharmacist should interview the patient and review the chart. During the team conference, a comprehensive patient database will be generated that allows medications to be linked to diagnoses. To aid in selecting appropriate medications, the potential for drug-induced functional impairment of mobility, continence, and mental state is reviewed. Recommendations for therapy and establishment of therapeutic endpoints will conclude the patient conference. The pharmacist can contribute much in the process of comprehensive functional assessment and to the goal of achieving optimal pharmacotherapy in older patients.

Drug-induced illness in the elderly

The elderly are predisposed to adverse drug reactions because of age-related physiologic changes, interaction of one drug with another, and interaction between a drug and a coexisting medical condition. Recognition of such adverse reactions is essential, because many are reversible and many are even preventable. Assessment of clinical disorders in the elderly should include evaluation of drugs as a causal or aggravating factor. Careful choice and dosage of drugs in the elderly will minimize the likelihood of drug-induced illness.

Effect of adrenergic agents on urethral pressure and urethral compliance measurements in dog proximal urethra

The effects of adrenergic drugs on urethral compliance and urethral closure pressure at the proximal urethra of dogs were investigated using a new probe. The probe, with a balloon at the tip, was equipped with two generating and two detecting electrodes. The probe was inserted into the proximal urethra, and saline was then infused at a constant rate into the balloon with an infusion pump. The pressure and cross-sectional area of the urethra were recorded and a correlation curve of these parameters was drawn. The regression (of the form y = ax + b) was determined from the curve. Urethral compliance and closure pressures were obtained from the values of "a" and "-b/a" respectively, and the maximum cross-sectional area was measured when no further distension of the urethra was obtained. Urethral compliance decreased after the administration of phenylephrine, but increased after the administration of prazosin and labetalol. The urethral closure pressure decreased after the administration of dopamine and haloperidol. There was no change in either urethral compliance or closure pressure after the administration of clonidine, yohimbine, isoproterenol, or propranolol. The results indicate that adrenergic drugs work on urethral compliance, and that the alpha-adrenergic receptor of the proximal urethra is of the alpha-1 type. The changes in the urethral pressure after dopamine administration seems to be a response mediated by dopamine receptors.

Relationship between drug use and urinary incontinence in elderly women

Two hundred older women with urinary incontinence were studied to observe the influence of their prescription and nonprescription drug use on symptoms of incontinence. Ninety percent of women reported using medication, with an average use of four drugs. Medications statistically associated with urinary incontinence symptomatology were prostaglandin inhibitors, diuretics, and estrogen therapy. Further studies are needed to clarify the relationship between medication usage and the presence and severity of urinary incontinence.

Urinary incontinence in the elderly: etiology and treatment

Urinary incontinence is a common, though often hidden, medical problem among the elderly. Urinary continence requires integrity of the neural, muscular, and hormonal systems. Five distinct types of urinary incontinence can be distinguished based on patient symptoms. A variety of factors can impair continence, including aging, environmental barriers, and medications. Both pharmacological and nonpharmacological measures are useful in the treatment of incontinence.