URINARY INCONTINENCE: WHAT PHARMACISTS SHOULD KNOW

"6 Overactive bladder (OAB) is a disorder associated with a feeling of urgency and frequency and can lead to urge incontinence if a patient has associated urinary leakage; therefore all patients with urge incontinence will have OAB, but not all patients with OAB will have urge incontinence.7 Overflow incontinence is related to an obstructed urine flow and/or bladder underactivity where an individual has a full bladder, but is unable to completely void at time of urination, which later leads to leakage (i.e. benign prostate hyperplasia).8 Functional incontinence, unlike the other forms of incontinence, occurs when an individual has issues getting to the restroom due to an external factor (i.e. dementia, immobility, etc.), but is not associated with urinary tract dysfunction.8 This article will highlight the diagnosis and treatment of UUI and OAB. Risks Factors, Cause, and Diagnosis of UUI/OAB While UUI/OAB is primarily associated with advanced age, other risk factors identified include educational status, neurologic diseases like prior stroke, elevated body mass index (BMI), recurrent urinary tract infections (UTIs), and positive metabolic screening, which factors in hypertension and diabetes diagnosis, waist-to-hip ratio, and elevated triglycerides.10-12 The specific mechanism that causes UUI/OAB is unknown, however in patients with this condition, urodynamic control is not well regulated.7 The main muscle of the bladder, the detrusor muscle, will involuntary contract-regardless of the bladder volume-which leads to the urge to urinate. First-line therapy for a functioning patient with complaints of UI is nonpharmacological therapy. Currently, there are no standard terms for "plus" or "ultra plus" to measure a "saturation point," so product choice should be based on patient comfort and cost.21 The Simon Foundation for Continence (https://simonfoundation. org/) is a valuable resource to provide to patients who cannot afford urinary pads as it provides a directory of United States diaper and absorbent products banks.22 Pharmacological Management If nonpharmacological therapy fails and prescription therapy is warranted, antimuscarinic agents should be considered in adults diagnosed with OAB/UUI without features of bladder obstruction or mixed incontinence.6 This class of medications works by antagonizing the smooth muscle receptors on the bladder, thus inhibiting the action of acetylcholine which causes bladder contraction.23 Through this mechanism, the medica