Pharmacists' Role in Managing Male Urinary Incontinence

Mohammad A. Rattu, PharmD, CGP

Disclosures

US Pharmacist. 2015;40(8):35-39. 

In This Article

Diagnosis

There are various guidelines for each type of UI. Generally, the first step in the diagnostic evaluation of a patient presenting with UI is to determine whether the symptoms are transient/reversible or chronic.[2,8] The DIAPPERS mnemonic and the patient's medications should be reviewed in the differential diagnosis of transient/reversible UI.[2,5,8] The DIAPPERS mnemonic includes the following risk factors for UI: Delirium/dementia; Infections (e.g., UTI); Atrophic vaginitis/urethritis or atonic bladder; Pharmacologic agents (e.g., diuretics); Psychological disorders (e.g., depression); Endocrine or excessive urine output (e.g., from excess fluid intake, volume overload, hyperglycemia, diabetes insipidus); Reduced/restricted mobility (i.e., functional incontinence) or reversible urinary retention (e.g., from anticholinergics); and Stool impaction.[2,5,8] Pharmacists can help providers identify possible drugs or substances that worsen each type of UI (Figure 1 and Table 2).[2,5,9,10]

Figure 1.

Schematic Sites of Action of Selected Drug Classes That Worsen UI
α: alpha-adrenergic; β: beta-adrenergic; CCB: calcium channel blocker; M: muscarinic; PDE: phosphodiesterase; UI: urinary incontinence.
Source: References 2, 9, 10. Original artwork by Mohammad A. Rattu, PharmD, CGP.

If the patient responds to treatment for the aforementioned reversible causes (e.g., antibiotic for UTI, discontinuation of drugs that induce UI, enhancement of cognition or physical ability to void appropriately), no further intervention is necessary.[2] If not, the patient should be assessed for chronic incontinence. Assessment includes obtaining a thorough medical history, administering a symptom questionnaire (e.g., Brown et al's "3 Incontinence Questions" survey[11] to determine urge or stress incontinence predominance), reviewing a voiding diary, performing a physical examination (including a cough stress test), measuring postvoid residual (PVR) urine via ultrasound, and obtaining a laboratory evaluation (e.g., urinalysis).[2,8,11] Of course, if the patient has any alarm symptoms (pain, hematuria, proteinuria, abnormal digital rectal examination or marked prostate enlargement, recurrent UTI, prior pelvic surgery/radiotherapy, fistula, PVR >200 mL), a referral to a specialist is warranted.[2,8]

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