Articles

"Gotta Go, Gotta Go, Gotta Go..."

By M. Lawler, Pharm D Candidate & P. Hueseman, Rph.

By now most U.S. households have become familiar with this jingle after a great advertising campaign was put out by a pharmaceutical manufacturer promoting a product for urinary incontinence. But beyond that commercial, as we age, it often becomes a more personal journey. You may begin noticing in your late 30s and beyond that you just don't have the bladder control you once did. Just the thought of a bathroom visit can send you running. Whether this condition is something you've grown into or something that someone in your life is experiencing, we want you to know that there are options to help with its treatment.

Urinary incontinence is the involuntary leakage of urine and is not a normal part of aging. It is classified into two types: transient and established. Transient urinary incontinence is short lived and reversible and is usually caused by a problem outside of the urinary tract. Examples of causes are infection, atrophic urethritis (thinning of the cells that line the urinary tract), drugs, psychiatric disorders, excessive output, stool impaction, and restricted mobility. Established incontinence is usually from a problem within the urinary tract.

Involuntary bladder contractions are the leading cause of incontinence in older persons and are also common in younger persons. Frequent voiding is characteristic and the urge to void comes on abruptly. The volume of leakage is usually moderate to large and night incontinence is common. Outlet incompetence is the most common cause of incontinence in younger women and the second most common cause in older women. Outlet incompetence expresses itself as stress incontinence. Coughing, laughing, bending, or lifting can cause instantaneous leakage.

Stress incontinence occurs whenever you increase your intra-abdominal pressure so much that your urethral muscle (urethral sphincter) and pelvic floor muscles can't hold back the urine that's in the bladder. The most common reason why these muscles fail is that they are too weak from lack of use or from damage during childbirth. If you have significant amounts of fat in your abdomen, this also increases intra-abdominal pressure. Smoking places you at a greater risk for stress incontinence because of the repeated pressure on the pelvic floor muscles from chronic coughing. After menopause, some women experience urinary stress incontinence due to hormone changes. The outer third of the urethra, which is sensitive to estrogen, can become thin and irritated as estrogen production decreases. A small amount of estrogen cream can restore the tissue in this area and help to regain urinary control. Estriol cream is good for this condition and is not absorbed into the blood stream.

There is conflicting evidence on the effects of other delivery forms of estrogen on urinary incontinence. Findings presented at the 2003 American Urogynecologic Society/Society of Gynecologic Surgeons Joint Scientific Meeting showed that low-dose estrogen has limited or no clinically significant effect on urinary incontinence. But this estrogen was supplied transdermally and probably did not reach high enough levels in the blood.
According to a study done at Eastern Virginia Medical School and reported in Seminars in Reproductive Medicine in 2005, estrogen can help urogenital symptoms associated with atrophic vaginitis and dryness. Estrogen improves the thickness of the epithelial layer of skin and increases collagen content. Estrogen has also been shown to reduce the number of urinary tract infections in women plagued by frequent recurrence. So there is some evidence that it works and many testimonies from users exist. Try the estriol cream as this has the best evidence for success and will not cause systemic side effects.

Another issue in women’s urogenital health is the use of probiotics. The concept of probiotics arose from the realization that humans are inhabited with bacteria from birth and that these organisms play a role in preventing disease. These bacteria are referred to as "friendly" bacteria and are responsible for several important biological functions, such as assisting with digestion, fighting off other harmful bacteria, and stimulating the immune system. Probiotics are live microorganisms, which when administered in adequate amounts confer a health benefit on the host. Studies have proven that probiotics can help prevent or control bacterial vaginosis, inflammatory bowel disease, and chronic diarrhea. They also help prevent recurrent bladder and yeast infections. Most of these products contain species of lactobacillus, but the greater the variety of the normal natural flora, the better protection the product will provide. See our product, Suprema-dophilus, for a good option. It contains multiple strains of Lactobacilli and Bifidobacterium to restore and maintain the natural bacteria needed to protect the body.

If you are troubled with urinary incontinence or have additional questions
and would like a recommendation for treatment to discuss with your
physician, please call 1-800-728-0288 and ask to schedule a consultation
with one of our pharmacists. For additional information, please go to our
website at www.bpharmacysolutions.com.