Drug induced incontinence
Drug induced incontinence
Drugs are likely to be the most common cause of incontinence in elderly. Drugs known to cause incontinence are:
Diuretics induce water excretion by the kidneys. Rapid filling of the bladder is a stronger factor than the ability to delay micturition. When taking diuretics, the time point of administration is important. Elderly should be made aware of rapid effects of diuretics.
- caffeine has a strong diuretic effect.
Alcohol can alter memory, impair mobility, and cause increased urine output, resulting in incontinence. In addition, it has a sedative effect that may alter a person's awareness of the need to void.
- anticholinergic agents: antihistamines, antidepressants, phenothiazines, disopyramides, opiates, Parkinson drugs, α-adrenergic agents.
Drugs with anticholinergic properties are taken commonly by persons with insomnia, pruritus, vertigo (dizziness), and other symptoms or conditions. Side effects include urinary retention with associated urinary frequency and overflow incontinence. Besides anticholinergic actions, antipsychotics such as haloperidol may cause sedation, rigidity, and immobility.
Benzodiazepines, especially long-acting agents such as flurazepam and diazepam, may build up in the bloodstream of an older person and cause confusion and alter the persons ability to recognize the urge to void. Sedatives also decrease the activity of the brain centres involved in the inhibition of the micturition.
- α-adrenergic agents: α1-receptor blockers in endocrine diseases, α-blockers in cardiology and α-adrenergic receptor agonists in urology.
α-adrenergic stimulation increases urethral tone (resulting in urine retention) and α-adrenergic block reduces it (resulting in incontinence). Stress incontinence may become symptomatic in women treated with α-antagonists as antihypertensive therapy. Older men with a large prostate may develop acute urinary retention and overflow incontinence when taking multicomponent "cold" capsules that contain α-agonists and anticholinergic agents, especially if a nasal decongestant and a nonprescription hypnotic antihistamine are added.
Which of the following is NOT a cause of dark urine?
Extra info: Not all cases of porphyria; some types don’t not discolor urine. A Parkinsonian patient is on L-dopa. A TB patient is on rifampicine. These drugs produce a darker urine. A massive crushing trauma patient suffers from myoglobinuria.
Which drug is least likely to induce incontinence?
Extra info: Diltiazem is a calcium channel blocker. Furosemide and hydrochlorothiazide are diuretics and increase diuresis. Oxazepam is a benzodiazepine, which cause sedation and will decrease the ability to recognize the urge of micturition.