- Email: [email protected]
Update on treatments for urinary incontinence
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Update on Treatments for Urinary Incontinence Carol A. Miller, RN-C, M S N Although urinary incontinence (UI) is a common problem in older adults, it should never be considered part of normal aging. When UI occurs in people of any age, the ideal approach is to view it as a condition that can be reversed with the right interventions rather than simply managed with incontinence products. Three years ago in this column, medications that can create risks for developing UI and medications sometimes used to treat it were discussed? Since then, not much has changed with regard to drugs used to treat UI, but much has changed in recommendations for nonpharmacologic interventions. The only recent development in drug treatment of UI is the use of alpha-blockers (e.g., terazosin) to manage the UI associated with benign prostatic hypertrophy. This column will vary from its usual focus on new developments in drug treatments. Instead it will discuss new developments in nonpharmacologic interventions for UI because nurses working with older adults have an important responsibility to be able to discuss safe and effective nonpharmacologic interventions for UI as the first strategy for reversing the condition. Nurses even may be in a position to raise questions about older medications being used for U I treatment. Older adults are particularly susceptible to the adverse effects of autonomic nervous system medications, the drug category most often used for UI. If adverse effects are suspected, the nurse can suggest that the older adult talk with her or his physician or nurse practitioner about nonpharmacologic interventions that might be effective. Recently updated guidelines from the Agency for Health Care Policy and Research 2 emphasize the importance of addressing the risk factors for UI before initiating management interventions. Risk factors within the scope of nurses to identify include diminished mobility, cigarette smoking, fecal impaction, environmental barriers, low fluid intake, diminished cognitive status, and adverse medication effects. 1 Certain medical conditions,
Geriatric Nursing Volume 19, Number 2
such as stroke, dementia, diabetes, and estrogen depletion, also may be causative UI factors. After risk factors are addressed, these types of interventions may be used to control UI: surgery, medications, biofeedback, continence retraining, pelvic muscle exercises (PMEs), and a variety of minimally invasive procedures. This column will review the latter two because they are the two interventions with the most developments Older adults in the past few years. In recent years, periurethral are particularly collagen injections and several other minimally lnvasive susceptible procedures have been developed to treat UI. Visual laser to the ablation and transurethral electrovaporization are two adverse effects types of minimally invaslve surgical procedures being of autonomic used for benign prostatic hypertrophy. Pessaries and a nervous system variety of recently approved intravaginal or intraurethral medications, devices may be effective measures for resolving stress UI. the drug category The newest development in intraurethral devices is severmost often used al disposable devices for selfinsertion. One type of device for UI. controls urination by inflating and deflating a small balloon that rests at the bladder neck. Another recent development is a bladder neck prosthesis that has been found to be helpful in controlling stress UI in women. Because nonsurgical devices for the control of U I are developing rapidly, people with UI should be encouraged to keep up-to-date by obtaining information from a knowledgeable health care provider or from the resources listed in Table 1. When weakening of the pelvic floor muscles
109
Table 1. Ul Information Resources Agency for Health Care Policy and Research AHCPR Publications Clearinghouse p.o. Box 8547 Silver Spring, MD 20907 (800) 358-9295 Website: http://www.ahaprgov/ Free information on incontinence: Caregiver Guide (AHCPR Pub. No. 96-0683L Quick Reference Guide for Clinicians (96-0686), Patient Guide (96-0684), Sl~anish Language Patient's Guide (96-0685), ALERT for Directors of Nursing (96-0063) Kimberly-Clark Corp. Dept. M. RO. Box 349 Neenah, WI 54957-9973 (800) KC-HELPS t524-3577) Continuing education program, community education kit for professionals that contains patient education brochures and Kegel exercise instruction sheets
causes UI, exercises to strengthen these muscles can cure or improve the symptoms. A l t h o u g h PMEs were first advocated in the late 1940s for postpartum therapy, they recently have b e e n "rediscovered" both for U I control and e n h a n c e d sexual pleasure. These exercises c o m m o n l y
MAYOCLINICSCOTTSDALE
i~
'"~'~ ~Y ~'
"
~ 4,!,
Geriatric Practitioner The Certified Gerontologic
Nurse Practitionerwill functionas a primary caregiverto adultsin extendedcarefacilitiesand as a member of the hospital-basedgeriatricconsultingteam. In additionto followingpatientsafter dischargefrom the hospital the Nurse Practitionerwillwork with the physicianstaff in Community InternalMedicIneon other clinicaland administrativeactivities related to the GeriatricsConsultingService. Mustbe a certified Nurse Practitionerwith Arizonalicenseor eligible. MayoClinicScottsdaleoffers an excellentsalaryand benefits package, Relocationassistanceavailable. If you can imagine yourself contributing to the Mayo tradition of excellence, send your scannable resume, indicating position desired, to: Mayo Clinic Scottsdale, Human Resources, 13400 E. Shea Blvd., Scottsdale, AZ 85259, or e-maih [email protected]; or call our 24-hour job hotline at 602-301-7678; or visit our website at www.mayo.edu
As an Equal Opportunity Employer, we value diversity. Mayo Clinic Scottsdale conducts referenceand background cheeks; drug testing is required of all candidates.
National Association for Continence (NAFC) ~.O. Box 8306 Spartanburg, SC 29305-8306 Helpline: (800) BLADDER (252-3337) Website: http://www.nafc.org Resource guide; continence referral service: audiovisuals newsletters. and other publications aoout incontinence Simon Foundation for Continence RO. Box 835 Wilmette, IL 60091 (847) 864-3913: hotline (800) 23-SIMON [237-4666) Audiovisuals, newsletters, and other publications about incontinence Procter & Gamble Attention: ATTENDS brand manager 1 Procter & Gamble Plaza Cincinnati, OH 45202 (800) 4ATTEND [428-8363) Videotape for anyone who uses incontinence products, newsletter for nursing assistants Jn facilities that use ATTENDS products
are r e c o m m e n d e d for people with stress or urge UI, in m e n after prostatic surgery, and in w o m e n with stress U I after multiple surgical repairs? P M E may be combined with other interventions, such as biofeedback or pelvic floor electrical stimulation. New devices (e.g., vaginal weight cones) are available to assist in performing P M E or to facilitate identification of the pubococcygeus muscle. These exercises have no contraindications or negative effects and can be initiated by any motivated person. A l t h o u g h describing PMEs in detail is b e y o n d the scope of this column, nurses can obtain educational materials a b o u t P M E and devices available for pelvic muscle r e h a b i l i t a t i o n from the resources listed in Table 1. Nurses can stay updated on new developments in continence interventions by calling the toll-free n u m b e r s of the National Association for Continence and the Simon F o u n d a t i o n for C o n t i n e n c e or by joining these organizations and receiving their newsletters.
References 1. Miller CA. Medications can cause or treat urinary incontinence. Geriatr Nurs 1995;16:253-4. 2. Fantl JA, Newman DK, Colling J, et al. Managing acute and chronic urinary incontinence. Clinical practice guideline no. 2. 1996 Update. Rockville (MD): U.S.Department of Health and Human Services, Public Health Service,Agency for Health Care Policyand Research. AHCPR Publication No. 96-0686.March 1996.
Mayo Clinic Scottsdale uses a computerized resume database. Resumes
are accepted on a continuous basis for all positions. Individuals interested in other opportunities are encouraged to send a scannable resume to Human Resources. Specific skills and education (i.e., RN, BSN, Word, Excel, PowerPoint) should be listed. For best results, please use a standard typeface (10-14 points recommended) and avoid using graphics and dark colored paper.
110
CAROL A. MILLER, RN-C, MSN, is a gerontologic nurse specialist with Care & Counseling, MillerANetzler Associates, in Cleveland, Ohio. Geriatr Nuts 1998; 19:109-10 Copyright © 1998 by Mosby, Inc. 0197-4572/98/$5.00 + 0 34/1/89636
G e r i a t r i c N u r s i n g Volume 19, Number 2
.
.
.
.
.
.
.
.
nsult
Update on Treatments for Urinary Incontinence Carol A. Miller, RN-C, M S N Although urinary incontinence (UI) is a common problem in older adults, it should never be considered part of normal aging. When UI occurs in people of any age, the ideal approach is to view it as a condition that can be reversed with the right interventions rather than simply managed with incontinence products. Three years ago in this column, medications that can create risks for developing UI and medications sometimes used to treat it were discussed? Since then, not much has changed with regard to drugs used to treat UI, but much has changed in recommendations for nonpharmacologic interventions. The only recent development in drug treatment of UI is the use of alpha-blockers (e.g., terazosin) to manage the UI associated with benign prostatic hypertrophy. This column will vary from its usual focus on new developments in drug treatments. Instead it will discuss new developments in nonpharmacologic interventions for UI because nurses working with older adults have an important responsibility to be able to discuss safe and effective nonpharmacologic interventions for UI as the first strategy for reversing the condition. Nurses even may be in a position to raise questions about older medications being used for U I treatment. Older adults are particularly susceptible to the adverse effects of autonomic nervous system medications, the drug category most often used for UI. If adverse effects are suspected, the nurse can suggest that the older adult talk with her or his physician or nurse practitioner about nonpharmacologic interventions that might be effective. Recently updated guidelines from the Agency for Health Care Policy and Research 2 emphasize the importance of addressing the risk factors for UI before initiating management interventions. Risk factors within the scope of nurses to identify include diminished mobility, cigarette smoking, fecal impaction, environmental barriers, low fluid intake, diminished cognitive status, and adverse medication effects. 1 Certain medical conditions,
Geriatric Nursing Volume 19, Number 2
such as stroke, dementia, diabetes, and estrogen depletion, also may be causative UI factors. After risk factors are addressed, these types of interventions may be used to control UI: surgery, medications, biofeedback, continence retraining, pelvic muscle exercises (PMEs), and a variety of minimally invasive procedures. This column will review the latter two because they are the two interventions with the most developments Older adults in the past few years. In recent years, periurethral are particularly collagen injections and several other minimally lnvasive susceptible procedures have been developed to treat UI. Visual laser to the ablation and transurethral electrovaporization are two adverse effects types of minimally invaslve surgical procedures being of autonomic used for benign prostatic hypertrophy. Pessaries and a nervous system variety of recently approved intravaginal or intraurethral medications, devices may be effective measures for resolving stress UI. the drug category The newest development in intraurethral devices is severmost often used al disposable devices for selfinsertion. One type of device for UI. controls urination by inflating and deflating a small balloon that rests at the bladder neck. Another recent development is a bladder neck prosthesis that has been found to be helpful in controlling stress UI in women. Because nonsurgical devices for the control of U I are developing rapidly, people with UI should be encouraged to keep up-to-date by obtaining information from a knowledgeable health care provider or from the resources listed in Table 1. When weakening of the pelvic floor muscles
109
Table 1. Ul Information Resources Agency for Health Care Policy and Research AHCPR Publications Clearinghouse p.o. Box 8547 Silver Spring, MD 20907 (800) 358-9295 Website: http://www.ahaprgov/ Free information on incontinence: Caregiver Guide (AHCPR Pub. No. 96-0683L Quick Reference Guide for Clinicians (96-0686), Patient Guide (96-0684), Sl~anish Language Patient's Guide (96-0685), ALERT for Directors of Nursing (96-0063) Kimberly-Clark Corp. Dept. M. RO. Box 349 Neenah, WI 54957-9973 (800) KC-HELPS t524-3577) Continuing education program, community education kit for professionals that contains patient education brochures and Kegel exercise instruction sheets
causes UI, exercises to strengthen these muscles can cure or improve the symptoms. A l t h o u g h PMEs were first advocated in the late 1940s for postpartum therapy, they recently have b e e n "rediscovered" both for U I control and e n h a n c e d sexual pleasure. These exercises c o m m o n l y
MAYOCLINICSCOTTSDALE
i~
'"~'~ ~Y ~'
"
~ 4,!,
Geriatric Practitioner The Certified Gerontologic
Nurse Practitionerwill functionas a primary caregiverto adultsin extendedcarefacilitiesand as a member of the hospital-basedgeriatricconsultingteam. In additionto followingpatientsafter dischargefrom the hospital the Nurse Practitionerwillwork with the physicianstaff in Community InternalMedicIneon other clinicaland administrativeactivities related to the GeriatricsConsultingService. Mustbe a certified Nurse Practitionerwith Arizonalicenseor eligible. MayoClinicScottsdaleoffers an excellentsalaryand benefits package, Relocationassistanceavailable. If you can imagine yourself contributing to the Mayo tradition of excellence, send your scannable resume, indicating position desired, to: Mayo Clinic Scottsdale, Human Resources, 13400 E. Shea Blvd., Scottsdale, AZ 85259, or e-maih [email protected]; or call our 24-hour job hotline at 602-301-7678; or visit our website at www.mayo.edu
As an Equal Opportunity Employer, we value diversity. Mayo Clinic Scottsdale conducts referenceand background cheeks; drug testing is required of all candidates.
National Association for Continence (NAFC) ~.O. Box 8306 Spartanburg, SC 29305-8306 Helpline: (800) BLADDER (252-3337) Website: http://www.nafc.org Resource guide; continence referral service: audiovisuals newsletters. and other publications aoout incontinence Simon Foundation for Continence RO. Box 835 Wilmette, IL 60091 (847) 864-3913: hotline (800) 23-SIMON [237-4666) Audiovisuals, newsletters, and other publications about incontinence Procter & Gamble Attention: ATTENDS brand manager 1 Procter & Gamble Plaza Cincinnati, OH 45202 (800) 4ATTEND [428-8363) Videotape for anyone who uses incontinence products, newsletter for nursing assistants Jn facilities that use ATTENDS products
are r e c o m m e n d e d for people with stress or urge UI, in m e n after prostatic surgery, and in w o m e n with stress U I after multiple surgical repairs? P M E may be combined with other interventions, such as biofeedback or pelvic floor electrical stimulation. New devices (e.g., vaginal weight cones) are available to assist in performing P M E or to facilitate identification of the pubococcygeus muscle. These exercises have no contraindications or negative effects and can be initiated by any motivated person. A l t h o u g h describing PMEs in detail is b e y o n d the scope of this column, nurses can obtain educational materials a b o u t P M E and devices available for pelvic muscle r e h a b i l i t a t i o n from the resources listed in Table 1. Nurses can stay updated on new developments in continence interventions by calling the toll-free n u m b e r s of the National Association for Continence and the Simon F o u n d a t i o n for C o n t i n e n c e or by joining these organizations and receiving their newsletters.
References 1. Miller CA. Medications can cause or treat urinary incontinence. Geriatr Nurs 1995;16:253-4. 2. Fantl JA, Newman DK, Colling J, et al. Managing acute and chronic urinary incontinence. Clinical practice guideline no. 2. 1996 Update. Rockville (MD): U.S.Department of Health and Human Services, Public Health Service,Agency for Health Care Policyand Research. AHCPR Publication No. 96-0686.March 1996.
Mayo Clinic Scottsdale uses a computerized resume database. Resumes
are accepted on a continuous basis for all positions. Individuals interested in other opportunities are encouraged to send a scannable resume to Human Resources. Specific skills and education (i.e., RN, BSN, Word, Excel, PowerPoint) should be listed. For best results, please use a standard typeface (10-14 points recommended) and avoid using graphics and dark colored paper.
110
CAROL A. MILLER, RN-C, MSN, is a gerontologic nurse specialist with Care & Counseling, MillerANetzler Associates, in Cleveland, Ohio. Geriatr Nuts 1998; 19:109-10 Copyright © 1998 by Mosby, Inc. 0197-4572/98/$5.00 + 0 34/1/89636
G e r i a t r i c N u r s i n g Volume 19, Number 2