Medication Management in Residential Aged Care

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Managing urinary incontinence

Urinary incontinence is common, but underreported. A survey conducted in Australian GP waiting rooms found that only 30% of participants with urinary incontinence had spoken to a health professional about it.^[1]

People may be reluctant to talk about incontinence because they believe that it is a normal part of ageing.^[2] Embarrassment, lack of awareness of treatment options, fear of surgery or the doctor's gender may be important factors for some.^[3,4]

Think about medicines and mobility

Ask patients or their carers about medicine use, or request a formal medicines review, to help to identify incontinence that is caused or worsened by medicines.

Environmental factors, reduced mobility, impaired dexterity and cognitive impairment can prevent people from getting to or using the toilet.

Removing clutter and providing non-slip floor surfaces and adequate lighting may help. Height adjustment or grab rails can make the toilet easier to use.^[6] Clearly identify the toilet for those with cognitive impairment and consider velcro fastenings or trousers with elastic waistbands if clothing or dexterity is an issue.^[5,7]

Physical and behavioural therapies are first line

Physical and behavioural therapies promote self-management and have less risk of side effects than medicines. These can include: pelvic floor exercises, bladder training and prompted voiding.

Anticholinergics

Avoid anticholinergic agents in people with dementia because of the risk of cognitive decline and delirium.^[7] To find out more about prescribing drugs used in dementia, read NPS News 59: Drugs used in dementia in the elderly.

What resources are available?

• The Bladder & Bowel Website
• Continence Foundation of Australia
• The National Continence Helpline ph: 1800 33 00 66
• Physiotherapists specialising in continence therapies at Australian Physiotherapy Association 

References

1. Byles JE, et al. Int Urogynecol J Pelvic Floor Dysfunct 2005;16:29-38.
2. Dugan E, et al. J Am Geriatr Soc 2001;49:462-5.
3. Norton PA, et al. Bmj 1988;297:1187-9.
4. Miller YD, et al. Int J Behav Med 2003;10:143-61.
5. The Royal Australian College of General Practitioners. Managing incontinence in general practice: Clinical practice guidelines. 2002. (accessed 6 August 2009).
6. Australian Government Department of Health and Ageing. What now? Helping clients live positively with urinary incontinence. 2007. (accessed 11 August 2009).
7. Yap P, Tan D. Aust Fam Physician 2006;35:237-41.