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Monday, May 12, 2008

Going to the dogs

I delight in watching Cesar Milan on National Geographic Channel, doing what he does to give dogs the bast chance in life, to be a dog.

Recently an episode included a dog with stress incontinence.

I'm sure you know about this if you have loved a dog enough to make one your companion.

Anxiety and stress cause incontinence in people too. So do drugs.

And so does a problem greatly overlooked called drug interaction.

I get annoyed with prescribers when I talk with their patients and learn that these folks have no idea of side effects and interactions of the pills they are swallowing.

My annoyance comes from the fact that any prescriber is required to explain this information to a person for whom they write the script. It's the law, and it is the right thing to do.

I provide a paid educational service that details the drug data and interaction potential. My clients are grateful because I also help them how to discuss their concerns with that prescriber. It brings a lot of relief, and hopefully better health to the person.

I don't use Rx drugs and I think I am fortunate because of it. If I did I would probably wonder why this kind of thing happens and think about the impact of spiritual healing. I would also turn to selected flower essences or other vibrational remedies to correct the problem and the emotions.

Generally, in spiritual healing, when anyone has a urinary problem, it is defined as the need to ask yourself why you are pissed off.

And I'd see this as a real reason to be so!
Urinary Incontinence More Common in Elderly Women Taking Certain Medications
Jacquelyn K. Beals, PhD, Laurie Barclay, MD
Release Date: May 7, 2008

From American Geriatrics Society (AGS) 2008 Annual Scientific Meeting

May 7, 2008 (Washington, DC) — Elderly women receiving alpha-blocker or estrogen therapy are at increased risk for urinary incontinence, according to a study presented here at the American Geriatrics Society 2008 Annual Meeting. A 12-month longitudinal study investigated the effects of 8 common medications with possible urologic effects. Only alpha-blockers and estrogens were associated with an increase in self-reported urinary incontinence.

Study participants were from the Health, Aging, and Body Composition Study, instituted in 1996 by the Geriatric Epidemiology Section of the National Institute on Aging. The present study enrolled 959 elderly women aged 70 to 79 years (average age, 73.3 years), 46% of whom were black. Few were chronic smokers, approximately 40% drank some alcohol, 39% were overweight, and 27% were obese.

Christine M. Ruby, PharmD, BCPS, assistant professor of the Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, and Clinical Pharmacy Specialist in Geriatrics, Benedum Geriatric Center, Pittsburgh, Pennsylvania, presented the study. As she explained in her talk, "In terms of medication use, a 'brown bag' method was used rather than electronic pharmacy records, and [the data were] measured at 1 point in time."

Medications of interest were central nervous system medications (antipsychotics, including antidepressants, benzodiazepines, and opioids, which were combined into 1 group), diuretics, anticholinergics, estrogen, and alpha-blockers. The most common medication was thiazide diuretics, taken by 25% of the women; 22.2% took estrogen, and 2.3% used alpha-blockers.

During the year, investigators assessed self-reported urinary incontinence. This was defined as leaking urine at least weekly. Dr. Ruby noted, "Nearly 1 in 5 [of the patients] had problems leaking urine daily or weekly.... The overwhelming majority reported urge-like symptoms, and about 25% of these women reported stress-like [incontinence] symptoms."

The main outcome measure was a dichotomous variable for women with self-reported leaking daily or weekly during the 12-month study. There were 3 subcategories: women for whom stress incontinence was the primary symptom, those with urge incontinence as the primary symptom, and those who could not identify one or the other as primary.

Data analysis showed that women using alpha-blockers were 5-fold more likely than nonusers to have urinary incontinence (adjusted odds ratio [AOR], 5.06; 95% confidence interval [CI], 1.98 - 12.93). Women using estrogens had 63% more incontinence than nonusers (AOR, 1.63; 95% CI, 1.09 - 2.45). No significant associations were found for the other medications.

In an email interview with Medscape Internal Medicine, Dr. Ruby described the effects of alpha-blockers: "Peripheral alpha-blockers are used for management of mild to moderate hypertension in men and women. In men, alpha-blockers are also used for treatment of benign prostatic hyperplasia. In women, alpha-blockers may relax the smooth muscles of the bladder neck...having a detrimental effect on a woman's ability to keep dry."

Thus, alpha-blockers might worsen the problem in women who have stress incontinence; in women with urge incontinence, the sphincter may not be tight enough for them to reach the bathroom in time.

Estrogens have been prescribed in the past to treat urinary incontinence. Dr. Ruby said that the current study "is consistent with what was found in the Women's Health Initiative...that estrogens may actually have a detrimental effect, may affect collagen in a negative way, and that may mean women."

Medscape Internal Medicine also talked with section moderator George A. Kuchel, MD, professor of medicine, Travelers Chair in Geriatrics and Gerontology, director of the University of Connecticut Center on Aging, and chief of the Division of Geriatric Medicine at the University of Connecticut Health Center, Farmington, about the role of estrogens.

"For many, many years," Dr. Kuchel said, "we prescribed estrogen for incontinence because we thought that it would restore the tissues to their youthful state. But when the clinical trials were actually done...[they] showed, actually quite surprisingly, that women who were randomized to get estrogen actually had more incontinence than those who were not randomized to get estrogen."

Dr. Kuchel continued, "[It] turns out that both estrogen and also alpha drugs have effects not just on the outlet but also on the body [of the bladder], which has not been studied very much.... Estrogen deficiency results in decreased ability of the bladder body to contract.... [B]y giving may be making women more wet by...making the contraction stronger."

To clarify the ways that estrogens and alpha-blockers affect bladder emptying, Dr. Kuchel suggested that a study should "look at women who were taking both estrogen and alpha-antagonists. Because they potentially work through different mechanisms, their risks [for urinary incontinence] should be greater than either one alone."

Dr. Ruby and Dr. Kuchel have disclosed no relevant financial relationships.

American Geriatrics Society 2008 Annual Meeting: Abstract P39. Presented May 3, 2008.

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