Zeitschrift für Gerontologie und Geriatrie

, Volume 45, Issue 6, pp 464–467 | Cite as

Polypharmacy and incontinence

  • H. TalaszEmail author
  • M. Lechleitner
Beiträge zum Themenschwerpunkt


Polypharmacy as well as urinary incontinence are common geriatric problems. Possible adverse drug effects remain a matter of concern in geriatric medicine and must be considered in urinary incontinence. The occurrence or aggravation of lower urinary tract symptoms might be caused by medication, especially when the symptom is newly diagnosed. On the other hand geriatric patients are at an increased risk for adverse effects of medications, commonly used for treatment of urinary incontinence. Especially antimuscarinic drugs reveal several complex anticholinergic adverse effects. Therefore, knowledge of inappropriate medication and of possible adverse drug effects is important in the diagnostic evaluation and therapeutic considerations to prevent a cascade of symptom-related medications.


Adverse effects Anticholinergics Geriatrics Incontinence Polyuria 

Polypharmazie und Inkontinenz


Polypharmazie wie auch Inkontinenzleiden stellen häufige geriatrische Probleme dar. Nicht selten können sich beide Konditionen gegenseitig beeinflussen und verstärken. Harninkontinenz kann in manchen Fällen ein Hinweis für eine Medikamentennebenwirkung sein. Andererseits können Medikamente, in erster Linie Anticholinergika, die in der Therapie von Inkontinenzleiden eingesetzt werden, bei geriatrischen Patienten schwere unerwünschte Medikamentennebenwirkungen und -interaktionen verursachen. Grund dafür sind veränderte pharmakokinetische und pharmakodynamische Eigenschaften. Daher muss bei diesen Patienten sowohl bei der Evaluierung als auch in der Therapie von Inkontinenzsymptomen ein besonderes Augenmerk auf mögliche Medikamentennebenwirkungen und -interaktionen gelegt werden.


Nebenwirkungen Anticholinergika Geriatrie Inkontinenz Polyurie 


Conflict of interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest.


  1. 1.
    Asplund R, Aberg H (1991) Diurnal variation in the levels of antidiuretic hormone in the elderly. J Intern Med 229(2):131–134PubMedCrossRefGoogle Scholar
  2. 2.
    Beers MH, Ouslander JG, Rollingher I et al (1991) Explicit criteria for determining inappropriate medication use in nursing home residents. UCLA Division of Geriatric Medicine. Arch Intern Med 151(9):1825–1832PubMedCrossRefGoogle Scholar
  3. 3.
    Boudreau DM, Yu O, Gray SL et al (2009) Concomitant use of cholinesterase inhibitors and anticholinergics: prevalence and outcomes. J Am Geriatr Soc 57:1238–1244CrossRefGoogle Scholar
  4. 4.
    Callaway E, Halliday R, Naylor H (1992) Cholinergic activity and constraints on information processing. Biol Psychol 33:1–22PubMedCrossRefGoogle Scholar
  5. 5.
    Chapple CR, Khullar V, Gabriel Z et al (2008) The effects of antimuscarinic treatments in overactive bladder: an update of a systematic review and meta-analysis. Eur Urol 54:543–562PubMedCrossRefGoogle Scholar
  6. 6.
    Cigolle CT, Langa KM, Kabeto MU et al (2007) Geriatric conditions and disability: the Health and Retirement Study. Ann Intern Med 147:156–164PubMedGoogle Scholar
  7. 7.
    DuBeau CE, Kuchel GA, Johnson T et al (2009) Incontinence in the frail elderly. In: Abrams P, Cardozo L, Khoury S, Wein A (eds) 4th International Consultation on Incontinence. Recommendations of the International Scientific Committee: Evaluation and Treatment of Urinary Incontinence, Pelvic Organ Prolapse and Faecal Incontinence. 4th ed. Health Publication Ltd, Paris, pp 961–1024Google Scholar
  8. 8.
    Gallagher P, Ryan C, Byrne S et al (2008) STOPP (Screening Tool of Older Person’s Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation. Int J Clin Pharmacol Ther 46(2):72–83PubMedGoogle Scholar
  9. 9.
    Gill SS, Mamdani M, Naglie G et al (2005) A prescribing cascade involving cholinesterase inhibitors and anticholinergic drugs. Arch Intern Med 165:808PubMedCrossRefGoogle Scholar
  10. 10.
    Hogan DB (1997) Revisiting the O complex: urinary incontinence, delirium and polypharmacy in elderly patients. CMAJ 157(8):1071–1077PubMedGoogle Scholar
  11. 11.
    Holroyd-Leduc JM, Mehta KM, Covinsky KE (2004) Urinary incontinence and its association with death, nursing home admission, and functional decline. J Am Geriatr Soc 52:712–718PubMedCrossRefGoogle Scholar
  12. 12.
    Holt S, Schmiedl S, Thürmann PA (2010) Potentially inappropriate medications in the elderly: the PRISCUS list. Dtsch Ärztebl 107:543–551Google Scholar
  13. 13.
    Kessler TM, Bachmann LM, Minder C et al (2011) Adverse event assessment of antimuscarinics for treating overactive bladder: a network meta-analytic approach. PLoS ONE 6(2):e16718. doi: 10.1371/journal.pone.0016718PubMedCrossRefGoogle Scholar
  14. 14.
    Laroche ML, Charmes JP, Merle L (2007) Potentially inappropriate medications in the elderly: a French consensus panel list. Eur J Clin Pharmacol 63:725–731PubMedCrossRefGoogle Scholar
  15. 15.
    Madhuvrata P, Cody JD, Ellis G et al (2012) Which anticholinergic drug for overactive bladder symptoms in adults. Cochrane Database Syst Rev 1:CD005429PubMedGoogle Scholar
  16. 16.
    Milsom I, Altman D, Lapitan MC et al (2009) Epidemiology of urinary and faecal incontinence and pelvic organ prolapse. In: Abrams P, Cardozo L, Khoury S, Wein A (eds) 4th International Consultation on Incontinence. Recommendations of the International Scientific Committee: Evaluation and Treatment of Urinary Incontinence, Pelvic Organ Prolapse and Faecal Incontinence. 4th ed. Health Publication Ltd., Paris, France, pp 35–111Google Scholar
  17. 17.
    Modi A, Weiner M, Craig BA et al (2009) Concomitant use of anticholinergics with acetylcholinesterase inhibitors in Medicaid recipients with dementia and residing in nursing homes. J Am Geriatr Soc 57:1238PubMedCrossRefGoogle Scholar
  18. 18.
    Novara G, Galfano A, Secco S et al (2008) A systematic review and meta-analysis of randomized controlled trials with antimuscarinic drugs for overactive bladder. Eur Urol 54(4):740–764PubMedCrossRefGoogle Scholar
  19. 19.
    Österreichisches Basisassessment. Accessed 12 June 2012Google Scholar
  20. 20.
    Ouslander JG, Johnson TM (1998) Incontinence. In: Hazzard WR, Blass JP, Ettinger WH et al (eds) Principles of Geriatric Medicine and Gerontology. 4th Ed. McGraw-Hill, New York, pp 1595–1613Google Scholar
  21. 21.
    Ouslander JG et al (1998) Arginine vasopressin levels in nursing home residents with nighttime urinary incontinence. J Am Geriatr Soc 46:1274–1279PubMedGoogle Scholar
  22. 22.
    Mann E, Böhmdorfer B, Frühwald T et al (2012) Potentially inappropriate medication in geriatric patients: the Austrian consensus panel list. Wien Klin Wochenschr 124(5–6):160–169Google Scholar
  23. 23.
    Robinson D, Cardozo L (2012) Antimuscarinic drugs to treat overactive bladder. BMJ 344:e2130. doi:10.1136/bmj.e2130PubMedCrossRefGoogle Scholar
  24. 24.
    The American Geriatrics Society 2012 Beers Criteria Update Expert Panel (2012) AGS updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 60(4):616–631CrossRefGoogle Scholar
  25. 25.
    Kerrebroeck P van et al (2002) The standardisation of terminology in nocturia: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn 21:179–183PubMedCrossRefGoogle Scholar
  26. 26.
    Weiss JP, Blaivas JG, Bliwise DL et al (2011) The evaluation and treatment of nocturia: a consensus statement. BJU Int 108:6–21PubMedCrossRefGoogle Scholar
  27. 27.
    Woodford H, George J (2007) NICE guidelines on urinary incontinence in women. Age Ageing 36:349–350PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  1. 1.Department of Internal and Geriatric MedicineHochzirl HospitalZirlAustria

Personalised recommendations