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Urinary Incontinence - Interview with Dr. Adrian Wagg

Posted Aug 31st, 2020

Urinary Incontinence - Interview with Dr. Adrian Wagg

I had the opportunity to speak with a world-renowned expert on incontinence, who happens to be another Canadian Geriatrician.  Dr. Adrian Wagg  explained in detail how to prevent, classify, and treat urinary incontinence.  Listen to the interview to learn more (Just click on the orange arrow above)!

Quick facts about Urinary Incontinence (UI):

  • It affects 1 in 3 women and 1 in 12 men 

  • It cost 66 billion USD in 2012

  • Risk factors for incontinence in women includes smoking and obesity

  • Men with Urinary Incontinence are more likely to take early retirement

What kind of incontinence is it?

There are 4 main types of urinary incontinence and your symptoms can tell you a lot about which one it is:
1. Stress incontinence: loss of small amount of urine with certain activities like running, jumping, laughing or coughing.
2. Urge incontinence: often referred to as Overactive Bladder (OAB), this causes an almost overwhelming urge to urinate, sometimes associated with loss of urine.
3. Overflow: Can cause small dribbles of urine on a constant basis, and is usually related to a partially blocked bladder outlet or less contractile bladder muscle
4. Disability-associated Incontinence:  When a person is too weak or confused to get to the toilet on time, urinate loss can be a side effect.
 Of course, there can be a mixture of different types as well, called "Mixed Incontinence".

Your doctor will want to find out as much as possible about the pattern of your symptoms and your lifestyle habits, including medications and fluid intake (caffeine and alcohol intake too!).  They will ask you about:

  • What activities cause urine to leak?
  • Is the leaking constant or intermittent?
  • How many times do you go to the toilet in a day?
  • How many cups of coffee, cans of pop, or bottles of water do you drink in a day and at what times?
  • What medications do you take?

Some types of incontinence are reversible, and your doctor will want to rule those out before starting a more permanent treatment plan.  You may want to keep a bladder diary for a few days.

Treatment Options

Treatment also depends on the type of incontinence, as well as the person's other health issues and preferences.

Stress: first line treatment involves pelvic floor exercises   which can be taught by a nurse or physiotherapist and can be practiced almost any place at any time.   Bladder training is  a form of behavioral modification that can help a person with stress or urge incontinence delay toilet trips, but it does take some persistence and motivation.  For some with mixed symptoms, medications may be helpful (as for urge incontinence, below)

Urge: there are 2 main classes of medications that can help reduce the urges associated with an overactive bladder:
  1. Anti-muscarinincs: the newer ones (like solifenacin and fesoteradine) are fairly low in side effects, but the odler generation of anti-muscarinic, oxybutinin, is highly likely to cause constipation, dry mouth, sleepiness and confusion.
  2. Beta-adrenergic agonists: mirabegron is a beta receptor agonist that helps to relax the bladder muscle and has fewer side effects than the antimuscarinics.
In some cases, both mirabegron and an antimuscarinic medication can be taken at the same time.


Overflow: If the bladder muscle is weak or paralyzed, a person may need to self-catheterize several times a day, or may have an in-dwelling catheter, although this carries a higher risk of infection.  If the overflow is due to an enlarged prostate gland there are 2 types of medications that might help:
  1.  5-alpha-reductase inhibitors (e.g. finasteride), which shrink the prostate gland
  2. Alpha-1--antagonists (terazosin for example) which relax the bladder muscles


Disability-Associated: this type of incontinence usually affects those living with cognitive impairment or mobility limitations, or both. Management of this type of incontinence might include a combination of behaviour modification, use of pads and continence products, and toileting routines with helpers or special equipment.

For more information about incontinence, have a listen to my chat with Dr. Adrian Wagg.  Dr. Wagg is a Geriatrician, and has published dozens of research papers about urinary incontinence in older adults. 

If you'd like a transcript,  please fill in the form below and join our mailing list to get a link so that you can download the complete transcript, and get the latest in Geriatric news and education from me, Dr. Nicole Didyk, at TheWrinkle.ca, delivered straight to your inbox.

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