Geriatric Patients and Bladder Medications

The 2012 guidelines for the treatment of overactive bladder in adults (updated in 2014) recommends as first line treatment behavioral therapies. These therapies include bladder training, bladder control strategies, pelvic floor muscle training, fluid management- all tools that can be learned in the Institute’s Pelvic Floor Level 1 course. These behavioral therapies may also be combined with medication prescription, according to the guideline.

When medications are prescribed for overactive bladder, oral anti-muscarinics or oral B3-adrenergic agonists may be prescribed. Although these drugs may help to relax smooth muscles in the bladder wall, the side effects are often strong enough to make the medication difficult to tolerate. Side effects of constipation and dry mouth can occur, and when they do, patients should communicate that to their physician so that the medication dosage or class can be evaluated and modified if possible. We know that patients who have constipation tend to have more bladder dysfunction, so patients can get stuck in a vicious cycle.

Although patients and their medications are screened at their prescriber’s office and often at the pharmacy, it is important to remember that therapists are an important part of this safety mechanism. Patients may not be candidates for anti-muscarinics if they have narrow angle glaucoma, impaired gastric emptying, or a history of urinary retention. When patients are taking other medications with anticholinergic properties, or are considered frail, adverse drug reactions can also occur. Our geriatric patients may have some additional considerations, not just in medication screening, but also in evaluation and intervention. If you are interested in learning more about pelvic rehabilitation for those in the geriatric population, check out our new continuing education course, Geriatric Pelvic Floor Rehabilitation with Heather S. Rader, PT, DPT, BCB-PMD. The next opportunity to take the class is January 16-17, 2016 in Tampa.