dry eye dx and tx

Incontinence and Dry Eye

BY KATHERINE M. MASTROTA, MS, OD, FAAO

It is estimated that at least 10 million Americans suffer from urinary incontinence. The condition affects either gender but is twice as common in women. The rates of urinary incontinence in women increase with age, with 20 to 30 percent of young women to up to 50 percent of older women suffering varying degrees of urinary incontinence.

Stress Versus Urge Incontinence

Stress incontinence occurs when increased pressure against the bladder, such as from coughing or laughing, causes urine leakage. In women, stress incontinence results from inadequate strength of the pelvic floor muscles that support the bladder. These muscles can be weakened by weight gain, sports injury, pregnancies, and vaginal child birth. Estrogen helps keep the lining of the bladder and urethra healthy: lowered estrogen levels following menopause may be a contributing factor to stress incontinence.

Men can also experience stress incontinence—most commonly after prostate surgery, which can damage the urinary sphincter.

In men, inflammation of the prostate gland, prostatitis, can be associated with incontinence. Prostatitis can affect men of any age, and an estimated 50 percent of men experience the disorder during their lifetime. Incontinence can often stem from enlargement of the prostate gland, a condition known as benign prostatic hyperplasia that generally occurs in men over the age of 40.

Urge incontinence, also referred to as “overactive bladder,” is involuntary loss of urine accompanied by an acute urge to urinate. The sudden, overwhelming need to urinate is thought to result from spasms of the bladder caused by nerve or muscle damage, inflammation, or irritation.

Managing Incontinence

Why is a discussion of incontinence in a dry eye column? The answer lies in the fact that many of your patients who have urinary incontinence will have been prescribed antidepressants or anti-cholinergic agents to manage their condition. In the November 2009 Dry Eye Dx and Tx column, William Townsend, OD, FAAO, reminded us that antipsychotic and antidepressant systemic medications may precipitate or exacerbate dry eye.

Antidepressants can limit leakage in incontinent patients by tightening muscles at the neck of the bladder and through their ability to relax the bladder smooth muscle. Imipramine (Tofranil, Novartis) is a common tricyclic antidepressant that may be used to treat both stress and urge incontinence.

Anticholinergic medications, whose side effect profile includes dry eye, block nerves that control contraction of bladder smooth muscle, making them useful for urge incontinence. Drugs in this category include oxybutynin (Ditropan, Ortho-McNeil-Janssen Pharmaceuticals, Inc.), tolterodine (Detrol, Pfizer), darifenacin (Enablex, Novartis/Proctor & Gamble), solifenacin (Vesicare, Astellas Pharmaceuticals Inc.) and trospium (Sanctura, Allergan/Indevus Pharmaceuticals, Inc.).

Ideally, non-pharmaceutical management of incontinence would best serve our ocular surface disease patients. Encourage both male and female patients who have this condition to explore Kegel exercises to strengthen pelvic floor and sphincter muscles to reduce urine leakage.

Advise patients who suffer from urinary incontinence to become neither over-hydrated nor dehydrated. Dehydration concentrates bladder-irritating urinary salts. Carbonated drinks, tea and coffee with or without caffeine, artificial sweeteners, corn syrup, and foods and beverages high in spice, sugar, and acid can also irritate the bladder. Finally, Subak et al (2009) demonstrated that weight loss in overweight women reduced stress incontinence. CLS

To obtain references for this article, please visit http://www.clspectrum.com/references.asp and click on document #171.

Dr. Mastrota is secretary of the newly formed Ocular Surface Society of Optometry (OSSO). She is center director at the New York Office of Omni Eye Services and is a consultant to Allergan, AMO, B+L, Inspire, Noble Vision, and Cynacon Ocusoft.