Urge urinary incontinence in palliative care
Urge urinary incontinence (overactive bladder) is uncontrolled loss of urine due to increased activity of the detrusor smooth muscle. It can be worse in a patient with stress or functional incontinence.
Symptoms of urge urinary incontinence in patients with palliative care needs may improve with an anticholinergic drug. Suitable regimens are:
1oxybutynin 2.5 to 5 mg orally, 2 to 3 times daily oxybutynin
OR
1oxybutynin 3.9 mg/24 hours patch transdermally, replaced twice weekly (every 3 to 4 days). oxybutynin
More selective anticholinergic drugs (eg solifenacin, darifenacin) can be used to treat urge urinary incontinence and are associated with fewer adverse effects. For those unable to tolerate any anticholinergic effects, mirabegron may be used. These drugs are not subsidised on the Pharmaceutical Benefits Scheme (PBS) at the time of writing.
See General management of urinary incontinence in palliative care for additional strategies.
For postmenopausal women with urge urinary incontinence, consider using intravaginal estrogen therapy—see the Sexual and Reproductive Health guidelines for dosage.