Alayne Markland, DO: Considerations for Treating Urge Incontinence in Older Adults

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Markland discusses the use of anticholinergics, beta 3-agonists, and nonpharmacologic treatments for urge urinary incontinence, based on her session at ACP.

Urge incontinence is a common problem in older adults that generally increases in frequency and severity with greater age and cognitive dysfunction.

In her session at the 2024 American College of Physicians (ACP) Internal Medicine meeting in Boston, Alayne Markland, DO, associate professor of medicine in the division of gerontology, geriatrics, and palliative care at the University of Alabama at Birmingham and associate director of clinical programs in the Birmingham/Atlanta Geriatric Research, Education, and Clinic Center, discussed what she referred to as a “threefold” topic on urge type urinary incontinence.

“The 3 main topics were just how common it is, so prevalence and impact. The second part was kind of the workup from a clinical perspective on what could be done, and then the meat of the whole entire talk was really on the treatment,” Markland explained in an interview with HCPLive.

Specifically, she referenced recent evidence showing the duration of use of anticholinergic medications over a long-term period can increase the incidence of dementia in older adults, emphasizing the importance of considering the benefits versus the risks of using these medicines for urge urinary incontinence. Markland was also careful to note the effects on mild cognitive impairment in the longer term are still unknown.

Regarding the use of beta 3-agonists, Markland said they are “at least as efficacious, and in some cases more so, than the anticholinergics, with less side effects,” citing potential concerns about cardiac heart rate and blood pressure elevations but pointing out the risk does not seem to be notable based on clinical trial data.

Markland referred to herself as a “huge believer” in nonpharmacologic treatment for bladder problems, mentioning her involvement in clinical studies around behavioral treatments. Specifically, she highlighted pelvic floor muscle exercises as “a big cornerstone of the nonpharmacologic treatments” and explained their evidence for improving symptoms as well as patients’ ability to teach themselves using online resources.

Markland has no relevant disclosures.