MANAGING SYMPTOMS( continued)
If bladder infection is not the cause of urinary urgency and incontinence, the symptom often responds to drugs that stimulate the muscle at the neck of the bladder. Even when the bladder wall muscle contracts abnormally, the ability of the bladder to empty, and the sensation that it needs to do so, can be inhibited in this way. Two of the more popular drugs are oxybutynin( Ditropan) and tolterodine( Detrol). Both drugs can cause dry mouth and constipation. The latter is often already a problem in PSP and can be treated by fluids, fiber, stool softeners, and, in more severe cases, laxatives. These drugs must not be overused, as they can actually worsen the urinary problem by making it so difficult to empty the bladder that it overfills, weakening the bladder wall muscle.
Some drugs used to treat the movement disorder of PSP, such as amantadine and amitriptyline, can share this side effect of worsening the urinary difficulty. Incontinence during the night is especially common because of the reduced availability of a caregiver to aid the trip to the bathroom and because the recumbent position increases blood flow to the kidneys, producing more urine per hour. Nighttime incontinence can be reduced by avoiding drinking fluids after supper. However, this must not be accomplished at the cost of reducing the total daily fluid intake and causing dehydration. If urinary incontinence in PSP fails to respond to these measures, it may be necessary to use an absorbent pad or adult diaper. The advice of a visiting nurse is often useful in choosing between this method and a urinary catheter. The nurse can also provide instruction in avoiding skin irritation. For men, a condom( Texas) catheter is usually preferable to an indwelling( Foley) catheter because the latter allows bacteria to ascend the urethra, giving the bacteria a surface in the bladder on which to grow and cause infection.
58