treating incontinence for underlying mental and physical health

Conditions: Urinary Incontinence, Urge; Urinary Incontinence; Overactive Bladder; Incontinence, Urge; Incontinence, Urinary; Incontinence

Summary: the triumph study is a randomized, double-blinded, 3-arm, parallel-group trial designed to compare the effects of anticholinergic bladder therapy versus a) beta-3-adrenergic agonist bladder therapy and b) no bladder pharmacotherapy on cognitive, urinary, and other aging-related functional outcomes in ambulatory older women with urgency-predominant urinary incontinence and either normal or mildly impaired cognitive function at baseline.


Eligibility criteria:
inclusion criteria: * aged 60 years or older at the time of enrollment * female sex at birth, without surgical or hormonal gender re-assignment therapy * able to walk to the bathroom and use the toilet without assistance * report urinary incontinence starting at least 3 months prior to screening * report that at least half of incontinence episodes occur with a sudden or strong sensation of urgency * report 2 or more urgency incontinence episodes over a 7-day period * willing to provide informed consent and adhere to study procedures throughout the length of the study exclusion criteria: * prior clinician diagnosis of dementia, or a montreal cognitive assessment (moca) score of 17 or lower on screening cognitive evaluation * current use of anticholinergic, beta-3-adrenergic agonist, or other medication designed to improve urgency incontinence symptoms, or use in the past 1 month * initiation, discontinuation, or dose change of dementia medications (such as donepezil, galantamine, memantine, rivastigmine) in the past 1 month (but candidates on stable doses are eligible) * initiation, discontinuation, or dose change of other drugs with strong anticholinergic effects (based on the beers list) in the past 1 month (but candidates on stable doses are eligible) * initiation, discontinuation, or dose change of other drugs that can affect urinary frequency, including diuretics, in the past 1 month (but candidates on stable doses are eligible) * current urinary tract infection (uti) based on screening urinalysis and culture (but candidates can re-present for re-screening after undergoing treatment for uti) * history of allergy or sensitivity to either of the study medications or an ingredient in the placebo or study medication capsule * severe hepatic impairment (child-pugh score b or greater) or renal impairment (creatinine clearance \<30 ml/min) as a contraindication to both study medications * current bladder obstruction or urinary retention (defined by symptoms suggesting difficulty emptying the bladder in addition to postvoid residual urine volume greater than 150 cc by portable bladder ultrasound) * uncontrolled hypertension (based on measured systolic blood pressure greater than 180 or diastolic blood pressure greater than 110 mmhg) as a contraindication to beta-3-adrenergic therapy * self-reported history of gastric retention, uncontrolled narrow angle glaucoma, myasthenia gravis, severe ulcerative colitis, or toxic megacolon as contraindications for anticholinergic bladder therapy * use of drugs with adverse interactions with one of the study medications in the past 1 month, including potent cyp3a4 inhibitors, hepatic enzyme metabolism inducers, narrow therapeutic index drugs metabolized by cyp2d6, or intention to start taking one of these medications during the study treatment period * history of bladder surgery, invasive intra-vesical therapy, or bulk bladder injections in the past 3 months (more remote surgery will not be exclusionary), or intention to undergo one of these procedures in the study treatment period * use of other specialized incontinence therapy (electrostimulation, pelvic physiotherapy, formal behavioral therapy overseen by certified practitioners) in the past 3 months (more remote therapy will not be exclusionary), or intention to undergo one of these procedures in the study treatment period * inability to sign informed consent or complete questionnaires, interviews, or study testing in english * other condition that would prevent the participant from completing study procedures, in the opinion of the investigators (e.g., uncontrolled psychosis)