DescriptionAn in-depth report on the causes, diagnosis, treatment, and prevention of urinary incontinence.
A number of medications are available that increase sphincter or pelvic muscle strength or relax the bladder, thus increasing its capacity to hold urine. Medications can be prescribed for all kinds of incontinence, but they are generally most helpful for urge incontinence.
Medications Specifically for Urge Incontinence
Anticholinergics. Anticholinergics work in the following ways:
A major 2003 analysis reported that these agents produce small but significant improvements. However, the medications have not been rigorously compared with behavioral methods, such as bladder training and Kegel exercises, which are very effective for most cases of urge incontinence. Anticholinergics can have distressing side effects, notably dry mouth.
Propantheline (ProBanthine) was the most commonly prescribed anticholinergic, but has been largely replaced by newer anticholinergics with fewer side effects. They include oxybutynin (Ditropan, Oxytrol), tolterodine (Detrol), and hyoscyamine (Levbid, Cytospaz).
Extended-release versions of oxybutynin (Ditropan XL) and tolterodine (Detrol LA) are proving to be especially effective. They improve continence and have fewer adverse effects than short-acting forms. According to a 2002 study of Detrol LA, they also improve the quality of life. In a major 2003 comparison study of the extended release agents, oxybutynin was slightly more effective than tolterodine, but dry mouth was reported more often. A skin patch form of oxybutynin (Oxytrol) is now available that appears to be effective and have fewer side effects, such as dry mouth and constipation, than the oral form.
Overactive Bladder Treatments for Children
Side effects of anticholinergic agents include the following:
Antispasmodics. Antispasmodic drugs help relax the bladder muscle and are used for urge incontinence. Before bladder relaxants are prescribed, a thorough evaluation for obstructions in the ureter must be performed to avoid excessive urine retention. The two antispasmodics most commonly prescribed include flavoxate (Urispas) and dicyclomine (Bentyl). They also have anticholinergic properties. They have been used for years, although studies suggest that Urispas has very little benefits for most patients with urge incontinence. In May 2004, the FDA approved a new antispasmodic, Sanctura, for the treatment of overactive bladder with symptoms or urge incontinence.
Possible side effects reported with use of antispasmodic drugs include:
M3 selective receptor antagonists: Two separate Phase III clinical trials suggest that Enablex (darifenacin hydrobromide) significantly reduces overactive bladder symptoms, including night-time awakenings and urge incontinence. FDA approval for Enablex is expected by the end of 2004.
Capsaicin and Analogs. Studies have reported beneficial effects from instillation of capsaicin, a component of hot red chili peppers, into the bladder of people with hyperactive and hypersensitive bladders. Temporary adverse effects, however, can be distressing. A capsaicin analog called resiniferatoxin may be more effective than capsaicin and have fewer side effects.
Alpha-Blockers. Alpha-blockers are drugs that relax smooth muscles and improve urine flow. They are useful for men with benign prostatic hyperplasia who have urge incontinence. They include terazosin (Hytrin), doxazosin (Cardura), tamsulosin (Flomax) and alfuzosin (Xatral). Tamsulosin may be particularly beneficial.
Medications Specifically for Stress Incontinence
Alpha-Adrenergic Agonists. Alpha-adrenergic agonists are used to strengthen the smooth muscle that opens and closes the internal sphincter. They include ephedrine and pseudoephedrine, which are common ingredients in numerous over-the-counter decongestants and appetite suppressants.
Such agents may be helpful for patients with mild stress incontinence not caused by nerve damage, although evidence on their benefits is weak. They also can have significant side effects, particularly ephedrine. In fact, products containing a similar agent, phenylpropanolamine (PPA), have been taken off the market because of reports of a higher risk for stroke in some women who took it.
Side effects include the following:
The may have adverse effects on the heart in people with existing heart problems. People with glaucoma, diabetes, hyperthyroidism, heart disease, or high blood pressure should avoid alpha-adrenergic agonists.
Nitrovasolidators. Deficiencies in nitric oxide, a gas that keeps blood vessels open, has been associated with many disorders, including incontinence. Agents that release nitric oxide, such as nitroflurbiprofen, are being investigated for urinary incontinence.
Tricyclic and Similar Antidepressants
Evidence indicates that both urge and stress incontinence are affected, in part, by central nervous system processes, particularly signal transmission. Investigators are particularly interested in serotonin and noradrenaline, which are chemical messengers (called neurotransmitters) that affect pathways involved with urination. (These neurotransmitters are also important for many other emotional and physical functions.) Antidepressants targeting one or both of these neurotransmitters are sometimes used for urge incontinence and may also be helpful for some people with stress incontinence.
Other Drugs Used or Investigated for Incontinence
Desmopressin. Studies have reported that desmopressin (DDAVP), a drug used for bedwetting in children, may be helpful in the treatment of urinary incontinence in adults that occurs during sleep. The drug affects sodium levels and there is a slight risk for water intoxication with this agent.
Botulinum (Botox). Botulinum, the deadly toxin that sometimes contaminates improperly cooked foods, is also a powerful muscle-relaxant. Tiny injected amounts of a purified form (Botox) can relax the muscles and may help control over-active bladders that cause urge incontinence. It may also help relieve urinary retention that might occur after incontinence surgeries.