The different types of urinary incontinence, including overactive bladder, can be treated with a variety of medications. Combining these urinary incontinence medications with behavioral therapies has also been shown to be more effective than use of medications or behavioral therapy alone.
If you have been diagnosed with urge incontinence or overactive bladder, your doctor may recommend anticholinergics, which are the most common drugs used to treat overactive bladder. Anticholinergics (some of which are also referred to as antimuscarinics) decrease the activity of the bladder wall muscle (detrusor muscle) and increase the capacity of the bladder.
- Darifenacin (Enablex), a recent addition to the anticholinergic class, is most helpful in elderly patients who have dementia, because it is less likely to cause confusion, a common side effect of anticholinergics.
- Fesoterodine fumarate (Toviaz) is indicated for overactive bladder patients who have urge incontinence, urgency, and frequency. The drug is taken once daily.
- Flavoxate (Urispas) helps relieve symptoms of urinary frequency, urinary urgency, and nocturia, as well as urinary incontinence associated with prostatitis. Dosing can be a problem, as it must be taken 3 to 4 times daily.
- Hyoscyamine sulfate (Levbid) is mainly used to treat gastrointestinal disorders, but is also prescribed for bladder spasms. The regular form must be taken 3 to 4 times daily, while the extended form can be taken twice daily.
- Oxybutynin (Ditropan) helps prevent urge incontinence by relaxing the detrusor muscle. The regular form is taken 2 to 3 times daily, while the extended release form (Ditropan XL) can be taken once daily. A patch (Oxytrol) is available, but it releases a smaller dose than the oral form. Gelnique is a gel formulation that is applied to the skin once daily.
- Propantheline (Pro-Banthine) is prescribed to treat gastrointestinal ulcers as well as help relax the bladder muscles and relieve bladder spasms. Typical dosing is three times daily before meals.
- Solifenacin (VESIcare) is another newer addition to the anticholinergic line and is similar to tolterodine and is taken once daily.
- Tolterodine (Detrol, Detrol LA) helps with symptoms of urinary frequency, urgency, and urge incontinence, and has less impact on the salivary glands than does oxybutynin and is better tolerated. Detrol is taken twice daily, while Detrol LA is taken once.
- Trospium chloride (Sanctura) is an anticholinergic/ antimuscarinic that is prescribed to treat overactive bladder. Trospium chloride works by reducing bladder muscle tone, which in turn reduces urinary spasm and frequency. The typical dose is twice daily before meals or an empty stomach.
Anticholinergics have a host of common side effects, including blurry vision, confusion (mostly in the elderly), constipation, double vision, dry mouth, loss of coordination, sensitivity to light, and urinary retention, among others.
In addition to anticholinergics, there are several other medication options you and your doctor may consider for treatment of urinary incontinence and overactive bladder.
- Tricyclic antidepressants are frequently prescribed for urge incontinence and overactive bladder, as well as stress incontinence. Tricyclic antidepressants work by blocking nerve signals and reducing urinary muscle spasms. Imipramine (Tofranil), for example, relaxes the bladder muscle while causing the sphincter muscle to contract. This characteristic of imipramine make it a treatment choice for some men who experience urinary incontinence related to sexual activity (stress incontinence), although the drug is not as effective in men who have had prostate surgery. Examples of other tricyclic antidepressants include desipramine hydrochloride (Norpramin), doxepin hydrochloride (Sinequan), and nortryptyline (Pamelor). Side effects of tricyclic antidepressants may include blurry vision, changes in appetite, dizziness, and dry mouth.
- Duloxetine, an antidepressant in the drug class selective serotonin and norepinephrine reuptake inhibitors (SNRIs) changes how the brain utilizes specific brain chemicals. Exactly how it helps control the bladder is not known.
- Alpha-blockers is a class of drugs typically used to treat BPH. They work by relaxing the smooth muscles of the prostate and bladder neck, which then allows normal urine flow and prevents abnormal bladder contractions that can lead to urge incontinence. Drugs in this class include alfzosin (Uroxatral), doxazosin (Cardura), tamsulosin (Flomax), and terazosin (Hytrin). Side effects include dizziness, fatigue, and headache. Taking an alpha-blocker along with an anticholinergic may relieve symptoms of overactive bladder and urge incontinence than either medication alone.
- Collagen is technically not a drug; it is a protein that can be injected around the neck of the bladder. The collagen causes the bladder neck to expand, which in turn reduces pressure on the bladder and helps improve function of the urinary muscles. Collagen injections usually need to be repeated after several months to achieve control over incontinence.
- 5-alpha reductase inhibitors are drugs typically used to treat BPH. However, your doctor may prescribe one of the two current 5-alpha reductase inhibitors (dutasteride [Avodart] or finasteride [Proscar]) if he or she believes an enlarged prostate is a cause of your urinary incontinence. Side effects of 5-alpha reductase inhibitors include breast enlargement, erectile dysfunction, and low sperm count.
- Botox (onabotulinumtoxin A), a drug perhaps better well known as a wrinkle relaxer, is the trade name for botulinum toxin, a protein made by the bacterium Clostridium botulinum, said to be the most potent neurotoxin ever found. In August 2011, the Food and Drug Administration (FDA) approved the use of Botox for overactive bladder caused by neurologic disorders such as multiple sclerosis and spinal cord injuries for adults who have not responded to or who cannot tolerate anticholinergic drugs. Botox is also used off-label for urge incontinence. Treatment with Botox for urinary incontinence involves injecting the drug into the bladder with the help of a cystoscope, which helps the doctor see the inside of the bladder while making the injection. Botox causes the bladder muscle to relax as well as increases the amount of urine the bladder can hold. Initial injections of Botox have been reported to cause urinary tract infections in nearly half of all patients. Other side effects include urinary retention (17%), fatigue (6%), constipation (4%), and muscle weakness (4%). In rare cases, it can cause an inability to urinate at all. Read more about Botox
Men with stress incontinence may respond to anticholinergics and tricyclic antidepressants urinary incontinence medications. If you have overflow incontinence and it is caused by BPH, your doctor will likely prescribe medications for an enlarged prostate, but drug treatments for BPH do not always improve symptoms of overflow incontinence.
See also
Vitamin A, Carotenoids Reduce Lower Urinary Tract Symptoms
