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Medications for Incontinence: What Are the Most Effective Ones and How Do They Work?

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Medications for Incontinence:  What Are the Most Effective Ones and How Do They Work?

 

 

Written by Urologist and Sexual Health Expert Dr. Jennifer Berman

 

Over the past decade, the medical and surgical treatments for urinary incontinence have expanded and improved. Patients now have more options than ever before. New medications have been released for urge incontinence with fewer side effects and greater efficacy. Surgical treatments have also expanded and improved to become less invasive, outpatient as opposed to inpatient, and with shorter recovery times.

    

There are also new home-use products on the market that focus on pelvic floor strengthening for stress urinary incontinence. And for urge incontinence, there are bladder relaxation products that can be used in the doctor’s office or at home.

    

Overactive bladder (OAB), also referred to as urge incontinence, results when the bladder spontaneously contracts, involuntarily and without any element of control. It’s caused by improper firing of the nerves that support the filling, emptying, and sensations in the bladder.

 

In a patient with OAB, the network of nerves that control bladder filling – allowing the bladder to relax and expand, emptying and contracting the bladder, and giving the patient the sensation of having a full bladder – do not function properly  in a coordinated fashion. The nerves that send signals to the brain basically misfire and trigger abnormal bladder contractions. These bladder contractions can cause you to feel the need to urinate even when your bladder isn't full.

    

The medications to treat OAB relax the bladder and block the unwanted bladder contractions that result in leakage. This diminishes the sensation of urgency and frequency, which is typically what sends patients running to the bathroom.

 

These medications fall into a category called anticholinergics, which block the action of a chemical messenger called acetylcholine. Anticholinergic medications include:

·         Oxybutynin (Ditropan XL, Oxytrol)

·         Tolterodine (Detrol)

  • Darifenacin (Enablex)
  • Solifenacin (Vesicare)
  • Trospium (Sanctura)
  • Fesoterodine (Toviaz)

 

These medications are usually given as a pill or tablet that you take by mouth. Oxybutynin is also available as a cream or skin patch that delivers a continuous amount of medication. The most common side effects of anticholinergics are dry mouth and constipation. Other less common side effects include heartburn, blurry vision, rapid heartbeat (tachycardia), flushed skin, urinary retention and cognitive side effects, such as impaired memory and confusion. The most common side effect of the oxybutynin skin patch is skin irritation. Your doctor may recommend that you rotate the location of your patch.

 

There is another medication called Mirabegron or Myrbetriq that’s used to treat urge incontinence. It, too, relaxes the bladder muscle though it uses an alternate neurological pathway. These drugs improve bladder filling and increase the amount of urine that is held in the bladder. Some side effects of Mirabegron include increased blood pressure, common cold symptoms (nasopharyngitis), urinary tract infection and headache. Constipation also may occur.

 

Other available treatments for overactive bladder include Botox injections, bladder pacemakers, and biofeedback, though the most common and first line of treatment for overactive bladder is typically medication.

 

A second type on incontinence is called Stress Urinary Incontinence, commonly referred to as SUI. This refers to leakage of urine during strenuous activity such as coughing, laughing, sneezing, lifting, or exercising.  With stress incontinence, movements and activities such as coughingsneezing, and lifting put greater abdominal pressure on the bladder causing leaks.

 

A number of things can contribute to stress incontinence, particularly in women. The most common culprits are pregnancy, childbirth and menopause. In cases of stress incontinence, the muscles in the pelvic floor and the supporting ligaments to the bladder and urethra become thinner and weaken. This results in increased risk for urine leakage and prolapse of the bladder, which occurs when the support to the bladder fails and it protrudes or bulges into the vaginal canal.

 

Treatments for stress incontinence are basically limited to surgical intervention. The sling procedure is designed to support the urethra and there are also corrective surgeries for bladder prolapse. There are no medications to treat stress incontinence because it is an anatomical issue caused by changes in the pelvic floor support structures.

 

It is important to speak to your health care provider if you are experiencing any type of bladder leakage. Make it a priority to determine the cause, rule out infection, tumor or stones or other medical issues that can cause leakage, and to get the best possible treatment.

 

 

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Previous
Men’s Product Guide: Finding the Right Absorbent Product
Next
Treating Incontinence with Botox | Depend