Leaky Bladder Treatment – Medication for Incontinence

Incontinence is the involuntary passing of urine and often referred to as a leaky bladder. Drug therapy for incontinence may not be effective in every case. Depending on the cause and individual response to medication, drugs may only offer short term relief. Along with surgery, devices,  behavioral and/or physical therapy, drugs may assist with the long term management of incontinence in both men and women.

Drugs for Incontinence

Anticholinergic Drugs

  • Indication : Primarily used for urge incontinence and overactive bladder syndrome (unstable bladder).
  • Action : Reduces contractility of the detrusor muscle (bladder wall).
    • Muscarinic receptors are activated by acetylcholine (parasympathetic stimulation) released by the nerves innervating it.
    • Receptor activation results in muscle contraction.
    • Anticholinergic drugs block these muscarininc receptors thereby preventing acetylcholine from attaching to it and activating the muscle.
  • Side Effects :
    • Dryness of mucus membrane linings (mouth, nose, throat)
    • Nausea
    • Constipation
    • Dizziness
    • Headache
    • Skin rashes
    • Diminished sweating
    • Palpitations
  • Chemical Names :
    • Oxybutynin
    • Tolterodine
    • Solifenacin
    • Darifenacin
    • Fesoterodine
    • Trospium

Alpha-Adrenergic Agonist Drugs

  • Indication : Stress incontinence
  • Action : Improves muscle tone of sphincters.
    • Sphincter muscles remain contracted due to sympathetic stimulation which prevents the outflow of urine.
    • Bladder muscles, particularly the neck of the bladder, contain large amounts of receptors sensitive to alpha agonists.
    • This causes muscle contraction and helps withs with urinary retention.
  • Side Effects :
    • Insomnia
    • Anxiety
    • Headache
    • Difficulty breathing
    • Sweating
  • Chemical Names :
    • Pseudoephedrine
    • Phenylpropanolamine (recalled in the United States)

Tricyclic Antidepressants

  • Indication : Urge, stress, mixed incontinence.
  • Action : Helps to relax the detrusor muscle (bladder wall) and stimulate contraction of urethral sphincter muscle. May aggravate overflow incontinence.
  • Side Effects :
    • Dry mouth
    • Nausea
    • Fatigue
    • Insomnia
    • Blurred vision
    • Dizziness
  • Chemical Names :
    • Imipramine
    • Doxepin

Estrogen Replacement Therapy (Topical Estrogen)

  • Indication : Post menopausal incontinence. Atrophic urethritis.
  • Action : Improves blood supply and restores thickening of the wall of the urethra.
    • Low level of estrogen results in thinning and reduced blood flow to the wall of the urethra.
    • This decreases restriction to urine flow.
    • Similar changes are seen in the vagina, bladder and labia.
  • Side Effects :
    • Nausea
    • Breast tenderness
    • Headache
    • Mood swings
    • Edema
  • Chemical Names :
    • Estradiol
    • Dienestrol

Alpha-Blockers (Alpha Adrenergic Antagonists)

  • Indication : Overflow incontinence caused by enlarged prostate and other causes of outlet obstruction.
  • Action : Relaxes smooth muscle of the prostate and bladder neck.
    • This muscle relaxation allows for the passage of urine out of bladder.
    • This prevents excessive stretching of the bladder which can then lead to bladder muscle contractions.
  • Side Effects :
    • Nasal congestion
    • Headache
    • Hypotension (low blood pressure)
    • Increased heart rate (tachycardia)
  • Chemical Names :
    • Terazosin
    • Doxazosin
    • Tamsulosin
    • Alfzosin

Other Drugs

  • Desmopression (antidiuretic) decreases urine production and is mainly used for bedwetting (nocturnal enuresis) in children.
  • Duloxetine (serotonin-norepinephrine reputake inhibitor) increases urethral sphincter smooth muscle tone. Indicated for mixed incontinence (stress, urge).

Related Articles

  1. What is Incontinence? Poor Bladder Control
  2. Urinary Incontinence – Causes (Urine Leakage, Poor Bladder Control)
  3. Severe Incontinence (Urinary) in Men, Women, Infants

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