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Bladder control problems: Medications for treating urinary incontinence

Find out about the different types of medication that work to treat bladder control problems, plus discover promising new medical therapies for treating urinary incontinence.

By Mayo Clinic staff

You've given up coffee and soda. You've followed your doctor's suggestions for bladder retraining. But bladder control remains a problem. What else can you do? Ask your doctor about medication options.

Effective medication has long been available for people with overactive bladder and urge incontinence — a bladder control problem marked by sudden, intense urinary urges and urine leakage. There are fewer options for stress incontinence — urine leakage prompted by a physical movement or activity, such as coughing, sneezing or heavy lifting.

Which drugs can help control urinary incontinence?

The major types of medications used to manage urinary incontinence are anticholinergics and estrogen. Other options include the antidepressant imipramine and the synthetic hormone desmopressin, which is more commonly used for bed-wetting in children.

How the drugs work

Here's an overview of the most common medications and their possible side effects.

Anticholinergics
Overactive bladder, one of the causes of urge incontinence, is characterized by abnormal bladder contractions, which make you want to urinate even when your bladder isn't full. Anticholinergic drugs block the action of a chemical messenger — acetylcholine — that sends the signals that trigger these contractions.

Several drugs fall under this category, including:

  • Oxybutynin (Ditropan)
  • Tolterodine (Detrol)
  • Darifenacin (Enablex)
  • Solifenacin (Vesicare)
  • Trospium (Sanctura)
  • Fesoterodine (Toviaz)

Some are available in an extended-release form, meaning you take them once a day. These may have fewer side effects than the immediate-release versions, which are usually taken multiple times a day. Still, the immediate-release form may be helpful if you experience incontinence only at certain times, such as at night, or if you want to take a medication only at certain times, such as when you travel. Oxybutynin is also available as a cream or skin patch that delivers a continuous amount of medication.

Side effects
The most common side effect of anticholinergics is dry mouth. To counteract this effect, you might suck on a piece of candy or chew gum to produce more saliva. Other less common side effects include constipation, heartburn, blurry vision, rapid heartbeat (tachycardia), 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. To remedy this, your doctor may recommend that you rotate the location of your patch.

Estrogen
A woman's bladder and urethra contain receptors for the hormone estrogen. Estrogen helps maintain the strength and flexibility of tissues in this area. After menopause, a woman's body produces less estrogen. The theory is that this drop in estrogen contributes to the deterioration of the supportive tissues around the bladder and urethra, which makes these tissues weak and may aggravate stress incontinence.

Estrogen is known to improve blood flow, enhance nerve function and correct tissue deterioration in the urethra and vaginal areas. Applying low-dose, topical estrogen in the form of a vaginal cream, ring or patch may help tone and rejuvenate these areas and relieve some of the symptoms of stress incontinence or urge incontinence.

In general, there's not a lot of scientific evidence to support using topical estrogen to treat urinary incontinence, but many women report that it's helpful for their urinary symptoms. Estrogen may have a role when used in combination with other therapies, such as pelvic floor muscle training.

Combination hormone replacement therapy (estrogen plus progestin) isn't the same as topical estrogen and is no longer used for urinary benefits. Oral estrogen replacement is also not the same as topical estrogen, and it may actually worsen incontinence symptoms.

Side effects
When topical estrogen therapy is used correctly, it doesn't usually cause side effects. However, topical estrogen is usually paired with another medication or therapy to treat incontinence.

Imipramine
Imipramine (Tofranil) is a tricyclic antidepressant. It makes the bladder muscle relax, while causing the smooth muscles at the bladder neck to contract. As such, it may be used to treat mixed — urge and stress — incontinence. Imipramine may cause drowsiness, so it's often taken at night. Because of this, imipramine may be useful for nighttime incontinence, as well. It may also be helpful for children who bed-wet at night (nocturnal enuresis).

Side effects
Serious side effects are rare but can include cardiovascular problems, such as irregular heartbeat and dizziness or fainting from reduced blood pressure when you stand up quickly. Children and older adults may be especially susceptible to these side effects. Other side effects, including dry mouth, blurry vision and constipation, are similar to those of anticholinergics. Tricyclic antidepressants interact with many different medications, so make sure your doctor knows which medications you're taking before you begin taking imipramine.

Desmopressin
Desmopressin is a synthetic version of a natural body hormone called anti-diuretic hormone (ADH). This hormone decreases the production of urine. Your body normally produces more ADH at night, so the need to urinate is lower then. In children, bed-wetting may be caused by a shortage of nighttime production of ADH. Desmopressin is commonly used to treat bed-wetting in children. Research suggests that desmopressin may also reduce urinary incontinence in adult women.

Side effects
Although it's uncommon, there is a risk of water retention and sodium deficiency in the blood (hyponatremia), which has in rare cases led to seizures, brain swelling and death. Be sure your doctor knows your full medical history and is aware of all the medications you are taking before you begin using this drug.

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References
  1. Urge urinary incontinence/overactive bladder. National Association for Continence. http://www.nafc.org/bladder-bowel-health/types-of-incontinence/urge-incontinence. Accessed April 10, 2009.
  2. Non-surgical treatment for female stress urinary incontinence. National Association for Continence. http://www.nafc.org/bladder-bowel-health/types-of-incontinence/stress-incontinence/non-surgical-treatment-for-female-stress-urinary-incontinence. Accessed April 10, 2009.
  3. How medications affect your bladder. National Association for Continence. http://www.nafc.org/bladder-bowel-health/types-of-incontinence/urge-incontinence/medications. Accessed April 6, 2009.
  4. DuBeau, CE. Treatment of urinary incontinence. http://www.uptodate.com/home/index.html. Accessed April 6, 2009.
  5. Herbruck LF. Stress urinary incontinence: An overview of diagnosis and treatment options. Urology Nursing. 2008;28:186.
  6. Karsenty G, et al. Botulinum toxin A (Botox) intradetrusor injections in adults with neurogenic detrusor overactivity/neurogenic overactive bladder: A systematic literature review. European Association of Urology. 2008;53:275.
  7. Cartwright R, et al. Management of overactive bladder. Current Opinion in Obstetrics and Gynecology. 2008;20:489.
  8. Information for healthcare professionals: Desmopressin acetate (marketed as DDAVP Nasal Spray, DDAVP Rhinal Tube, DDAVP, DDVP, Minirim and Stimulate Nasal Spray). U.S. Food and Drug Administration. http://www.fda.gov/CDER/DRUG/InfoSheets/HCP/desmopressinHCP.htm. Accessed April 10.
  9. MacDonald R, et al. Neurotoxin treatments for urinary incontinence in subjects with spinal cord injury or multiple sclerosis: A systematic review of effectiveness and adverse effects. The Journal of Spinal Cord Medicine. 2008;31:157.
  10. Pettit PDM (expert opinion). Mayo Clinic, Jacksonville, Fla. April 26, 2009.
  11. Klingele CJ (expert opinion). Mayo Clinic, Rochester, Minn. April 27, 2009.
  12. FDA requires boxed warning for all botulinum toxin products. U.S. Food and Drug Administration. http://www.fda.gov/bbs/topics/NEWS/2009/NEW02005.html. Accessed May 1, 2009.

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May 8, 2009

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