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Medications can effectively control many types of incontinence. Some drugs
work by stopping excessive contractions of the bladder, whereas others are
muscle relaxants that permit more complete bladder emptying during urination.
In addition, some drugs prevent leakage by directly tightening the bladder
neck and urethral muscles. Many of the drugs are
anticholinergic: that is, drugs that block the passage of
impulses through the low back nerves. Hormonal medications, such as
estrogen, may improve bladder control by helping the urinary
muscles to function normally. And antibiotics may eliminate short-term
incontinence by treating an underlying urinary tract infection.
All medications have the potential to produce harmful side effects,
especially if they are used for long periods in susceptible individuals.
Of the medications prescribed for urinary incontinence, hormonal preparations
and alpha-blockers cause the most concern. In particular, hormone
replacement therapy with estrogen has been associated with increased risks
for cancers of the breast and endometrium (lining of the
uterus). Therefore, before taking any medication, ask your
physician about the long-term risks and benefits of anti-incontinence drugs.
Anticholinergic Medications
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Propantheline bromide (Pro-Banthine)
Although bladder spasm is not an FDA-approved indication for this drug,
propantheline has been widely prescribed over the years for the treatment of urge incontinence (typical dosage: 7.5-30 to be taken without
food 3 to 5 times/day). It is a classic anticholinergic medication that
stops muscle contractions in the normal bladder. Some of the unwanted side
effects of propantheline include dry mouth, visual blurring, nausea,
constipation, tachycardia (fast heartbeat), drowsiness and confusion.
Propantheline is specifically contraindicated (improper) for patients with
obstructive urinary tract disorders and for those with narrow-angle glaucoma
(eye disease characterized by high pressure within the eye).
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Oxybutynin chloride(Ditropan)
Oxybutynin is an anticholinergic drug medication that also directly relaxes
bladder smooth muscle. It is prescribed for neurogenic bladder patients, and patients who have
symptoms of bladder instability with voiding: that is, patients with urge incontinence, frequency, urinary leakage, or painful
urination. The typical dosage is 2.5-5.0 mg to be taken orally 3 to 4
times/day). Oxybutynin's notable side effects are dry mouth, dry skin,
visual blurring, nausea and constipation.
Ditropan® XL Extended-release tablets contain oxybutynin chloride.
Ditropan® XL is a once-a-day medication for overactive bladder. One tablet
releases medication into your system continuously for relief that lasts up
to 24 hours with one dose. In many patients, once-a-day Ditropan® XL
has been shown to help effectively treat urgency, frequency, and wetting
accidents. Some patients use far fewer pads. Some patients experienced
relief after taking Ditropan® XL after 1 week. In a
clinical study with Ditropan® XL, patients experienced a 90% reduction (from
16 to 2) in the number of wetting accidents per week versus patients taking
a sugar pill who experienced a 51% reduction (from 21 to 11). The typical
dosage is 5-15 mg to be taken orally 1 time/day. In clinical studies, the
most common side effect was dry mouth. However, only 1% of patients
discontinued therapy for this reason. Other common side effects included
constipation, drowsiness, diarrhea, blurred vision, dry eyes, dizziness, and
runny nose. Only 7% of patients in clinical studies discontinued therapy due
to side effects.
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Hyoscyamine sulfate (Levbid; Cytospaz)
Hyoscyamine sulfate, like oxybutynin chloride, is an
anticholinergic and antispasmotic drug. It is prescribed for
the treatment of urge incontinence. Hyoscyamine sulfate is specifically
contraindicated (improper) for patients with obstructive urinary tract
disorders (for example, bladder neck obstruction due to an enlarged prostate) and for those with glaucoma or ulcerative colitis
(severe inflammation of the large intestine). - The usual dosage of
hyoscyamine sulfate is one to two 0.375 mg tablets every 12 hours.
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Tricyclic Antidepressants (TCAs)
Tricyclic antidepressants -- such as imipramine pamoate (Tofranil-PM) --
are often prescribed as part of incontinence treatment programs, but they
are not FDA-approved for incontinence. Tricyclic antidepressants have
anticholergenic effects. Many experts believe that tricyclic
antidepressants are beneficial because they decrease nighttime incontinence
and are useful for the management of urge incontinence. The usual oral dose of imipramine is
10-25 mg, 1 to 3 times/day, for a total daily dose of 25-100 mg).
Other tricyclic antidepressants that potentially may be useful for
incontinence are: doxepin hydrochloride (Sinequan), desipramine
hydrochloride (Norpramin), and nortryptyline hydrochloride (Pamelor).
Alpha-1 Adrenergic Blocking Agents (Alpha Blockers)
Benign prostatic hyperplasia -- non cancerous enlargement
of the prostate -- can encroach upon the urinary tract, leading to overflow or urge incontinence. Alpha-1 adrenergic receptor blocking
agents --known as alpha-1 blockers or alpha blockers -- are used to treat BPH,
because they reduce the tone of striated and smooth muscle, thereby
decreasing urethral resistance and relieving symptoms of obstruction.
Alpha blockers should not be used in people who are hypersensitive (have an
exaggerated reaction) to such medication or who experience postural
hypotension (extremely low blood pressure when standing up or standing still).
Terazosin hydrochloride (Hytrin)
Terazosin hydrochloride also blocks the alpha-1 adrenergic receptor sites in
the body. Like doxazosin, terazosin is prescribed for the treatment of
urinary outflow obstruction in BPH, as well as for hypertension. The typical
dose is 1-10 mg, taken once daily.
Tamsulosin hydrochloride (Flomax)
Tamsulosin hydrochloride blocks only the alpha-1a adrenergic receptors in the prostate. Tamsulosin is used to treat the signs and symptoms of
BPH; however, because of its prostate-specificity, tamsulosin is not a
recommended treatment for hypertension. The usual oral dose of tamsulosin is
0.4-0.8 mg, once daily.
Alpha Adrenergic Agonists
Alpha adrenergic agonists are drugs which stimulate sites in the nervous
system that respond to the chemical norepinephrine. Therefore, patients
suffering from forms of incontinence requiring increased muscle tone and
urethral resistance -- for example, stress incontinence -- may benefit from the use
of alpha-adrenergic agonists.
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Phenylpropanolamine hydrochloride
Phenylpropanolamine hydrochloride is found in many prescription and
nonprescription cough/cold preparations and antihistamines (anti-allergy
drugs). A typical dosage for bladder control is 25-75 mg in sustained-
released form, twice a day. Phenylpropanolamine, like all other alpha
adrenergic agonists, should not be used by individuals with obstructive
forms of incontinence; it should be used with caution by individuals with
hypertension (high blood pressure), hyperthyroidism (overactive thyroid
gland), arrhythmia (irregular heartbeat), and angina (heart pain caused by
decreased oxygen supply to the heart muscle).
Pseudoephedrine Hydrochloride
Pseudoephedrine Hydrochloride is found in many prescription and
nonprescription cough/cold preparations and antihistamines. A typical dosage
for bladder control is 15-30 mg, three times a day.
Other Alpha Adrenergic Agonists
Other Alpha Adrenergic Agonists include ephedrine and epinephrine and
norepinephrine. Since the actions of these drugs are so widespread within
the body, they are not specifically indicated for incontinence and should be
prescribed with caution. The significant side effects of these drugs are
hypertension, tachycardia
(fast heartbeat) and arrhythmia (irregular heartbeat).
Tolterodine Tartrate (Detrol)
Tolterodine tartrate is a new drug that is classified as a muscarinic receptor
antagonist: that is, it blocks nerve receptors that respond to the chemical muscarine.
Both bladder contraction and salivation (formation of saliva) are controlled by
muscarinic receptors. By blocking muscarinic nerve receptors, tolterodine
tartrate can reduce symptoms of urinary frequency or urgency, and it is able
to treat bladder over activity and urge incontinence.
The typical dose of tolterodine tartrate is 1-2 mg, twice a day.
Tolterodine tartrate should not be used in people who are hypersensitive
(have an exaggerated reaction) to the drug or who have urinary retention,
gastric (stomach) retention, or uncontrolled narrow-angle glaucoma (eye
disease characterized by high pressure within the eye).
Hormonal Replacement/Estrogen Therapy
Estrogen therapy helps to maintain and restore the health of urethral
tissues in women who have undergone menopause (the end of monthly menstrual
periods). In particular, estrogen appears to reduce stress incontinence and heighten bladder outlet
resistance by increasing blood flow, tone and nerve response in the urethral muscle. Yet
the exact mechanism of estrogen is still unknown.
Studies suggest that estrogen replacement therapy, by oral or vaginal
administration, may benefit patients with stress incontinence or mixed incontinence. To prevent an abnormal build-up of the
endometrium (lining of the uterus), estrogen replacement should be given
with the pregnancy hormone progesterone (Premphase).
Medications such as Introl and Suctimpro should only be used if the patient's uterus is present --that is, only if
the patient has not had a hysterectomy (operation to remove the uterus).
Various doses of estrogen and progesterone are available. Oral conjugated estrogen
usually is given at doses of 0.3-1.25mg per day, and vaginal estrogen is given at
0.5-2.0g per day.
In addition, estradiol --the most potent naturally-occurring estrogen in humans
--is available as a skin-patch (Alora, Climara, Fempatch, Vivelle, Estraderm) and
as a vaginal ring (Estring). All of the sepreparations release estrogen slowly.
Estrogen therapy is not recommended for patients with diagnosed or suspected cancer
of the breast, cervixoruterus, or for patients with undiagnosed vaginal bleeding or
blood clotting disorders such as thrombophlebitis (inflammation and clotting of the veins)
or thromboembolism (blood clot |plugging2 of a blood vessel).
Combined Estrogen/Alpha-Adrenergic Agonist Therapy
Since estrogen therapy appears to heighten the response of nerve receptors
in the urethra (that is, the alpha-adrenergic receptors, which
increase the tone of striated and smooth muscle), it is believed that a
combination of estrogen and alpha-adrenergic agonists (drugs specific for
the alpha-adrenergic receptors) may be beneficial in women who have
undergone menopause and who lose bladder control because of insufficiency
(malfunction) of the urinary sphincter muscles.
A common estrogen/alpha-adrenergic agonist combination is phenylpropanolamine
(PPA, 25-100 mg twice a day) plus intravaginal or oral conjugated estrogen
(1.25 mg/day orally or 2 g/day vaginally). Phenylpropanolamine is found in
many over-the-counter cough/cold preparations, such as Tavist-D, Comtrex,
Dimetapp, Triaminic, and Robitussin-CF.
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