Bladder control problems: Medications for treating urinary incontinence

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 medications are 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 used to treat some forms of urinary incontinence along with 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 in this category, including:

• Oxybutynin (Ditropan, Gelnique)
• 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), 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. 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, an estrogen-containing ring or a 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 some 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, which is also known as Kegel exercises. Typically, you need four to 12 weeks of treatment before you notice improvement. And symptoms usually return about four to six weeks after therapy ends.

Combination hormone replacement therapy (estrogen plus progestin) isn't the same as topical estrogen and is no longer used to treat urinary incontinence. Oral estrogen replacement also is 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 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). Imipramine is usually not a good fit for older adults.

Side effects
Serious side effects from imipramine 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, lowering the need to urinate. 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 that results in a low sodium level in the blood (hyponatremia). This 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.

Newer therapies

Researchers are looking into new drugs and therapies, including onabotulinumtoxin type A (Botox).

Onabotulinumtoxin type A (Botox). Injections of Botox into the bladder muscle may benefit people who have an overactive bladder. Botox blocks the actions of acetylcholine and paralyzes the bladder muscle.

Studies have found that Botox significantly improves symptoms of incontinence and causes few side effects. Some studies indicate it may increase urinary tract infections, but the data aren't conclusive. Benefits can last up to nine months. Botox may be helpful for people who haven't responded to other medications. The Food and Drug Administration (FDA) has not yet approved this drug for incontinence, so it may not be covered by some insurance.

The FDA warns that adverse reactions including respiratory arrest and death may occur after the use of Botox for both approved and unapproved uses.

See your doctor

When talking to your doctor, carefully review all the medications you're taking, including over-the-counter drugs or herbal remedies. Some medications increase bladder control problems. Others may interact with incontinence medications in a way that increases symptoms. Your doctor can help you decide if you need medicine to treat your bladder control problem and, if so, which one may be best for you.

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