Taking medication for an overactive bladder should not be considered as a first resort. However, in extreme cases where pelvic floor exercises, behaviour therapy and dietary changes are not effective, medication can be necessary for reducing the symptoms.
The number of residents in the UK with incontinence is growing rapidly. In response to this, pharmaceutical companies are developing more forms of medication for an overactive bladder. Pharmaceutical companies have developed several new incontinence medications, aiming to combat the problem and ensure help is available for incontinent individuals. Despite the help that is currently available, approximately one-half of patients with incontinence have never discussed the problem with a physician. However, asking a physician for medication can bring invaluable life changes. This blog will advise you on the various medications available for treating incontinence.
Before prescribing you medication, physicians will determine the nature and cause of your incontinence. The evaluation should rule out reversible conditions, conditions requiring special evaluation and overflow bladder. A history, physical examination, and urinalysis can identify conditions that may require specialist care. Your physician will then prescribe you the most suitable medication for your condition.
One option of medication is oxybutynin, a nonselective anticholinergic agent which is available in short and long-acting oral forms (Ditropan) and as a transdermal patch (Oxytrol). Tolterodine, a selective anticholinergic agent is another commonly prescribed medication. Tolterodine 2mg twice daily has been proven to be effective against all the troublesome symptoms of overactive bladder. It is available in short and long-acting oral forms. The long-acting formulations of oxybutynin and tolterodine are preferred over their short-acting counterparts because they are more effective in controlling incontinence symptoms and cause fewer anticholinergic side effects. A recent study compared long-acting oral oxybutynin with long-acting tolterodine. This study randomised almost 800 patients with urge incontinence to receive 10 mg of long-acting oxybutynin per day or 4 mg of long-acting tolterodine per day. After 12 weeks, patients in both groups had similar reductions in incontinence episodes (from about 37 per week to 11 per week). Slightly more patients in the oxybutynin group had no episodes of incontinence, however oxybutynin-treated patients had a 50 percent higher rate of moderate or severe dry mouth.
The lack of studies and comparisons between drugs for the treatment of urinary incontinence leaves physicians in a quandary about which medication is best. A recent review has suggested that all of the anticholinergic drugs have similar efficacy. Unfortunately, there is little evidence to guide family physicians in the choice of anticholinergic medications for urge incontinence. Patients who prefer a transdermal preparation may be candidates for transdermal oxybutynin, assuming they do not experience cutaneous side effects. The choice between long-acting oral tolterodine and long-acting oral oxybutynin is more difficult and depends largely on whether more emphasis is put on having slightly better control of incontinence or minimising anticholinergic side effects. These potential side effects can include constipation and dry mouth. Anticholinergic agents, on the other hand, may worsen cognitive function and should be used with caution in patients with Dementia. Anticholinergic agents are contraindicated in patients with angle-closure glaucoma and urinary outflow obstruction.
Below are some medications that are commonly used for various types of incontinence:
Medications often prescribed for urge incontinence
>Ditropan® (oxynutynin) *transdermal/patch
>Detrol LA® (tolterodine)
>Sanctura® (trospium chloride)
>Sanctura XR® (trospium chloride extended release)
>Toviaz® (feosterodine fumarte)
>Gelnique® (oxybutynin chloride) *topical gel
>Oxytrol® (oxybutynin transdermal system)
Drugs used to tighten up the bladder outlet muscle for stress incontinence include:
Medications for controlling bowel incontinence include:
>Lomotil® (diphenoxylate with atropine)
>Nulev® (hyoscyamine sulphate)
>Lotronex® (alosetron) *for women only/IBS predominant
The following drugs are used for overflow incontinence and stimulate the bladder muscle, relax the sphincter. They are also effective in shrinking the prostate to allow unrestricted urine flow:
The following drugs help improve the condition of the vagina and urethral lining due to a decrease in female hormones after menopause:
>Estring® (estrodiol vaginal ring)
>Vagifem® (estrodiol vaginal tablets)
After you have been provided with medication, it is also useful to try self-help techniques to further lessen the symptoms. You could try the following:
>Empty your bladder regularly, especially before physical activity.
>Avoid drinking caffeine or a lot of fluid before activities.
>Avoid lifting heavy objects.
>Practice Kegel exercises.
If you have been prescribed drugs for your condition, you are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.