Bladder Control: Managing Urinary Incontinence With Medication
Medically reviewed by Lindsay Cook, PharmDMedically reviewed by Lindsay Cook, PharmDBladder control problems, or urinary incontinence, can cause an uncontrolled urgency to urinate, increased visits to the bathroom, and accidental leakage. Different medical conditions, aging, and lifestyle habits can all contribute to these symptoms.When nondrug strategies fail to help, medications are available to address symptoms and improve quality of life.Anticholinergic medications are the mainstay of urinary incontinence management. Other prescription treatment options include Botox (onabotulinumtoxinA), beta-3 adrenergic agonists, estrogen, muscarinic receptor antagonists, and certain types of antidepressants. In some cases, over-the-counter (OTC) medications can help.
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AnticholinergicsAnticholinergic medications work by blocking the neurotransmitter acetylcholine from binding to its receptors.For bladder control, these medications block the muscarinic M3 receptors on the smooth muscles of the bladder to prevent contractions that would unintentionally release urine.Medications belonging to this family of drugs include:Oxybutynin: Available in tablet form (under its generic name) and transdermal patch (under brand name Oxytrol)Tolterodine: Available in tablet form (under the brand name Detrol)Darifenacin: Available in tablet form (under its generic name)Solifenacin: Available in tablet form (under the brand name VESIcare) and in a liquid form (VESIcare LS)Trospium: Available in tablet and capsule form (under its generic name)Side EffectsSide effects of anticholinergic medications can include:Blurry visionConstipationDryness of the mouthHeadachesHigher than usual heart rateIndigestionInsomnia (trouble sleeping)Sore throatStomach painProblems with memoryUrinary retention (inability to empty the bladder)Urinary tract infection (UTI)BotoxBotox injections in the bladder are sometimes given after traditional anticholinergic medications have failed because people have shown better compliance with Botox over anticholinergics.You may be a candidate for Botox if traditional oral medications have not helped your symptoms.Botox is injected into the bladder muscle by tunneling a thin camera with an injector in through the urethra. The effect of a one-time injection lasts around six months to one year.Side EffectsThe most common side effects of Botox injection include repeated UTIs while Botox remains in the bladder. A possible temporary side effect is also trouble completely emptying the bladder for the first few weeks after the injection. If this is the case, you may receive a catheter to completely void the bladder until the body is accustomed to the medication.Beta-3 Adrenergic AgonistsBeta-3 adrenergic agonists are an alternative class of medications to anticholinergics that generally cause fewer adverse effects.Beta-3 adrenergic agonists work by activating the beta receptors in the urinary bladder, which allows muscles associated with that area to relax.As a result, the bladder muscles are relaxed when filling up with urine, which allows the bladder to contain its urine instead of sending the brain signals of urinary urgency. When this happens, symptoms associated with overactive bladder are reduced.Medications that fall under the beta-3 adrenergic agonists class of drugs are Myrbetriq (mirabegron) and Gemtesa (vibegron).Though both medications work well, comparative studies have suggested that vibegron may be more effective in reducing the amount of urine voided during urination (an indicator of a functional bladder).They have similar tolerability, although mirabegron has a higher risk of nasopharyngitis and cardiovascular-related side effects.Side EffectsSide effects associated with mirabegron include:Hypertension (high blood pressure)Nasopharyngitis (common cold)UTIsHeadachesA life-threatening emergency known as angioedemaSide effects associated with vibegron include:Urinary retentionHeadacheRashEstrogenStudies have shown that topical application of low-dose estrogen may help postmenopausal women with overactive bladder symptoms. Estrogen improves the elasticity and strength of the bladder; this allows the bladder to relax more, giving you more control.It is important to note that estrogen should not be taken if you have not achieved menopause because it will not provide benefits in terms of managing your symptoms.Side EffectsSome side effects of vaginal estrogen can include:Changes in sex drive (libido)Breast tendernessGastrointestinal effects, such as nausea, stomach cramps, and bloatingTofranil (Imipramine)Tofranil is an antidepressant that can help with symptoms of nighttime bladder control problems in children and teenagers. This is known as enuresis, or an involuntary release of urine during sleep.Tofranil belongs to a class of medications called tricyclic antidepressants. Although the mechanism of how imipramine works is unclear, its anticholinergic side effects are presumed to help cause urine retention. Studies have suggested it may work better when combined with oxybutynin.Side EffectsSide effects can include:Changes in blood pressureHeart palpitationsSerious cardiovascular complications, such as heart attack or arrhythmiasAnxiety Dry mouthRashNausea and vomitingCymbalta (Duloxetine)Duloxetine is an antidepressant that belongs to a family of medications known as serotonin-norepinephrine reuptake inhibitors (SNRIs). Studies show that duloxetine helps with urinary stress incontinence due to its dual action on both serotonin and norepinephrine.Side EffectsSide effects can includeConstipationDecreased appetiteDizzinessDry mouthFatigueNauseaOver-the-Counter and Alternative OptionsSome over-the-counter options for symptoms are available, depending on the type of urinary problem.Oxybutynin is the main ingredient in an OTC patch that you apply to the skin to help with overactive bladder symptoms. However, it is only available over the counter for use in women (under the brand name Oxytrol for Women). Oxybutynin for men must be obtained through a prescription.OTC products containing phenazopyridine, an analgesic for urinary problems, are also available. These are typically taken to manage UTI symptoms, such as urinary pain, burning, urgency, and frequency. Examples include AZO Urinary Pain Relief and AZO Bladder Control.Though they can relieve symptoms, these products do not treat UTIs. If you are experiencing UTI symptoms, visit a healthcare provider for a proper diagnosis and prescription treatment.Other nondrug therapies may be effective for types of incontinence not linked to an infection or underlying medical condition. This can include:Bladder trainingPelvic floor muscle exercisesLimiting triggers, such as caffeine and alcoholic drinksSummarySeveral medications can help with symptoms associated with bladder control problems (urinary incontinence). These medications can help improve quality of life by reducing urinary frequency and urgency.Work with your healthcare provider to determine the best medication for you based on your type of incontinence and any other concurrent health conditions. Medications may be available by prescription or over the counter.The author would like to recognize and thank Shreya Kumar for contributing to this article. Read the original article on Verywell Health.
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