Medications for Urge Incontinence and Overactive Bladder

When physical therapy and behavior modifications or environmental modifications fail to address urge incontinence or overactive bladder problems, medications may be an appropriate second-line therapy.  There are several approved medications for the treatment of overactive bladder(OAB) or urge incontinence(UI).  The most commonly used is oxybutynin, either in pill form or as a topical gel (Gelnique®).  It is among the original medications approved for OAB/UI, and can be effective.  It is also now available over-the-counter as Oxytrol patches.  Other medications in the same class as oxybutynin include tolterodine (Detrol®), fesoterodine (Toviaz®), darifenacin (Enablex®), solifenacin (Vesicare®), trospium (Sanctura®), among others.  Each of these medications is in a class known as “anticholinergics” (an-tee-kol-in-urge-icks).  They work to block the chemical messengers instructing the bladder to contract and empty.  Unfortunately, their effects are not limited to the bladder, and for that reason may cause constipation, dry mouth, and pupil dilation (which makes them unacceptable to use in a type of glaucoma known as “narrow-angle”), as well as other side-effects.  However, in someone who has no known reasons to avoid those medications, they may be quite helpful in reducing the symptoms of OAB or UI.  Certain individuals do better on particular medications, however, none of these medications has specifically been shown to be superior to any of the others.  Starting with the smallest dose and working up from there to an appropriate effect is typically how these medications are prescribed.  It may take a few weeks before the full effects are seen.

A new class of medications has just been introduced, with only one approved medication available in the US.  This is mirabegron (Myrbetriq®), which is, scientifically speaking, a beta-3 receptor agonist.  In English this means that it stimulates chemical receptors in the bladder that cause the bladder to relax.  Because it is a totally different class of medications, the side effects are generally different.  The likelihood of constipation, dry mouth, etc. is reduced.  It may be used in narrow angle glaucoma.  However, individuals with uncontrolled or poorly controlled high blood pressure are not considered good candidates for this medication, as there is a slight risk of elevated blood pressure or fast heart rate.  Because it is new, it is also more expensive than the older medications, making it more difficult to obtain for some individuals.  Samples and coupons can be helpful in reducing costs, however, depending upon an individual’s medication coverage or financial situation it may be difficult or impossible to afford.  We anxiously await newer medications in this class as well.

For night time urinary frequency, certain individuals may be given a medication called desmopressin, as a tablet or a nasal spray at night to reduce urine production at night.  It requires close monitoring because it may cause a dangerous drop in sodium levels in the blood under certain circumstances.  However, it may be very helpful for individuals with just night-time frequency for whom other treatments have been unsatisfying or ineffective.

None of these medications are approved to treat stress urinary incontinence (SUI).  Please see earlier posts regarding the different types of urinary incontinence and how they are treated.

This is meant to be a basic overview to familiarize you with types of medications and their names.  I feel strongly that starting with medications is usually not necessary or advisable, and should be used only as a second-line treatment in most cases.  If you have questions or concerns, discuss them with your physician.  For more information or a consultation, call 561-701-2841.
www.urogynecologypalmbeach.com

Author

Linda Kiley, MD

Dr. Kiley is a Board Certified subspecialist in Female Pelvic Medicine and Reconstructive Surgery, and is also Board Certified in general Obstetrics and Gynecology.

You Might Also Enjoy...

What Makes This Practice Different?

Is anyone tired of the confusing, mixed messages in the media and on social media these days regarding health and well-being?  Tired of consulting Dr. Google and either getting more confused or becoming frightened from what you are reading?  Tired of going to the doctor’s office for answers and having your doctor, NP or PA…

Interstitial Cystitis Basics

What is Interstitial Cystitis/Painful Bladder Syndrome? Interstitial Cystitis or Painful Bladder Syndrome are terms used to describe uncomfortable or painful bladder symptoms that may include or mimic recurrent urinary tract infections, feelings of urgency and frequent need to urinate (including at night), burning, pain, pelvic pressure or discomfort.  A wide range of symptoms make the…

Mycoplasma and ureaplasma

These organisms have a special structure that makes them resistant to most typical antibiotics. They are often called “fastidious” or “atypical bacteria” for that reason.  While they may be present normally in small numbers in humans and animals, they may cause infection, inflammation, or predispose to other types of infections.  They are considered “opportunistic” in…

Insurance news

We are now accepting virtually all Blue Cross/Blue Shield insurance plans, most all Cigna plans, and regular Medicare in our practice. Please call for an appointment!  

Nocturia

What is it?  Getting up to urinate two or more times per night. What causes it?   There are many causes for frequent nighttime urination.  It is essential to determine the cause in order to order the proper treatment. There are two basic types of nocturia, high-volume and low-volume.  The cause and treatment is different for each type. How…

New YouTube Channel

Please subscribe to our new Youtube channel, “The Holistic Urogynecologist” for videos concerning pelvic health. We are continually adding new videos with new topics.   https://www.youtube.com/channel/UCukWQQ9zMldxhS6AA8bu5YA