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| Medicines for urinary incontinence |
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Reviewed by Dr Hilary McPherson, consultant obstetrician and gynaecologist and Dr Kate Patrick, specialist
registrar
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Medicines can help many of the symptoms of urinary incontinence
and night-time leaking.
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Anticholinergics are used to treat urge
urinary incontinence (UUI), and they are often used in conjunction with bladder
retraining. They can also help problems caused by an overactive bladder such as
frequently needing the toilet during the night or passing urine while
asleep.
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Desmopressin is sometimes used for night-time
urine problems.
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Tricyclic antidepressants have been used to
treat UUI. They are rarely used now because other medicines are more effective
and have fewer side effects.
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Vaginal oestrogens can be useful for an
overactive bladder if the cause proves to be oestrogen deficiency - for example
in women who have passed the menopause.
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Duloxetine hydrochloride is a medicine that
can help SUI if symptoms are more severe. It may be combined with pelvic floor
muscle retraining.
Anticholinergic medicines
Anticholinergic medicines are the main medicines used to treat
urge urinary incontinence. They are also known as antimuscarinic
medicines.
The following anticholinergic medicines are used in the
UK.
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Darifenacin (Emselex)
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Flavoxate (Urispas)
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Oxybutynin (Cystrin,
Ditropan,
Kentera patches,
Lyrinel
XL)
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Propiverine (Detrunorm)
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Solifenacin (Vesicare)
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Tolterodine (Detrusitol, Detrusitol
XL)
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Trospium (Regurin).
Propantheline (Pro-Banthine) is also available, but is rarely
used these days.
How do they work?
Anticholinergic medicines help control urge incontinence by
relaxing the overactive detrusor muscle in the bladder wall.
They work by blocking the involuntary nerve messages that
cause the bladder wall to contract and release urine.
As a result, sudden uncontrollable bladder contractions happen
less frequently and the capacity of the bladder to hold urine increases. This
in turn reduces the need to pass urine.
Anticholinergic medicines are also sometimes used to control
excessive night-time urinating or bedwetting that is the result of an
overactive bladder.
Anticholinergic medicines aren't effective for SUI because it
isn't caused by an overactive detrusor muscle.
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Good advice
Anticholinergics can cause a dry mouth because they suppress
the action of your salivary glands.
Drinking more only stops dry mouth for a little while.
The more you drink, the more pressure you put on your
bladder, leading to a vicious cycle.
Instead, use sugar-free gum or sweets to stimulate the
salivary glands.
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What are the side effects?
The most common side effects are:
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dry mouth
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constipation
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blurred vision
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nausea
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abdominal pain
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drowsiness.
Desmopressin
Desmopressin is used to treat night-time urine problems that are
caused by a deficiency in a hormone called antidiuretic hormone.
How does it work?
Normally more urine is produced during the day, and the
kidneys concentrate the urine so less is produced at night. This process is
controlled by the antidiuretic hormone.
If the kidneys fail to concentrate urine in the night, it can
cause bedwetting or the need to go to the toilet a lot.
Desmopressin is an artificial version of antidiuretic hormone.
It can be used to suppress urine production at night if this proves to be
caused by a deficiency of the natural hormone.
The medicine comes as tablets (DesmoMelt,
Desmotabs) and as
nasal sprays (eg
Desmospray). They
are taken at bedtime to control urine production for 10-12 hours.
What are the side effects?
Side effects of desmopressin include:
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headache
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abdominal pain
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nausea
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nasal congestion and nosebleeds (with the nasal
spray).
Oestrogen replacement
Vaginal oestrogens (topical HRT) can sometimes be useful for
treating an overactive bladder in postmenopausal women where the cause is
oestrogen deficiency.
How does it work?
Women's ovaries gradually produce less oestrogen as they
approach the menopause. As a result, oestrogen levels in the blood
decline.
Oestrogen deficiency can affect the bladder and can also cause
vaginal dryness that can contribute to bladder control difficulties. Treatment
with vaginal preparations that release oestrogen into the local vaginal area
corrects the deficiency and relieves the related symptoms.
Vaginal oestrogens are available in the following formats in
the UK:
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vaginal creams
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pessaries
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vaginal rings.
What are the side effects?
HRT has received a lot of media coverage recently. It's
important you discuss all the risks and benefits of HRT with your doctor before
starting any treatment.
Topical HRT may not be suitable for some women, but for others
the benefits can outweigh the risks - particularly for vaginal products and if
used on a short-term basis.
Duloxetine
Duloxetine (Yentreve) is a medicine that can be used to treat
moderate to severe stress urinary incontinence. It has not been shown to be of
benefit for mild symptoms of SUI.
How does it work?
Duloxetine acts on the involuntary nerve signals that
normally control the
sphincter muscle in the
bladder.
It helps SUI by increasing the tone of the sphincter muscle,
making it less likely to open under stress and allow urine to leak out.
What are the side effects?
The most common side effects are:
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nausea
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dry mouth
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fatigue
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difficulty sleeping.
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References
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Based on a text by Dr Dan Rutherford, GP
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Last updated 16.10.2007
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