Bladder Control Problems (cont.)
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Anticholinergic and spasm-relieving drugs are used in urge incontinence to suppress bladder contraction and relax bladder smooth muscle. This class of drugs includes darifenacin (Enablex), dicyclomine (Antispas, Bentyl), flavoxate (Urispas), hyoscyamine (Anaspaz, Levbid, Levsin), methantheline (Banthine, Pro-Banthine), oxybutynin (Ditropan, Ditropan XL, Oxytrol), solifenacin (VESIcare), tolterodine (Detrol, Detrol LA), and trospium (Sanctura). Anticholinergic agents may help relieve urge incontinence. (Anticholinergic means to oppose or counteract the activity of certain nerve fibers that cause the bladder to contract.)
Some tricyclic antidepressants (TCAs), such as imipramine (Tofranil, Tofranil PM), have strong anticholinergic effects and may be prescribed to treat incontinence. Because the effects of newer, long-acting agents (for example, Detrol LA, Ditropan XL, Enablex, or VESIcare) last throughout the day, they need to be taken only once daily, which makes them very convenient. Additionally, the effects of Detrol and Detrol LA are mostly limited to the bladder, thus lessening the prevalence of side effects typically caused by anticholinergic medications.
Medications are sometimes used in stress incontinence. These medications can have serious side effects, such as high blood pressure. They are not for everyone. These medications include adrenergic agonists, such as midodrine (ProAmatine) and pseudoephedrine (Sudafed), which increase internal sphincter tone.
No medications are effective in treating overflow incontinence. A drug called Urecholine has been FDA approved for overflow incontinence but has not met with a lot of success in clinical practice.
See Understanding Bladder Control Medications for more information on medications used to treat incontinence.
George Lazarou, MD, FACOG
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