Medications

Stress incontinence results from a weak urinary sphincter. Medications that strengthen the urethral contraction include sympathomimetic drugs (such as Sudafed), estrogen (such as Premarin), and tricyclic antidepressant agents (such as Tofranil and Elavil), although none are overwhelmingly effective, and their use for treating stress incontinence are off-label indications.

Medical conditions that cause urge incontinence may be neurologic or nonneurologic. The urethra is healthy, but the bladder is hyperactive or overactive. Pharmacologic therapy for stress incontinence and an overactive bladder may be most effective when combined with a pelvic exercise regimen.

The three main categories of drugs used to treat urge incontinence include antispasmodic drugs (such as Bentyl, Levsin, Cystospaz, and Pro-Banthine), anticholinergic drugs (such as Enablex, VESIcare, Ditropan, Oxytrol, Detrol, and Sanctura), and tricyclic antidepressant agents (such as Tofranil and Elavil). You should not use anticholinergic drugs if you have narrow-angle glaucoma, urinary retention, bowel obstruction, ulcerative colitis, myasthenia gravis, or severe heart diseases. These medications can cause drowsiness. Anticholinergic drugs should not be taken with alcohol, sedatives, or hypnotic drugs.

When a single drug treatment does not work, a combination therapy such as oxybutynin (Ditropan) and imipramine (Tofranil) may be used, but side-effect risks should be reviewed with your physician.

In some cases, a medication called desmopressin (DDAVP) can be used to decrease nighttime urine production and help reduce nocturia.