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Medical Author:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Medical Editor:

Charles Patrick Davis, MD, PhD

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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Urinary tract infection

Antibiotics are the medication of choice for urinary tract infections. The doctor may also prescribe phenazopyridine (Pyridium) to relieve the burning pain during urination that can occur until antibiotics take effect. Some research suggests that estrogen replacement therapy may reduce urinary tract infections in menopausal women and this issue continues to be researched. For some women, local estrogen therapy as either tablets (Vagifem) or creams (Premarin, Estrace) may reduce the frequency of urinary tract infections in women with vulvar-vaginal atrophy resulting from low estrogen levels.

Bladder control problems

• Anticholinergic and spasm-relieving drugs may be prescribed for urge incontinence. These suppress bladder contraction and relax the bladder smooth muscle. These medications include 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).
• Some tricyclic antidepressants have strong anticholinergic effects and may be prescribed for incontinence. These include imipramine (Tofranil, Tofranil PM).
• The antidepressant duloxetine (Cymbalta) is also sometimes used to treat stress incontinence.
• Adrenergic agonists such as midodrine (ProAmatine) and pseudoephedrine (Sudafed) can increase internal sphincter tone and may be prescribed for stress incontinence. These medications can have serious side effects, such as high blood pressure, and are not for everyone.
• Bethanechol (Urecholine) has been FDA approved for overflow incontinence but has not yet had consistent success in clinical practice. No other medications are known to treat overflow incontinence at this time.
• Estrogen replacement therapy or topical estrogen cream may be suggested to improve bladder function. The application of estrogen cream to the vagina and urethral area may help reduce urinary frequency and urgency and offers little absorption into the rest of the body; however, the safety and efficacy of estrogen therapy continues to be researched.

Bladder prolapse

Estrogen replacement therapy, administered orally as a pill or topically as a patch or a cream, may be recommended for bladder prolapse to strengthen the vaginal muscles. The topical cream offers little absorption into the rest of the body, so it avoids side effects and potential risks of estrogen therapy while providing a potent dose to the vaginal area. However, the safety and efficacy of estrogen therapy continues to be researched.

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