Rationale For Anticholinergic Use
Detrusor muscle contractions are essential for normal micturition, but involuntary contractions produce the symptoms of overactive bladder. Contractions depend on the activation of muscarinic receptors in the bladder by acetylcholine. The M3 muscarinic receptor-subtype is thought to be the most important in regulating detrusor contractions.
Anticholinergic drugs block muscarinic receptor activation and inhibit the spontaneous detrusor contractions found in overactive bladder. Drug efficacy is dose-dependent, but effectiveness is often limited by unwanted antimuscarinic effects in distant organs where other acetylcholine receptor-subtypes predominate . These adverse effects are also dose-dependent. They commonly include dry mouth, dry eyes, confusion, constipation, somnolence, blurred vision and increased heart rate.
There are no currently available drugs with pure selectivity for the muscarinic receptors in the detrusor. To try to improve the benefit:harm ratio a number of anticholinergics have been developed with greater selectivity for the detrusor or the M3 receptor, or with extended release properties.
Incontinence Associated With Benign Prostatic Hyperplasia
Chronic bladder outlet obstruction leads to functional changes, such as decreased bladder compliance and detrusor overactivity. In turn, this may result in frequency, urgency and urgency incontinence.10Detrusor overactivity, mediated by M2 and M3 muscarinic receptors, contributes to lower urinary tract symptoms in approximately 15% of men.11
In patients with overactive bladder syndrome secondary to bladder outlet obstruction, treatment varies from watchful waiting to drug therapy and various surgical options depending on the severity of symptoms and indications for intervention.11The mainstay of drug treatment includes alpha adrenergic receptor blockers and 5-alpha-reductase inhibitors. If the overactive bladder syndrome is secondary to bladder outlet obstruction there may be a role for combinations of these drugs. Although there is a risk of acute urinary retention with alpha adrenergic receptor blockers and antimuscarinic drugs in combination, the rate is low.12
With 5-alpha-reductase inhibitors, common adverse effects include fatigue, loss of libido and ejaculatory and/or erectile dysfunction. Long-term use at the end of four years shows an absolute reduction in the overall risk of developing prostate cancer.13The alpha blockers can cause hypotension. As the elderly are more susceptible to orthostatic hypotension, they may have an increased risk of falls.
What Are Important Things To Know About Urinary Incontinence And Medications
We need to remember that drugs are not free of consequences and that they always increase our risk for unwanted side effects. First, women who want help with their incontinence problems should seek to make lifestyle changes such as exercising more and losing excessive weight. The earlier in our lives we adopt such healthy behaviors, the better we will be when we get older . Keeping with these healthy behaviors is a key for success when dealing with incontinence. However, for some women, lifestyle changes may not be enough and they may wish to discuss the use of drugs to manage their incontinence. If you are considering asking your doctor about the use of drugs, go prepared. Women should inform themselves about the specific benefits, harms, and costs of the medications. Together women and their doctors can make the best choice and select the optimal balance between the benefits and potential harms of medications for treating incontinence.
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Other Therapies For Urge Urinary Incontinence
Botulinum toxin. Botulinum toxin A , a powerful neurotoxin produced by the bacterium Clostridium botulinum, has been studied as therapy for idiopathic detrusor overactivity in a variety of patients, including those who did not respond to anti-cholinergic drugs. BTX-A prevents the release of acetylcholine at the neuromuscular junction. This effect, in turn, inhibits depolarization of the detrusor muscle, resulting in chemical denervation of the bladder. BTX-A is administered via a cystoscopic technique that is reported to be safe and well tolerated. The toxin is injected directly into the detrusor muscle. In clinical trials, the duration of response was typically 3 to 6 months. Intravesical injections of BTX-A in patients with OAB resulted in increased bladder capacity, increased bladder compliance, and improved quality of life.239,240
A study of onabotulinumtoxinA in patients with idiopathic UUI or OAB indicated that doses ranging from 100 U to 150 U were effective in managing the disorder. Adverse effects included UTIs and urinary retention.240
Although clinical trials with BTX-A have not been robust, they suggest that this agent may offer potential benefits for patients with UUI. Further research is necessary to substantiate the usefulness of BTX-A in this population.
Why Is Urinary Incontinence A Health Issue
Urinary incontinence is a very common problem in aging women . When women leak urine during exercise, sneezing, or coughing, doctors call this type of incontinence stress-related . When women have strong urges to urinate and have trouble holding urine until getting to the bathroom, they may have what is known as urgency incontinence . Although most women have one or the other type of incontinence, older women often have both types. Incontinence hurts women’s self-confidence, interferes with their ability to enjoy their favorite activities, and decreases the quality of their lives .
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Cholinergic Drugs For Bladder Problems
This class of drugs includes bethanechol . Cholinergic refers to nerve cells or fibers that use a certain type of chemical to send signals within the body. Cholinergic drugs are used when the bladder is not emptied completely following urination. This problem is known as residual urine in the bladder.
- How cholinergic drugs work: These drugs contract the bladder, thus allowing complete emptying.
- Who should not use these medications: Individuals with the following conditions should not use cholinergic drugs:
- Parkinson’s disease
- Bladder or bowel obstruction
More On Drug Side Effects
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I’m sorry to say, however, that your aunt long ago reached the age where anticholinergic drugs should almost certainly be ruled out as a treatment option. In older patients, anticholinergics like the two your aunt has been prescribed can cause a wide range of adverse effects, including constipation , blurred vision, confusion and short-term memory problems, dizziness, anxiety, depression and hallucinations.
When considering how to treat urinary incontinence it’s important to remember two things. First, while the muscles in the bladder and urethra lose some of their strength as we get older , incontinence isn’t “normal” at any age. Second, urinary incontinence is a symptom, not a disease. Urge incontinence, for example, may be caused by:
I’d recommend that you work closely with your aunt’s physician or other health care provider to determine, if at all possible, what might be causing her incontinence. Smoking or being overweight can be contributing factors, for example.
While it’s not always possible to pinpoint a cause especially with very old patients I find that adjusting a patient’s medications often resolves or, at least, substantially lessens the problem. Some simple behavioral techniques including bladder training and scheduled toilet trips can help, too.
Also of interest:
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Mechanisms Of Urinary Continence
In healthy individuals, the urinary bladder senses the volume of urine by means of distention. Distention of the bladder excites afferent A-delta fibers that relay information to the pontine storage center in the brain. The brain, in turn, triggers efferent impulses to enhance urine storage through activation of the sympathetic innervation of the lower urinary tract . These impulses also activate the somatic, pudendal, and sacral nerves.1
The hypogastric nerves release norepinephrine to stimulate beta3-adrenoceptors in the detrusor and alpha1-adrenoceptors in the bladder neck and proximal urethra. The role of beta3-adrenoceptors is to mediate smooth-muscle relaxation and increase bladder compliance, whereas that of alpha1-adrenoceptors is to mediate smooth-muscle contraction and increase bladder outlet resistance.1 The somatic, pudendal, and sacral nerves release acetylcholine to act on nicotinic receptors in the striated muscle in the distal urethra and pelvic floor, which contract to increase bladder outlet resistance.1
Efferent sympathetic outflow and somatic outflow are stopped when afferent signaling to the brain exceeds a certain threshold. At this point, the parasympathetic outflow is activated via pelvic nerves. These nerves release acetylcholine, which then acts on muscarinic receptors in detrusor smooth-muscle cells to cause contraction. A number of transmitters, including dopamine and serotonin, and endorphins are involved in this process.1
What Should I Know About Storage And Disposal Of This Medication
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture .
Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA’s Safe Disposal of Medicines website for more information if you do not have access to a take-back program.
It is important to keep all medication out of sight and reach of children as many containers are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location â one that is up and away and out of their sight and reach.
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Data Collection And Management
The information collected over a three year period included a battery of detailed physiologic and performance measurements and questionnaire material regarding demographic characteristics, multiple aspects of health status, and medication use. For medications at year 3, participants were asked to bring to clinic all prescription and over the counter medications they had taken in the previous two weeks. Well trained examiners transcribed from the medication containers information on medication name, dosage form, and whether the medication was taken as needed.. The medication data was coded using the Iowa Drug Information System codes and then entered into a computerized database.14
Where To Go For Urinary Incontinence Treatment
For urinary incontinence treatment, start with your primary care doctor. Tell them you are having problems with bladder control. If your primary care doctor is unable to help, ask for a referral to a specialist. Doctors who specialize in treating urinary incontinence include urogynecologists, gynecologists with extra training in urinary incontinence, or urologists, doctors who specialize in problems of the urinary tract system in men and women.
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What Is The Evidence For Effective Treatments For Urinary Incontinence
Women have several options to manage their urinary incontinence and these primarily include either drug or non-drug treatments. Many studies have shown that the majority of women improve their symptoms using non-drug conservative interventions and these include:
Intra-vaginal electrical or magnetic stimulation may help some women with incontinence . However, some women do not benefit from these non-drug treatments, or they are unable to access these treatments, or make the necessary lifestyle changes. In this case, doctors may suggest the use of drugs to help with incontinence problems. We review the current scientific evidence about the effectiveness of these drugs to help manage incontinence.
Medicine For Stress Incontinence
If stress incontinence does not significantly improve with lifestyle changes or exercises, surgery will usually be recommended as the next step.
However, if you’re unsuitable for surgery or want to avoid an operation, you may benefit from an antidepressant medicine called duloxetine. This can help increase the muscle tone of the urethra, to help keep it closed.
You’ll need to take duloxetine tablets twice a day and will be assessed after 2 to 4 weeks to see if the medicine is beneficial or causing any side effects.
Possible side effects of duloxetine can include:
Do not suddenly stop taking duloxetine, as this can also cause unpleasant side effects. A GP will reduce your dose gradually.
Duloxetine is not suitable for everyone, however, so a GP will discuss any other medical conditions you have to determine if you can take it.
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Medications For Treating Incontinence
There are several medications used to treat incontinence. The main types of incontinence that respond to drug treatment are stress and urge incontinence.
Some of the medication used for stress incontinence include:
- Oestrogens are used to re-vitalise the urethral tissue structures enabling a better seal or closure.
- Alpha-adrenergic agonists. These drugs are used to contract the muscles around the bladder neck and urethra. This forms a tighter seal that keeps urine from leaking under pressure.
The medications used for urge incontinence or over-active bladder syndrome include:
All of these drugs should be used in conjunction with bladder training and pelvic floor exercises. The combination of these techniques provides the best option for managing the bladder spasms that cause urge incontinence and strengthening urethral resistance in stress incontinence. Each of these incontinence medications affects people differently. You should consult your doctor to determine the best treatment for you.
* International not-for-profit organisation preparing, maintaining and promoting the accessibility of systematic reviews of the effects of health care.
Kimberly-Clark Australia makes no warranties or representations regarding the completeness or accuracy of the information. This information should be used only as a guide and should not be relied upon as a substitute for professional medical or other health professional advice.
Other urinary incontinence causes
Pelvic Floor Muscle Training
Your pelvic floor muscles surround the bladder and urethra and control the flow of urine as you pee.
Weak or damaged pelvic floor muscles can cause urinary incontinence, so exercising these muscles is often recommended.
A GP may refer you to a specialist to start a programme of pelvic floor muscle training.
The specialist will assess whether you’re able to squeeze your pelvic floor muscles and by how much.
If you can contract your pelvic floor muscles, you’ll be given an exercise programme based on your assessment.
Your programme should include a minimum of 8 muscle contractions at least 3 times a day and last for at least 3 months. If the exercises are helping after this time, you can keep on doing them.
Research has shown that pelvic floor muscle training can benefit everyone with urinary incontinence.
Find out more about pelvic floor exercises.
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In Case Of Emergency/overdose
In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at . If the victim has collapsed, had a seizure, has trouble breathing, or can’t be awakened, immediately call emergency services at 911.
If someone swallows oxybutynin gel, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.
Etiology And Risk Factors
Multiple factors, including age-related physiological changes, may result in or contribute to the various syndromes of UI. Both genitourinary and non-genitourinary factors may contribute to incontinence in aging patients. Age-related functional changes in the urinary tract may contribute to UI.32 In women, risk factors for these genitourinary changes include multiple or complex vaginal deliveries, high infant birth weight, a history of hysterectomy, and physiological changes related to the transition to postmenopause. Smoking, a high body mass index, and constipation are also associated with an increased risk of UI.3337
Pathophysiological causes of UI include lesions in higher micturition centers, in the sacral spinal cord, and in other neurological areas as well. UI may also be associated with numerous comorbidities, such as Parkinsons disease, Alzheimers disease, cerebrovascular disease, diabetes, hypertension, obstructive sleep apnea, and normal-pressure hydrocephalus. Functional factors, including mobility and dexterity, along with reaction time and lack of access to a bathroom facility, may also contribute to UI.3337
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Us Drug Watchdog Urges Women Nationwide To Demand Their Physician Explain The Risks Of Using A Mesh Product To Treat Urinary Incontinence Or Pelvic Organ Prolapse Before It Is Used In A Surgical Procedure
WASHINGTON, Nov. 16, 2022 /PRNewswire/ — The US Drug Watchdog says, “Over a decade ago we were one of the most quoted sources in the nation for victims of transvaginal mesh failures and we helped hundreds of women who were harmed by these types of medical products. We moved on from this initiative until a few months ago when we received a call from a young woman on the West Coast who had medical procedure using a mesh product to treat urinary incontinence very early in 2022.”
“Since her vaginal mesh surgical procedure, she has had to go through four revision surgeries in an attempt to remove this product from her body. The doctor who performed the procedure and the hospital are not returning her calls. Why are mesh products still being used-and or why haven’t the mesh product makers fixed the very serious issues with these types of medical products?”
“If you are a woman about to undergo a medical procedure where a mesh product is going to be used to treat urinary incontinence or pelvic organ prolapse-please ask your doctor about the risks-and have a witness there.”
Some symptoms of a vaginal mesh procedure-failure include:
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In some instances, the inability to have sexual intercourse
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