Other Bladder Control Medications
If symptoms of urinary incontinence are thought to be caused by an enlarged prostate, different medications can be offered to reduce these symptoms. The prostate gland wraps around the urethra , and if it is enlarged, it could squeeze the urinary passage tight, making the emptying of bladder more difficult and incomplete.
In brief, the following categories are available for the treatment of urinary symptoms caused by an enlarged prostate :
- Alpha-blockers, terazosin , doxyzosin , alfuzosin , silodosin , and tamsulosin , work by relaxing the muscles around the urethra and prostate, thus, making urination more comfortable and complete. These medications start to relieve symptoms within a few weeks, but they do not affect the prostate size.
- 5-alpha reductase inhibitors, finasteride and dutasteride , work by reducing the size of the prostate gland. They may take several months to become effective.
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.
When Are Medicines For Urinary Urgency And Incontinence Usually Prescribed
For people with stress incontinence, duloxetine may be advised if pelvic floor exercises alone are not helping to treat their stress incontinence. It is usually advised in women who do not want to undergo surgery, or in women who have health problems that may mean that surgery is unsuitable.
For people with urge incontinence, lifestyle measures and bladder retraining are normally tried first. If there is not enough improvement with bladder training alone, medicines may then be considered.
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Botox Injection For Bladder Problems
Botox injection has recently been approved by the Food and Drug Administration for the treatment of overactive bladder for patients who have failed to respond to standard therapy with anticholinergic medications.
Overactive bladder is a type of urinary incontinence caused by overactivity of the muscles in the bladder, causing frequent squeezing of the bladder and, thus, frequent urge to urinate. Botox can be injected into the bladder directly through a cystoscope .
How Successful Is Treatment For Urinary Incontinence
The outlook is promising for urinary incontinence treatment. About 80% of people with urinary incontinence can improve or even be cured. The best outcome depends, of course, on getting the correct diagnosis and following your doctor’s advice to help improve your condition.
American Academy of Family Physicians: “Urinary Incontinence: Embarrassing but Treatable.”
Jennifer Anger, MD, MPH, urologist, Cedars-Sinai Medical Center, Los Angeles.
Amy Rosenman, MD, co-author, The Incontinence Solution, urogynecologist, Santa Monica, CA, associate clinical professor, UCLA.
National Library of Medicine MedlinePlus Medical Encyclopedia: “Urge Incontinence.”
Halina Zynczynski, MD, director, division of Urogynecology and Reconstructive Pelvic Surgery, Magee-Women’s Hospital, associate professor of obstetrics and gynecology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
American Family Physician: “Selecting Medications for the Treatment of Urinary Incontinence.”
National Association for Continence: “Treatment Options for Incontinence.”
American Urological Association: “Diagnosis and Treatment of Overactive Bladder in Adults: AUA/SUFU Guideline.”
Global Library of Women’s Medicine.
Rovner, E. Rev Urol., 2004
What Is The Bottom Line About This Health Issue
If you have trouble with leaking urine, know that you are not alone many women suffer from urinary incontinence. There is no shame in discussing this problem with your doctor or an incontinence professional . The real harm is in ignoring incontinence. Non-drug treatments, such as healthy lifestyle changes or pelvic floor exercises, should be the first choice. Once you start adopting healthy behaviors, sticking to these good habits will serve you well in the long run.
Currently there are no effective medications for women with stress incontinence. In contrast, women with urgency incontinence have good evidence that several medications can be helpful. There are eight drug choices available and women can make informed decisions with their doctors. We “urge” you to take into account the balance between benefits and harm for each of eight available drugs and to make informed treatment decisions after discussions with incontinence professionals.
Treatment Of Urge Incontinence
The anticholinergic agents oxybutynin and tolterodine are used widely to treat urge incontinence. These medications are not, however, the most effective therapies. Behavior therapies are more effective, and theynot medicationsshould be first-line treatment.
Behavior therapies for urge incontinence include bladder training and pelvic floor muscle exercises. Bladder training is more effective than oxybutynin and improves incontinence in more than 50 percent of patients.6 Kegel exercises are even more effective. In a randomized controlled trial 7 comparing Kegel exercises with oxybutynin in patients with urge incontinence, patients performing Kegel exercises had an 81 percent reduction in incontinence episodes compared with a 69 percent decrease in oxybutynin-treated patients, a statistically significant difference.
Although biofeedback commonly is used to help patients learn effective Kegel technique, evidence suggests that biofeedback training does not result in decreased frequency of incontinence episodes compared with Kegel exercises alone.8 Physicians should keep in mind that successful use of Kegel exercises is dependent on a patients motivation and ability to cooperate with the exercise routine.
One patch twice weekly
86 to 95
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What Is The Role Of Medications In Urinary Incontinence Treatment
The goal of therapy is to improve the symptoms of frequency, nocturia, urgency, and urge incontinence. Pharmacologic treatment options include anticholinergics, antispasmodic agents, tricyclic antidepressants , and beta-3-adrenergic receptor agonists.
In patients with stress incontinence, alpha agonist treatment results in contraction of the internal urethral sphincter and increases the urethral resistance to urinary flow. Sympathomimetic drugs, estrogen, and tricyclic agents increase bladder outlet resistance to improve symptoms of stress urinary incontinence.
Pharmacologic therapy for stress incontinence and an overactive bladder may be most effective when combined with a pelvic exercise regimen. The 3 main categories of drugs used to treat urge incontinence include anticholinergic drugs, antispasmodics, and TCAs.
When a single drug treatment does not work, a combination therapy such as oxybutynin and imipramine may be used. Although their mechanism of action differs, oxybutynin and imipramine work together to improve urge incontinence.
Beta-3 adrenergic receptor agonists cause relaxation of the detrusor muscle and increased bladder capacity. These agents are indicated for overactive bladder with symptoms of urge urinary incontinence, urgency, and urinary frequency.
Russo E, Caretto M, Giannini A, Bitzer J, Cano A, Ceausu I, et al. Management of urinary incontinence in postmenopausal women: An EMAS clinical guide. Maturitas. 2021 Jan. 143:223-230. .
Antidepressants And Narcotic Pain Relievers
Some antidepressants and pain medications can prevent the bladder from contracting completely so that it does not empty. That gives rise to issues with urgency or frequency. They can also decrease your awareness that you need to go to the bathroom.
Some of these drugs can also cause constipation, Dr. Rackley says. Constipation, in turn, can cause indirect bladder incontinence, because being constipated takes up more room in the pelvis that the bladder needs to expand.
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Pharmacologic Agents That Cause Urinary Incontinence
A variety of drugs have been implicated in urinary incontinence, and attempts have been made to determine the mechanism responsible based upon current understanding of the processes involved in continence and the transmitters that play a role. Each of the processes described previously can be manipulated by pharmacologic agents to cause one or more types of incontinence.
The drugs commonly pinpointed in urinary incontinence include anticholinergics, alpha-adrenergic agonists, alpha-antagonists, diuretics, calcium channel blockers, sedative-hypnotics, ACE inhibitors, and antiparkinsonian medications. Depending upon the mode of action, the effect may be direct or indirect and can lead to any of the types of incontinence. Taking these factors into account, it is important to consider a patients drug therapy as a cause of incontinence, particularly in new-onset incontinence patients and in elderly patients, in whom polypharmacy is common.11,12
On the other hand, a pharmacologic agent or any other factor that results in chronic urinary retention can lead to a rise in intravesical pressure and a resultant trickling loss of urine. In this way, drugs that cause urinary retention can indirectly lead to overflow incontinence.2
It is useful to note that many antidepressants and antipsychotics exhibit considerable alpha1-adrenoceptor antagonist activity.1
Oab Or Incontinence Medications Used In Canada
|The most common adverse events found with anticholinergic medications include : dry mouth, constipation, impaired cognition and blurred vision. Talk to your doctor about limiting these side effects and which medication may be right for you.|
The two most commonly prescribed anticholinergic drugs are oxy- butynin and tolterodine , both of which are available in extended-release formulations.
Recently, medications have been developed that also limit unwanted side effects. These medications include darifenacin , solifenacin , trospium , fesotoredine , Myrbetriq® and oxybutynin chloride gel . Gelnique, is rubbed into the skin, making side effects like dry mouth milder because of constant absorption rates. Myrbetig is a new drug that works by a different mechanism to relax the bladder muscle without blocking the action of acetyl choline and therefore produces lesser side effects. The other drugs are anti-cholinergics but are more specific to the bladder muscle.
Re-injection can be considered when the effect diminishes but not within three months of the last injection
Since estrogen helps keep the urethra healthy and strong, the drop in estrogen that occurs in women after menopause especially with aging may contribute to incontinence. Applying estrogen in the form of a vaginal cream , tablet or ring may help ease symptoms of both stress and urge incontinence.
Incontinence And Alzheimers Disease
People in the later stages of Alzheimers disease often have problems with urinary incontinence. This can be a result of not realizing they need to urinate, forgetting to go to the bathroom, or not being able to find the toilet. To minimize the chance of accidents, the caregiver can:
- Avoid giving drinks like caffeinated coffee, tea, and sodas, which may increase urination. But dont limit water.
- Keep pathways clear and the bathroom clutter-free, with a light on at all times.
- Make sure you provide regular bathroom breaks.
- Supply underwear that is easy to get on and off.
- Use absorbent underclothes for trips away from home.
For more ways to deal with incontinence and other common medical problems in someone with Alzheimers, visit Alzheimers Disease: Common Medical Problems.
How To Do Them
Stand, sit or lie down with your knees slightly apart. Relax.
Find your pelvic muscle. Imagine that you are trying to hold back urine or a bowel movement. Squeeze the muscles you would use to do that. DO NOT tighten your stomach or buttocks.
Women: to make sure youve got the right muscle, insert your finger into your vagina while you do the exercise. You should feel a tightening around your finger.
Men: when you tighten the pelvic floor muscle, your penis will twitch and contract in towards your body.
- Tighten the muscles for 5 to 10 seconds. Make sure you keep breathing normally
- Now relax the muscles for about 10 seconds
- Repeat 1220 times, three to five times a day
Stick to it! You should begin to see results after a few weeks. Like any other muscle in your body, your pelvic muscles will only stay strong as long as you exercise them regularly.
If youre having a hard time doing Kegel exercises, your healthcare professional can teach you how to do them correctly. He/she may even suggest a tool or device to help make sure youre using the right muscles .
Your doctor may also suggest biofeedback, a training technique thats used to monitor the contraction of the pelvic floor muscles as you do your Kegel exercises. Biofeedback uses a machine that records the contractions of your muscles and translates the movement into a visual signal that you can watch on a monitor. Some people find this helpful in learning how to do Kegel exercises correctly.
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Medications That Can Cause Urinary Incontinence
Urinary , or the loss of bladder control, can be caused by various health conditions and physical changes, such as childbirth, changes in diet, infection, prostate issues, menopause, and neurological disorders. But there are also a number of medications can cause urinary incontinence in both men and women in a variety of different ways.
Diuretics such as hydrochlorothiazide , furosemide , bumetanide , triamterene with hydrochlorothiazide
Increase urine production by the kidney
Frequent urination, overactive bladder, stress incontinence
Muscle relaxants and sedatives such as diazepam , chlordiazepoxide , lorazepam
Cause sedation or drowsiness relax the urethra
Frequent urination, stress incontinence, lack of concern or desire to use the toilet
Narcotics such as oxycodone , meperidine , morphine
Cause sedation or drowsiness relax the bladder, causing it to retain urine
Lack of concern or desire to use the toilet, difficulty in starting urinary stream, straining to void, voiding with a weak stream, leaking between urinations, frequency incontinence
Antihistamines such as diphenhydramine and chlorpheniramine
Relax the bladder, causing it to retain urine
Alpha-adrenergic antagonists such as terazosin , doxazosin
Relax the muscle at the outlet of the bladder
Leaking when coughing, sneezing, laughing, exercising, etc.
From , Harvard Health Publishing
Home Remedies For Urinary Incontinence
Urinary incontinence can be described as the inability to control urination, leading to urine leakage or involuntary loss of urine.
It is a very common, and at times debilitating, urological disorder. According to the National Association for Continence , it affects about 25 million Americans.
Urinary incontinence can be divided into three main types:
- Urge incontinence occurs when an overactive or hyperactive bladder causes a sudden and intense urge to urinate causing involuntary loss of urine
- Stress incontinence occurs when physical activities like vigorous exercise, jumping, coughing, sneezing or even laughing put pressure on the bladder and it releases urine
- Overflow incontinence inability to completely empty the bladder, leading to frequent or constant dribbling of urine
Incontinence can be caused by a number of factors like age , weakened pelvic floor muscles due to surgery or childbirth, enlarged prostate, menopause, an overactive bladder, nerve damage, urinary stones, urinary tract infections and constipation.
Plus, certain foods, drinks and medications may stimulate your bladder and cause temporary incontinence.
It not only can cause discomfort and embarrassment, but can also be harmful if urine is left in the bladder creating a breeding ground for bacteria. Incontinence is not a disease in itself, but a symptom of an underlying condition or disorder.
Here are the top 10 home remedies for urinary incontinence.
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Which Medicine Is Usually Prescribed
As discussed above, duloxetine is prescribed for stress incontinence.
For people with urge incontinence, oxybutinin is normally prescribed first. If you have too many side-effects with this medicine, your doctor may choose a different antimuscarinic such as darifenacin, fesoterodine, propiverine, solifenacin, tolterodine, or trospium. Your doctor may also choose a slow-release preparation of oxybutinin or an oxybutinin skin patch to help lessen side-effects.
Propiverine is sometimes chosen if you have urinary urgency but you do not have urinary incontinence.
You may be prescribed mirabegron if you are unable to take an antimuscarinic.
Other medicines that are used less often are oestrogen applied to the vagina and desmopressin. These medicines are usually prescribed on the advice of a specialist doctor. Oestrogen applied to the vagina may be chosen for women who have gone through the menopause and desmopressin is considered if you are passing urine frequently at night and you are younger than 65 years of age.
Diagnosis Of Urinary Incontinence
The first step in treating incontinence is to see a doctor. He or she will give you a physical exam and take your medical history. The doctor will ask about your symptoms and the medicines you use. He or she will want to know if you have been sick recently or had surgery. Your doctor also may do a number of tests. These might include:
- Urine and blood tests
- Tests that measure how well you empty your bladder
In addition, your doctor may ask you to keep a daily diary of when you urinate and when you leak urine. Your family doctor may also send you to a urologist, a doctor who specializes in urinary tract problems.
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Different Types Of Incontinence
There are four basic types of incontinence: stress, urge, overflow and functional. They may occur alone, or in combination, especially in seniors.
Stress incontinence is the involuntary leakage of small amounts of urine in response to increased pressure on the bladder . It is present in about 35 per cent of incontinent seniors. It is more common in women, often because childbirth caused the pelvic muscles to relax. It also occurs, usually temporarily, in men who have had prostate surgery.
Urge incontinence is the leakage of large amounts of urine when someone is unable to reach the toilet after getting the urge to urinate. It accounts for 60-70 per cent of incontinence problems in seniors.
Overflow incontinence accounts for 10-15 per cent of urinary incontinence. It occurs when there is an obstruction in the bladder, which causes the bladder to overfill. Often, there is no sensation that the bladder is full. Then, when the bladder contracts, urine is released.
Functional incontinence accounts for 25 per cent of the incontinence seen in institutions. It often happens because a person has difficulty moving from one place to another. Poor vision, hearing or speech may interfere with reaching the toilet or telling caregivers of the need to use the toilet. This type of incontinence can also occur in the home.