Urge Incontinence

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Nonsurgical Treatment of Urge Incontinence

Treatments most commonly used for urge urinary incontinence are bladder training with timed voiding, medication, biofeedback, and electrical stimulation. It also may be helpful to distribute fluid intake throughout the course of the day and avoid foods that can irritate the bladder (e.g., coffee, tea, carbonated beverages, spicy foods, acidic foods).

Bladder Training with Timed Voiding

This treatment is used for urge and overflow incontinence. The patient keeps a voiding diary of all episodes of urination and leaking, and the physician analyzes the chart and identifies the pattern of urination. The patient uses this timetable to plan when to empty the bladder to avoid accidental leakage. In bladder training, biofeedback and Kegel exercise help the patient resist the sensation of urgency, postpone urination, and urinate according to the timetable.

Medication

Medications may be used to relax involuntary bladder contractions and improve bladder function. There are several types of medications, which can be used alone or in combination.

Anticholinergic Agents
Anticholinergic agents (e.g., oxybutynin, tolterodine, enablex, sanctura, vesicare, oxytrol) have proven to be effective in some patients with urge incontinence. These medications relax smooth muscle tissue and have an antispasmodic effect on overactive bladder.

Propantheline bromide (Pro-Banthine®) is prescribed to stop bladder muscle contractions (overactive bladder). Typical dosage is 7.5 to 30 mg taken without food three to five times per day.

Oxybutynin chloride (Ditropan®XL) relaxes bladder smooth muscle. This medication is prescribed to treat urge incontinence caused by overactive bladder.

Muscarinic receptor antagonist
Tolterodine tartrate (DetrolLA®) blocks nerve receptors that control bladder contraction and reduces urinary frequency and urgency in overactive bladder and urge incontinence. The typical dose is 2-4 mg, twice daily.

Patients who have an adverse reaction to the drug or who have the following conditions should not use this medication.

• Urinary retention
• Gastric retention
• Narrow-angle glaucoma

The oxybutynin transdermal system (Oxytrol®) is a thin, flexible, clear patch that is applied to the skin of the abdomen or hip, twice weekly, to treat overactive bladder. This treatment delivers oxybutynin continuously through the skin into the bloodstream and relieves symptoms for up to 4 days.

Patients who have urinary or gastric retention, uncontrolled narrow-angle glaucoma, and those with hypersensitivity to oxybutynin should not use the oxybutynin transdermal system.

Antispasmodic Medications
Hyoscyamine sulfate (Levbid®, Cytospaz®) and flavoxate (Urispas®) are antispasmodics prescribed for urge incontinence caused by overactive or neurogenic bladder. Typical dosage is one or two 0.375 mg tablets taken every 12 hours. These drugs should not be taken by patients with obstructive urinary tract disorders (e.g., enlarged prostate), glaucoma (i.e., eye disease characterized by increased intraocular pressure), or severe inflammation of the large intestine (ulcerative colitis).

Tricyclic Antidepressants
Tricyclic antidepressants (TCAs) have anticholinergic effects that reduce nighttime incontinence and help manage urge incontinence. TCAs include doxepin hydrochloride (Sinequan®), desipramine hydrochloride (Norpramin®), nortryptyline hydrochloride (Pamelor®), and imipramine pamoate (Tofranil-PM®). The usual dose of Tofranil is 10 to 25 mg taken one to three times per day for a total of 25 to 75 mg daily.

Side effects

Side effects associated with anticholinergics include the following:

• Confusion
• Constipation
• Dizziness
• Drowsiness
• Dry mouth
• Headache
• Nausea
• Nervousness
• Rapid heart rate (tachycardia)
• Urinary retention
• Visual blurring

Alpha-1-adrenergic blocking agents
These agents are used to treat benign prostatic hyperplasia (BPH), which compresses the male urethra and obstructs urine flow resulting in overflow and urge incontinence. Alpha blockers relax striated and smooth muscle, decreasing urethral resistance and relieving symptoms.

Three drugs commonly prescribed for treatment of BPH and associated incontinence include the following:

• Doxazosin mesylate (Cardura®), 1-8 mg, once daily
• Tamulosin hydrochloride (Flomax®), 0.4-0.8 mg, once daily
• Terazosin hycrochloride (Hytrin®), 1-10 mg, once daily

Side effects commonly experienced with these drugs include

• dizziness,
• fatigue, and
• headache.

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