Treatment of Urinary Incontinence: The Place of Drugs

Abstract

A good pharmacological treatment of urinary incontinence must be based on an appropriate understanding of the underlying physiological disturbance and on a basic knowledge of drugs, their mode of action on the urinary tract and their side effects. A general drug treatment policy must be established. This involves indications for treatment with the best drug, adjustment of the dosage, follow-up of the patient as well as the combination of drug treatment with nonpharmacological interventions like behavioral treatment procedures and pelvic floor training.

Incontinence Drug Utilization Patterns in Québec, Canada

“…This may also be one reason why discontinuation rates were so high in the present study. However, comparisons of this nature are difficult because of the complexity of incontinence and the influence that a variety of factors, including patient age and comorbidity [10,12], inaccurate diagnosis, drug dose and additional nonpharmacological treatments [13], might have on patient outcome.…”

“…Successful treatment of UI is contingent on an accurate diagnosis and can involve behavioral therapy, bladder education programs, fluid intake changes, pelvic muscle exercises, and pharmacotherapy [9–11]. Although the choice of specific pharmacological intervention is governed by the type of UI diagnosed, the tertiary amine oxybutynin has been used to treat the urinary urgency, frequency, and urge incontinence associated with overactive bladder due to detrusor instability [12–14].…”

“…Clinical trials have shown that both oxybutynin and flavoxate are associated with unpleasant side‐effects related to their anticholinergic activity profile [10,12,16]. As a result, compliance in clinical trials is poor, with many patients discontinuing treatment [12,15], raising the issue of whether current investments in UI pharmacotherapy provide adequate clinical returns.…”

Urinary Incontinence

“…1 0 T h e prime effector of continence is the synergic relaxation of the bladder wall muscle (detrusor) and contraction of bladder neck and pelvic floor muscles (Figure 1). 11 In bladder filling, sympathetic nerve fibers originating from the Th 11 to L 2 segments of the spinal cord, which innervate smoothmuscle fibers around the bladder neck and proximal urethra, cause these fibers to contract, allowing the bladder to fill. As the bladder fills, sensory stretch receptors in the bladder wall trigger a central nervous system (CNS) response.…”

“…There are at present no specific drugs that act on the micturition center in the frontal cortex or at sites in the midbrain or brain stem controlling bladder function. 11 However, at the level of the bladder itself, there are a number of drugs available for the treatment of incontinence, particularly for urge and stress incontinence (Table 3). 1 5 , 3 9-5 0…”