Bladder Control Medications

• People who have bladder control problems have trouble stopping the flow of urine from the bladder.
• This problem is also called urinary incontinence.
• Incontinence is a term used to describe uncontrollable leaking of a body secretion.

Any underlying disease or condition that may cause loss of bladder control must be treated. For example, antibiotics are necessary for treatment of urinary tract infections, and drugs that specifically decrease symptoms caused by an enlarged prostate gland may decrease urinary urgency. Drug treatment may be directed to relax the bladder so it can hold more urine, decreasing the need for frequent urination. Other drugs help tighten the sphincter muscles to avoid uncontrolled urine leakage. Still other drugs are used to help empty the bladder for conditions in which the bladder does not empty completely.

The anticholinergic class of drugs includes darifenacin (Enablex), dicyclomine (Antispas, Bentyl), flavoxate (Urispas), hyoscyamine (Anaspaz, Levbid, Levsin), methantheline (Banthine, Pro-Banthine), oxybutynin (Ditropan, Ditropan XL, Oxytrol, Gelnique), solifenacin (VESIcare), tolterodine (Detrol, Detrol LA), fesoterodine (Toviaz), and trospium (Sanctura).

Anticholinergic agents may help relieve urge incontinence. Anticholinergic means to oppose or counteract the activity of certain nerve fibers that cause the bladder to contract. Some tricyclic antidepressants (TCAs), such as imipramine (Tofranil, Tofranil PM), nortriptyline (Pamelor), or amitriptyline (Elavil), have strong anticholinergic effects and may be prescribed to treat incontinence. Because the effects of newer, long-acting agents (for example, Detrol LA, Ditropan XL, Enablex, or VESIcare) last throughout the day, they need to be taken only once daily, which makes them very convenient. Additionally, the effects of Detrol and Detrol LA are mostly limited to the bladder, thus lessening the prevalence of side effects typically caused by anticholinergics (for example, dry mouth and blurry vision).

• How anticholinergics work: Anticholinergics increase the amount of urine that the bladder can hold. These drugs also decrease the pressure associated with the urge to urinate.
• Who should not use these medications: Individuals with the following conditions should not use anticholinergics:
  • Allergy to anticholinergics
  • Poorly controlled narrow-angle glaucoma
  • Bladder or bowel obstruction
• Use: All anticholinergics are available as tablets or capsules. The amount and number of doses per day varies, depending on the particular drug. Additionally, oxybutynin is available as a topical patch (Oxytrol) that is applied to the skin twice a week.
• Drug or food interactions: Caution must be used when taking other drugs that may produce anticholinergic effects, such as antihistamines, drugs used to treat depression or schizophrenia, and some drugs used to treat heart-rhythm disturbances. They may add to risk of developing side effects as these classes of medications in general carry similar effects as the anticholinergic drugs.
• Side effects: Common side effects include dry mouth, blurred vision, and constipation. Palpitations and tachycardia (rapid heartbeat) have been reported. The ability to sweat effectively may be decreased.

This class of drugs includes midodrine (Pro-Amatine) and pseudoephedrine (Sudafed). Alpha-adrenergic drugs mimic actions of the sympathetic nervous system, which controls various involuntary body functions. Although not approved by the U.S. Food and Drug Administration for use in bladder control problems, these drugs have been prescribed to treat stress incontinence.

• How alpha-adrenergic stimulators work: These drugs help the bladder to retain urine by constricting the sphincter muscle and relaxing the bladder wall. These actions reduce urine leakage due to abrupt increases in pressure on the bladder, such as, coughing, sneezing, laughing, or bearing down.
• Who should not use these medications: Individuals with the following conditions should not use alpha-adrenergic stimulators:
  • Allergy to alpha-adrenergic stimulators
  • Kidney disease
  • High blood pressure
  • Hyperactive thyroid
• Use: Alpha-adrenergic stimulators are available as tablets and capsules. The amount and number of doses per day varies, depending on the particular drug.
• Drug or food interactions: These drugs may counteract the effect of high blood pressure therapy. Do not use within two weeks of taking monoamine oxidase inhibitors (MAOIs) such as phenelzine (Nardil), pargyline (Eutonyl), nialamide (Espril, Niamid), moclobemide (Aurorix, Manerix), procarbazine (Matulane), or isocarboxazid (Enerzer, Marplan). Extreme increases in blood pressure have occurred when combined with MAOIs.
• Side effects: Alpha-adrenergic stimulators may increase blood pressure, cause insomnia, and/or aggravate conditions such as diabetes, heart-rhythm disturbances, heart disease, glaucoma, or enlarged prostate.

This class of drugs includes bethanechol (Duvoid, Urecholine). 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:
  • Hyperactive thyroid (hyperthyroidism)
  • Peptic ulcer disease
  • Asthma
  • Bradycardia (slow heart rate) or low blood pressure
  • Seizures
  • Parkinson's disease
  • Bladder or bowel obstruction
• Use: Cholinergic drugs are taken by mouth and on an empty stomach (that is, one hour before eating or two hours after).
• Drug or food interactions: Cholinergic drugs may increase effects of other drugs that also have cholinergic effects, such as tacrine (Cognex), donepezil (Aricept), galanthamine (Reminyl), and rivastigmine (Exelon or Exelon Patch). Anticholinergic drugs (such as those listed above) will likely reduce the effect of cholinergic drugs.
• Side effects: Cholinergic drugs may cause vomiting, diarrhea, watery eyes, headache, dizziness, irregular heartbeat, wheezing, and/or breathing problems. Contact a doctor if these occur.

This class of medication, mirabegron (Myrbetriq), works by relaxing the bladder muscle during the storage phase, thus increasing the capacity of bladder to hold more urine. They can be used for the treatment of overactive bladder (OAB). Mirabegron (Myrbetriq) is the first drug in this category.

• How beta-agonist drugs work: They work by relaxing the bladder muscles and reducing bladder overactivity.
• Who should not use this medication: Individuals with the following conditions should not use mirabegron or a similar class of drugs:
  • Allergy to this drug
  • Uncontrolled blood pressure
  • Advanced liver disease
  • Advanced kidney disease
• Side effects of mirabegron include: elevation of blood pressure, urinary retention (inability to fully empty the bladder), dry mouth, inflammation of nasal passages, and constipation
• Use: Mirabegron can be taken orally with or without food. It should be taken whole without crushing or chewing.
• Drug or food interactions: Patients should inform their doctor if they are taking any other medications for leaky bladder. Certain medications actions and side effects can be enhanced if combined with mirabegron. For example, chlorpromazine, desipramine, digoxin, encainide, flecainide, metoprolol, nortriptyline, pimozide, propafenone, tetrabenazine, or thioridazine may have an increased risk of their side effects when combined with mirabegron.

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 (the urinary outlet from the bladder), 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 (prostatic hypertrophy):

• Alpha-blockers, terazosin (Hytrin), doxyzosin (Cardura), alfuzosin (Uroxatral), silodosin (Rapaflo), and tamsulosin (Flomax), 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 (Proscar) and dutasteride (Avodart), work by reducing the size of the prostate gland. They may take several months to become effective.

Botox (onabotulinumtoxinA) injection has recently been approved by the Food and Drug Administration (FDA) for the treatment of overactive bladder (OAB) 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 (catheter with a camera going into the bladder via the urethra).

Common side effects of Botox injection may include incomplete emptying, urinary tract infection, and painful urination.