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Incontinence Drugs and Side Effects

Incontinence Drugs

Incontinence drugs are available relax the bladder or reduce the amount of fluid produced by the body improving the ability to hold urine. Drugs are often prescribed for all kinds of bladder control problems, but they are generally most helpful for urge incontinence.

Drugs Used for Urge Incontinence work in the following ways:

  • reduce involuntary contractions of the bladder
  • Increase capacity of the bladder
  • Delay the urge to urinate

Medication can produce small improvements. However, urge incontinence drugs have not been rigorously compared against physical therapies, such as bladder training and Kegel exercises, which are very effective for most cases of urge and stress incontinence.

Drugs used to treat urge incontinence include:

  • Oxybutynin (Ditropan)  (Oxytrol) (Gelnique)
  • Tolterodine (Detrol)
  • Hyoscyamine (Levbid)  (Cystospaz)
  • Trospium (Sanctura)
  • Darifenacin (Enablex)
  • Solifenacin (Vesicare)
  • Fesoterodine (Toviaz)

Side effects of urge incontinence drugs include:

  • Dry eyes
  • Dry mouth
  • Headache
  • Constipation
  • Rapid heart rate
  • Confusion, forgetfulness, and deterioration of mental function
  • Hallucinations, especially for children and older adults

Alpha-blockers help improve urine flow, and are useful for men with prostate problems who also have urge incontinence. The newer selective alpha-blockers tamsulosin (Flomax), alfuzosin (Uroxatral), and silodosin (Rapaflo) are sometimes combined with other incontinence drugs to treat men with overactive bladder.

Drugs Used for Stress Incontinence

. . . like clonidine (Catapres), strengthen the smooth muscle that opens and closes the internal sphincter. These drugs include ephedrine and are often found in over-the-counter decongestants and appetite suppressants.

Stress incontinence drugs may be helpful for bladder control problems not caused by nerve damage, but also can have significant side effects, including agitation, insomnia, and anxiety.  People with glaucoma, diabetes, hyperthyroidism, heart disease, or high blood pressure should not take these drugs.

Antidepressants

Evidence shows both urge and stress incontinence are affected, in part, by central nervous system processes. Investigators are interested in other drugs which are chemical messengers that affect neurotransmitters involved with urination. Antidepressants targeting these neurotransmitters are sometimes used for urge incontinence and may also be helpful for some people with stress incontinence.

  • Tricyclic antidepressants, such as imipramine (Tofranil), may help both urge and stress incontinence. They relax the bladder and  strengthen the internal sphincter. However, these drugs may also have adverse effects on the heart and lungs, and other severe side effects in older adults.  They may actually cause overflow incontinence in some people.
  • Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) are similar to tricyclics but do not have the same side effects.  Duloxetine (Cymbalta) is approved in the U.S. for other conditions, but not for stress incontinence. However, it is sometimes prescribed off-label.

Anyone considering the use of antidepressants or other drug therapies for the treatment of incontinence or overactive bladder should consider other options before making a final decision.