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Advanced Approaches to Managing Incontinence: RX Solutions

There is medication available to treat some forms of incontinence, primarily overactive bladder and urge incontinence. The most common (and likely to help) are estrogen, the synthetic hormone desmopressin, a class of drugs called anticholinergics and the antidepressant imipramine.

Anticholinergics. These drugs block the action of acetylcholine, a chemical involved in causing abnormal bladder contractions that make you feel like you need to go even when your bladder isn't full. Toviaz (fesoterodine), Enablex (darifenacin) and Vesicare (solifenacin) are some of the heavily advertised brand names. Depending on your incontinence symptoms, your doctor may advise timed-release or immediate-release meds. Dry mouth is a common side effect, but you could also experience constipation or urinary retention, heartburn or a rapid heartbeat, blurry vision or even impaired memory and confusion.

Estrogen. The drop in estrogen production after a woman reaches menopause may explain why the supportive tissues around the bladder and urethra weaken and in turn worsen stress incontinence. Applying a low-dose topical (not oral) estrogen available in a vaginal cream, ring or patch may help blood flow and nerve function to relieve some stress incontinence or urge incontinence symptoms. Little research has been done to validate this therapy and there may be health reasons for you to avoid estrogen, but some women say it's helpful. Estrogen may work better when combined with lifestyle changes, like pelvic floor exercises.

Imipramine. This tricyclic antidepressant has a dual action—it makes the bladder muscle relax and the smooth muscles at the bladder neck contract. Because of this, it may help mixed urge and stress incontinence. It’s often prescribed for nighttime dosing because it can cause drowsiness—and may as a consequence help with nighttime incontinence. Rare side effects are an irregular heartbeat and dizziness or fainting from reduced blood pressure if you stand up quickly, especially if you’re older. Your doctor will need to evaluate its potential drug interactions if you’re taking medications.

Desmopressin. This is a synthetic version of anti-diuretic hormone (ADH) that decreases the production of urine. While often used to help kids with bedwetting issues, it may reduce urinary incontinence in women. Serious side effects are uncommon, but there is the potential for water retention and sodium deficiency in the blood, which in rare cases can lead to seizures, brain swelling and even death. As with the other drugs prescribed for urinary incontinence, your doctor will need to evaluate your medical history and other drugs you’re taking before recommending this option.