Medications for Overactive Bladder and Urge Incontinence

Medications play a crucial role in managing certain types of urinary incontinence, particularly overactive bladder (OAB) and urge incontinence. It’s important to note that while these medications can be highly effective for OAB and urge associated incontinence, there are currently no FDA-approved medications specifically indicated for stress urinary incontinence.

Understanding Medication Options

Dr. Stewart may offer medication as part of your treatment plan if you’re experiencing symptoms of overactive bladder, such as frequent urges to urinate, difficulty postponing urination, or urge incontinence. The primary goals of these medications are to:

1. Reduce bladder muscle contractions
2. Increase bladder capacity
3. Delay the initial urge to urinate

Types of Medications

Antimuscarinics (a.k.a. Anticholinergics)

Antimuscarinics are a commonly prescribed class of medications for overactive bladder:

• How they work: These drugs block the nerve signals that trigger involuntary bladder muscle contractions.
• Common examples:
  • Oxybutynin (Ditropan XL™, Oxytrol™)
  • Tolterodine (Detrol™)
  • Darifenacin (Enablex™)
  • Solifenacin (Vesicare™)
  • Trospium (Sanctura™)
  • Fesoterodine (Toviaz™)

“Anticholinergics can significantly reduce the frequency and urgency of urination for many patients with overactive bladder. However, it’s crucial to consider both the benefits and potential risks, especially with long-term use.” - Dr. Ryan Stewart

Beta-3 Adrenergic Agonists

A newer class of medications for overactive bladder:

• How they work: These drugs relax the bladder muscle, increasing its capacity to hold urine.
• Examples:
  • Mirabegron (Myrbetriq™)
  • Vibegron (Gemtesa™)

Combination Therapies

In some cases, a combination of an anticholinergic and a beta-3 agonist may be prescribed for enhanced efficacy.

Potential Side Effects and Risks

While these medications can be very effective, they may cause side effects and carry certain risks:

• Common side effects of antimuscarinics:
  • Dry mouth
  • Constipation
  • Blurred vision
  • Drowsiness
• Common side effects of beta-3 agonists:
  • Increased blood pressure
  • Headache
  • Nasopharyngitis

Important Risk Consideration: Dementia

Recent research has highlighted an important risk associated with long-term use of anticholinergic medications:

• Chronic use (more than three months) of anticholinergic medications for OAB is likely associated with an increased risk of new-onset dementia.
• Short-term use (less than four weeks) is generally considered safe for most individuals.
• When anticholinergics are indicated, extended-release formulations of trospium, darifenacin, and fesoterodine are preferred due to their more favorable neuropharmacological profiles.
• Oxybutynin IR should be avoided when possible due to its higher risk profile.

“We carefully consider the potential cognitive risks for all patients when prescribing antimuscarinics for chronic use. Our goal is to balance symptom relief with long-term health considerations.” - Dr. Ryan Stewart

Treatment Approach

Given the potential risks associated with antimuscarinics medications, our treatment approach typically follows these guidelines:

1. We often recommend trying a beta-3 agonist before an anticholinergic medication when pharmacological therapy is indicated for OAB.
2. If anticholinergics are used, we prefer options with more favorable risk profiles and monitor use closely.
3. For some patients, we may consider progressing to advanced therapies like botulinum toxin injections or neuromodulation earlier in the treatment process.

Shared Decision-Making

Dr. Stewart believes in a shared decision-making process when it comes to medication choices. We’ll discuss the potential benefits and risks of each option, considering your individual health profile and preferences.

Next Steps

If you’re struggling with symptoms of overactive bladder or urge incontinence, schedule a consultation with Dr. Stewart. We’ll perform a thorough evaluation, discuss your symptoms and medical history, and determine the most appropriate treatment options for you, always keeping in mind both effectiveness and long-term safety.

Remember, while medication can be very effective, it’s just one tool in our comprehensive approach to treating urinary incontinence. We’re committed to finding the right combination of treatments to help you regain control and improve your quality of life, while also safeguarding your long-term health.