Medications

Medications for urge incontinence (anticholinergics, antimuscarinics or antispasmodics)

You may have seen advertisements on television for a group of medications used to treat urge incontinence or overactive bladder. These medications work by relaxing the bladder muscles and decreasing the amount of abnormal spasms in the bladder. They may increase the interval between voids, and help alleviate symptoms of urgency and urinary frequency. As patients see improvement in their symptoms, some of the medications may be dosed higher for maximal improvement. Unfortunately, these medications may cause dry mouth, and some patients experience other side effects as well. Some of the newer pills or gel forms on the medications may have fewer side effects. This is an area of extensive research and new medications are continually in the process of development. Even if you have tried medications in the past, there may be newer therapies now available to you.

Estrogens

Aside from helping women deal with menopausal symptoms such as hot flashes and vaginal dryness, estrogens may be very helpful for women with bladder dysfunction and incontinence. Interestingly, in addition to the female organs, part of the bladder and the urethra are greatly influenced by estrogen. Once a woman goes through menopause, these organs go through a process called atrophy. The lining of the tissue thins and weakens. This may lead to vaginal and bladder irritation, urinary incontinence, pelvic prolapse, and sexual dysfunction. Some of these women may even have recurrent urinary or vaginal infections.

Atrophy, and its resultant problems, may be treated with estrogen therapy. It is usually treated with cream or a pill that is placed in the vagina. A ring that delivers estrogen is also available. This may be placed in the vagina by a physician and changed every three months. These medications can be given at very small doses so that they are not absorbed into the body and will only work locally in the vagina and urinary outflow tract. Some women who are on oral hormonal therapy may have symptoms of atrophy.

Usually, a local form of estrogen such as a cream, may be added to these women’s regimen. Since there is much controversy surrounding the use of hormones, it is best to discuss your individual situation with your physician. The risks and benefits of using these medications can be discussed at your office visit.