Merck Manual

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Some Drugs Used to Treat Urinary Incontinence

Some Drugs Used to Treat Urinary Incontinence

Drug

How It Works

Comments

For weakness of the urinary sphincter or pelvic muscles (bladder outlet incompetence) causing stress incontinence

Duloxetine

Helps strengthen contractions of the urinary sphincter

Not as thoroughly studied as many other drugs

Not approved for this use in the United States

Imipramine (a tricyclic antidepressant)

Helps strengthen urinary sphincter contractions and relax an overactive bladder (an anticholinergic effect*)

Also used for overactive bladder and urge incontinence

 FDA approved as temporary therapy for reducing nighttime incontinence (enuresis) in children aged 6 years and older

Pseudoephedrine (an alpha-adrenergic stimulant)

Helps strengthen urinary sphincter contractions

Can cause anxiety, insomnia, and, in men, inability to urinate

OTC medication used primarily as a decongestant

For bladder outlet obstruction in men causing urge or overflow incontinence

Alpha-adrenergic blockers:

  • Alfuzosin

  • Doxazosin

  • Prazosin

  • Silodosin

  • Tamsulosin

  • Terazosin

Help relax the urinary sphincter

Tend to increase the speed of urine flow and help the bladder empty more completely

May decrease blood pressure or cause fatigue

5-Alpha reductase inhibitors:

  • Dutasteride

  • Finasteride

Help shrink an enlarged prostate

Can take weeks or months to become effective

Sometimes decrease sex drive or contribute to erectile dysfunction

Phosphodiesterase type 5 (PDE5) inhibitor:

  • Tadalafil

Doctors are not certain how this drug affects an enlarged prostate

Low dose taken daily (also used to treat erectile dysfunction)

For overactive bladder with urge or stress incontinence

Darifenacin

Increases the bladder's filling capacity and decreases bladder wall muscle spasms (anticholinergic effects†)

Dicyclomine

Relaxes involuntary muscles

Increases the bladder's filling capacity and decreases bladder wall muscle spasms (anticholinergic effects*)

Not as thoroughly studied as many other drugs

Fesoterodine

Increases the bladder's filling capacity and decreases bladder wall muscle spasms (anticholinergic effects†)

Not as thoroughly studied as many other drugs

Hyoscyamine

Increases the bladder's filling capacity and decreases bladder wall muscle spasms (anticholinergic effects*)

Not as thoroughly studied as many other drugs

Imipramine (a tricyclic antidepressant)

Helps strengthen urinary sphincter contractions

Increases the bladder's filling capacity and decreases bladder wall muscle spasms (an anticholinergic effect*)

Particularly useful for nighttime incontinence

Mirabegron (a beta-adrenergic stimulant)

Relaxes the bladder wall

Not as thoroughly studied as many other drugs

May increase blood pressure

OnabotulinumtoxinA

(a type of botulinum toxin)

Blocks the nerve activity in the bladder muscle that causes the bladder to contract involuntarily

Injected into the bladder wall through a cystoscope inserted in the bladder

Used to treat incontinence in adults with overactive bladder caused by a neurologic disorder (such as multiple sclerosis) when other drugs are ineffective or have too many side effects

Oxybutynin

Many effects, such as relaxation of involuntary muscles and anticholinergic effects*, which include increasing the bladder's filling capacity and decreasing the bladder wall muscle spasms

May be the most effective drug

Available as a tablet, skin patch, and gel

Solifenacin

Increases the bladder's filling capacity and decreases bladder wall muscle spasms (anticholinergic effects†)

Tolterodine

Increases the bladder's filling capacity and decreases bladder wall muscle spasms (anticholinergic effects†)

Trospium

Increases the bladder's filling capacity and decreases bladder wall muscle spasms (anticholinergic effects*)

For weak bladder wall muscles with overflow incontinence

Bethanechol

Helps bladder wall muscles contract

Usually ineffective

Can cause flushing, abdominal cramps, and an increased heart rate

* Anticholinergic effects (such as dry mouth, constipation, and sometimes blurred vision or confusion) can be bothersome, particularly in older people.

† These drugs have anticholinergic effects that target the urinary system, so they tend to have fewer other anticholinergic side effects than other drugs with anticholinergic effects.

FDA = Food and Drug Administration; OTC = over-the-counter.