Overactive bladder (OAB) and urinary incontinence, or bladder leakage, are common medical conditions that can negatively impact a person’s quality of life. Medications are often prescribed as the first line of treatment for this condition, but despite their widespread use, they often fail to resolve the problem. Worse, these medications can also cause cognitive problems in seniors as a side effect, posing a serious drawback to their use. But back to the point of this post—why medications have failed to solve bladder leakage.
Identifying Causes of Urinary Incontinence
Urinary incontinence often has multiple causes, including nerve damage, weak pelvic floor muscles, and bladder problems. Medications to date act via a singular mechanism, relaxing some of the bladder muscles, which means they don’t effectively address the complex multifactorial causes of incontinence.
Common Types of Urinary Incontinence Medications
The most common types of urinary incontinence medications include:
- Antimuscarinics. These drugs work by blocking the action of the chemical messenger acetylcholine, which stimulates the muscles of the bladder. This reduces the contractions that cause incontinence and may help increase bladder control.
- Alpha-blockers. These drugs relax the muscles in the bladder neck and the prostate, which can help reduce incontinence. They are most commonly used to treat urge incontinence in men.
- Beta-3 agonists. These drugs stimulate the beta-3 receptors in the bladder, which can help reduce bladder contractions and improve bladder control.
- Tricyclic antidepressants. These drugs have antimuscarinic effects and may have similar benefits to beta-3 agonist medications.
The most common medications used to treat OAB are antimuscarinics, such as oxybutynin, tolterodine, solifenacin, and darifenacin, with trade names like Detrol, Ditropan, and Vesicare. By blocking the activity of the chemical called acetylcholine, which is responsible for muscle contractions in the bladder, antimuscarinics help to relax the bladder muscles and theoretically reduce the frequency of urinary urges and accidents. While sometimes helpful in the early stages of the condition, their effectiveness wanes. But that’s not the worst part. Antimuscarinics also cause side effects such as confusion, dry mouth, constipation, dizziness, and memory problems. The serious cognitive effects occur because these drugs affect the activity of certain brain regions involved in cognitive functions, especially in seniors. In fact, AARP has advised against their used in people over 50 years of age.
Beta-3 adrenergic agonists, namely mirabegron and vibegron, known as Myrbetriq and Gemtesa, medications stimulate the beta-3 receptors in the bladder. That stimulates similar detrusor muscle relaxation, increased bladder capacity and decreased frequency of urinary urges and accidents. While beta-3 agonists are generally well-tolerated, they can also cause side effects such as headache, nausea, diarrhea. On the plus side, central nervous system effects like drowsiness, confusion, and difficulty concentrating are believed to be rare compared to antimuscarinics.
It is important to note that all medications have side effects, and those used to treat OAB and incontinence are no exception. For example, a study of patients taking tolterodine found that they reported a higher frequency of memory impairment compared to those taking a placebo. Similarly, another study found that patients taking solifenacin reported increased difficulty with recall and attention compared to those taking placebo.
In some cases, the cognitive problems caused by these medications can be severe enough to impact daily activities such as driving or performing daily tasks. That’s why healthcare providers should be sure to discuss the potential side effects of these medications with their patients and their family and to carefully monitor their cognitive function while they are taking these drugs.
A Short-Term Solution
One of the main problems with urinary incontinence medications is their limited efficacy. Many of these drugs only provide temporary relief, and their efficacy can wane over time. And then there’s the cost of these urinary incontinence medications. Some of these drugs, specifically the newer ones like Myrbetriq and Gemtesa, are quite expensive, and many insurance plans don’t cover them. That can make it difficult for patients to access the treatments they need to manage their condition effectively.
A patient’s age, overall health, and lifestyle can also affect how well a particular incontinence medications works. Older patients may not metabolize medications as well as younger patients, which means higher doses are necessary to achieve the same effect. Patients with other health conditions, such as diabetes or heart disease, may also have different responses to medications. One of the biggest issues, regardless, is that incontinence medications simply don’t address the complexity of incontinence, which stems from a deterioration of the nerves, muscles, and coordination of the pelvic floor system and bladder organ.
In many cases, medication is often prescribed as a short-term solution to urinary incontinence, and patients may be understandably reluctant to take them long-term. Patients often experience a loss of efficacy over time, making it difficult to maintain long-term control of their incontinence.
The Bottom Line
Clearly, there are multiple reasons why medications have failed to resolve urinary incontinence for millions of people. From individual differences in biology and metabolism, to the complexity of the underlying causes of incontinence, to a concerning cost and side effect profile, medications aren’t the most effective solution for everyone. Patients and healthcare providers should consider alternative treatments, such as pelvic floor physical therapy, lifestyle changes, and neuromodulation to achieve better long-term control of incontinence. Here at The Continence Center in Reno, Nevada, our approach combines these treatments to create personalized solutions, with an outstanding track record of success. If you’d like to learn more, we invite you to contact the Nevada Surgical team today.
