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The information provided below is meant to give you a general idea about each of the medicines listed below. Only the most general side effects are included, so ask your doctor if you need to take any special precautions. Use each of these medicines as recommended by your doctor, or according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.

Common names include:

  • Darifenacin (Enablex)
  • Flavoxate (Urispas)
  • Oxybutynin (Ditropan, Oxytrol, and Gelnique)
  • Solifenacin (Vesicare)
  • Tolterodine (Detrol)
  • Trospium (Sanctura)
  • Fesoterodine (Toviaz)

These drugs act on the autonomic (automatic) nervous system to alter the balance between bladder pressure and sphincter tone. They specifically weaken the bladder emptying muscle, relieving incontinence that is caused by sudden urges to void due to a full or irritated bladder. Possible side effects include:

  • Urine retention
  • Dry mouth
  • Constipation or diarrhea
  • Nausea
  • Dizziness
  • Sleepiness
  • Blurred vision

Common names of topical estrogens include:

  • Ogen
  • Premarin
  • Estrace
  • Estring

Estrogen can also be given in oral, injectable, or transdermal forms, but evidence suggests that topical is best for this condition.

Estrogen is the hormone that stimulates and maintains the breasts, ovaries, uterus, and vagina. At menopause, estrogen levels drop dramatically and these organs begin to age. The tissue that supports the bladder is the anterior wall of the vagina. If this becomes weakened and stretched out, the bladder drops, and stress incontinence may result. Replacing estrogen in your body rejuvenates the vaginal wall and may cure the leaking.

Estrogen has both positive and negative effects. Currently, controversy rages over the use of estrogen in postmenopausal women. To avoid most of the side effects, estrogen for urinary stress incontinence can be given topically as a vaginal cream with results superior to giving it by other routes.

Possible side effects include:

  • Stronger bones
  • Healthier female tissues
  • More rapid growth of other female cancers, such as the breast and uterine cancers
  • Gall bladder disease
  • Blood clots
  • High blood pressure

Botulinum toxin type A can be injected directly into bladder muscles during an outpatient procedure. For people with urge incontinence, botox may be able to relax the bladder muscle.

Possible side effects include:

  • Pain
  • Infection
  • Inflammation

When using estrogen other than the topical creams, ask your doctor to discuss the pros and cons. Also, having a medical condition may mean that you cannot take certain medicines. For example, some people who have glaucoma cannot use anticholinergics.

If you have bladder trouble, check with your doctor before using any other medicines, including over-the-counter drugs and herbal supplements. Many have urinary side effects.

If you are taking medicines, follow these general guidelines:

  • Take your medicine as directed. Do not change the amount or schedule.
  • Use the measuring device that came with your medicine. If you need to use a spoon, cup, or syringe, make sure it has units that match your medicine. For example, if the medicine is given in milliliters (mL), the device should have mL on it.
  • Know what side effects could occur. Report them to your doctor.
  • Talk to your doctor before you stop taking the medicine.
  • Plan ahead for refills if you need them.
  • Do not share your medicine with anyone.
  • Drugs can be dangerous when mixed. Talk to your doctor if you are taking more than one drug, including over-the-counter products and supplements.

Call your doctor if:

  • You have concerns about estrogen treatment
  • Side effects are causing significant problems
References:

Berkow R, Beers M, Fletcher AJ. The Merck Manual of Diagnosis and Therapy. New York, NY: Pocket Books; 1999.

Botox treatment provides relief for bladder problems. US Air Force website. Available at: http://www.af.mil/news/story.asp?id=123132576. Updated January 26, 2009. Accessed December 3, 2010.

Facts and Comparisons. Drug Facts and Comparisons. 56th ed. St. Louis, MO: Facts and Comparisons; 2001.

Kasper DL, Harrison TR. Harrison's Principles of Internal Medicine. 16th ed. New York, NY: McGraw-Hill; 2005.

Phenylpropanolamine. Drug Bank website. Available at: http://www.drugbank.ca/drugs/DB00397. Accessed March 5, 2010.

Phenylpropanolamine. Med Help website. Available at: http://www.medhelp.org/drugs/phenylpropanolamine/show/4094. Updated November 2009. Accessed March 5, 2010.

Pseudoephedrine. Drug Bank website. Available at: http://www.drugbank.ca/drugs/DB00852. Accessed March 5, 2010.

Pseudoephedrine (oral route). Mayo Clinic website. Available at: http://www.mayoclinic.com/health/drug-information/DR601759/DSECTION=side-effects. Updated June 2009. Accessed March 5, 2010.

Stress urinary incontinence. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated February 2010. Accessed March 5, 2010.

Urge incontinence. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated December 2009. Accessed January 11, 2010.

Urinary incontinence in the elderly. Senior Care Pharmacy website. Available at: http://www.seniorcarepharmacy.org/publications/tcp/1997/aug/elderly.html. Accessed March 5, 2010.

Urinary incontinence: promising new therapies. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/bladder-control-problems/WO00123/NSECTIONGROUP=2. Updated May 8, 2009. Accessed December 3, 2010.

1/11/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/: AHRQ evidence report on treatment for overactive bladder in women 2009. Agency for Healthcare Research and Quality website. Available at: http://www.ahrq.gov/clinic/tp/bladdertp.htm. Published August 2009. Accessed January 11, 2010.

12/3/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/: Dmochowski R, Chapple C, Nitti VW, et al. Efficacy and safety of onabotulinumtoxinA for idiopathic overactive bladder: a double-blind, placebo controlled, randomized, dose ranging trial. J Urol. 2010;184:2416-2422.

Last reviewed September 2012 by Adrienne Carmack, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.