Medical management of urinary incontinence

Treatment options for urinary incontinence include behavioral techniques, pharmacologic agents, and surgical procedures. Caregivers use pharmacotherapy heavily because of its availability, immediacy of results, and convenience. However, only pharmacotherapy for urge incontinence has advanced to the level at which several drugs that have undergone rigorous scientific testing using randomized controlled trials have received FDA approval; these are the antimuscarinic and anticholinergic/direct smooth muscle relaxant drugs. However, promising new drugs targeting other receptors are under investigation. There is no FDA-approved drug for stress incontinence or overflow incontinence. Pharmacologic clinical trials for urinary incontinence are no different than pharmacologic trials in other areas. A randomized controlled trial is the best approach for documenting effectiveness and safety. A rigorous trial should include identification of primary and secondary outcomes. The measurement tools of outcomes must be reliable and validated. Preferably, the severity level of urinary incontinence should be established, and measurement of effectiveness must include durability. Not only must side effects be identified, but their impact on the quality of life must be quantified. An exciting area in pharmacologic treatment of urinary incontinence is the method of drug delivery. In addition to sustained release oral medication, the transdermal patch and the intravaginal route are starting to be used in clinical practice. The intravesical route is still in the investigational phase. Pharmacologic research for urinary incontinence is now entering an exciting time because technologic advances are creating new agents with more precise targeting and more sophisticated methods of delivery are being developed and tested.