[Drug therapy of female urinary incontinence]

Urinary incontinence is a frequently encountered and highly disabilitating disorder in women, especially after menopause. Several causes, sometimes associated, have been identified. After menopause, lower oestrogen levels lead to general cellular, biochemical, bacteriological and anatomic modifications in the urinary tract resulting in vaginal atrophy, diminished sphincter tone and increased bladder sensitivity. Treatment should always be based on results of urodynamic studies and adapted to the aetiologic diagnosis and patient demands. Medical treatment is usually associated with behavioural and physical therapy techniques. Drugs with an effect on bladder instability include: parasympathicolytic or anticholinergic agents which lower bladder pressure by inhibiting bladder receptors; tricyclic antidepressant for their central and peripheral anticholinergic effects; non-steroid anti-inflammatory agents which decrease urethral tone; antispasmodics; and oestrogens in menopaused women. Beta-mimetics, calcium inhibitors, opioids and myorelaxants are also used but in a limited number of cases due to side effects. Urethral instability may respond to tetracycline in case of infection or non-steroid antiinflammatory drugs. Oestrogens play an important role in improving urethral trophicity and sensitive response to alpha-stimulants. Surgery may be indicated in a limited number of specific cases.