Pharmacotherapy of urinary incontinence

Aging is associated with many changes that may predispose an individual to urinary incontinence. An appropriate pharmacologic treatment plan depends on identification of the type of incontinence and minimization of aggravating factors. Stress incontinence is caused by incompetence of the internal urethral sphincter and is most common in postmenopausal women. This type of incontinence may respond to estrogen therapy and/or alpha-adrenergic agonists. Urge incontinence may occur in both men and women as a result of inappropriate detrusor muscle contraction. This condition may be treated with estrogens, anticholinergics or smooth muscle relaxants. Hypertonicity of the detrusor muscle, usually secondary to a neurologic problem, leads to overflow incontinence. Although overflow incontinence is difficult to control, cholinergic agonists and beta-adrenergic blockers may be helpful. Finally, any obstruction of bladder outflow may cause overflow incontinence and is best treated by amelioration of the cause. However, alpha-adrenergic blockers and 5-alpha reductase inhibitors may be useful in selected cases.