What are the medications for overflow incontinence?

From the Guidelines

Medications for overflow incontinence should primarily focus on addressing the underlying cause of urinary retention, with alpha-blockers such as tamsulosin (0.4 mg daily) being a first-line treatment, especially for men with prostatic obstruction, as recommended by the 2024 AUA/SUFU guideline on the diagnosis and treatment of idiopathic overactive bladder 1.

Overview of Treatment Options

• Alpha-blockers: tamsulosin (0.4 mg daily), alfuzosin (10 mg daily), or doxazosin (starting at 1 mg daily, increasing as needed) are first-line treatments for men with prostatic obstruction, as they relax smooth muscle in the bladder neck and prostate, improving urine flow.
• Antimuscarinics: may be prescribed for patients with overactive bladder symptoms, including those with benign prostatic hyperplasia (BPH), as they can help reduce urinary frequency and urgency.
• Beta-3 agonists: such as mirabegron, may be used as monotherapy or in combination with alpha-blockers for patients with OAB symptoms and BPH, as they can help improve bladder capacity and reduce urinary frequency.

Considerations for Treatment

• Patients with elevated post-void residual (PVR) volumes should be informed of the potential risk of urinary retention when using antimuscarinic medications or beta-3 agonists.
• Clean intermittent catheterization (CIC) may be necessary for patients with neurogenic bladder or significant urinary retention.
• Lifestyle modifications, such as timed voiding and double voiding techniques, can complement medication therapy and improve treatment outcomes.
• Regular follow-up is essential to monitor treatment effectiveness and adjust therapy as needed, as recommended by the 2023 European Association of Urology guidelines on the management of non-neurogenic male lower urinary tract symptoms 1.

From the Research

Medications for Overflow Incontinence

• Overflow incontinence can be managed with pharmacologic treatment, including:
  • α-1-blockers as first-line treatment for moderate to severe overflow incontinence from BPH 2
  • 5-α reductase inhibitors as an adjunct medication in those with refractory overflow incontinence symptoms and a PSA ≥ 1.5 mg/dL 2
• α-1 adrenergic antagonists, such as doxazocin, terazosin, tamsulosin, and alfuzosin, can relax the smooth muscle of the bladder neck and prostate, decreasing resistance to urine flow and improving lower urinary tract symptoms 3
• 5-α reductase inhibitors, such as finasteride and dutasteride, can reduce prostate volume, improve lower urinary tract symptoms, increase peak urinary flow, and decrease the risk of acute urinary retention and need for surgical intervention 3
• Combination therapy with a 5-α reductase inhibitor and an α-1 adrenergic antagonist can significantly reduce the clinical progression of BPH over either drug class alone 3
• Anticholinergics, such as solifenacin, can be used in combination with α-blockers to improve storage symptoms in men with LUTS and overactive bladder 4

Treatment Considerations

• The choice of medication should be based on the individual patient's symptoms, medical history, and side effect profile 2
• Patients should be monitored for adverse effects, such as dry mouth and acute urinary retention, and dose modifications may be necessary to prevent these events 4
• Switching to a different α-blocker may be beneficial if one drug does not provide the desired effect in the treatment of BPH 5