From the Guidelines
Urge incontinence should be managed with nonpharmacologic therapies, such as pelvic floor muscle training and bladder training, as first-line treatment due to their effectiveness and low risk of adverse effects, as recommended by the American College of Physicians guideline 1.
Key Recommendations
- Nonpharmacologic therapies, including pelvic floor muscle training (PFMT) and bladder training, are effective in managing urge incontinence with a low risk of adverse effects 1.
- Pharmacologic therapies, such as anticholinergics (e.g., oxybutynin, tolterodine, solifenacin) and beta-3 adrenergic agonists (e.g., mirabegron), can be considered if nonpharmacologic therapies are unsuccessful, with the choice of medication based on tolerability, adverse effect profile, ease of use, and cost 1.
Treatment Options
- Bladder training: gradually increase the time between voids to improve bladder capacity and reduce urgency 1.
- Pelvic floor exercises (Kegels): perform 3 sets of 10 contractions daily to strengthen the pelvic floor muscles and improve continence 1.
- Fluid management: limit intake to 1.5-2 liters daily, reduce caffeine and alcohol, and avoid fluids 2-3 hours before bedtime to reduce urinary frequency and urgency.
- Anticholinergics: oxybutynin (5mg 2-3 times daily), tolterodine (2-4mg daily), or solifenacin (5-10mg daily) can be prescribed to reduce involuntary bladder contractions and increase bladder capacity 1.
- Beta-3 adrenergic agonists: mirabegron (25-50mg daily) offers an alternative with fewer side effects like dry mouth and constipation 1.
Special Considerations
- Postmenopausal women: topical vaginal estrogen can improve urethral function and reduce symptoms of urge incontinence.
- Severe cases: botulinum toxin injections into the bladder wall, percutaneous tibial nerve stimulation, or sacral neuromodulation may be considered if other treatments are unsuccessful.
From the FDA Drug Label
Tolterodine tartrate tablets are indicated for the treatment of overactive bladder with symptoms of urge urinary incontinence, urgency, and frequency. Tolterodine tartrate tablets were evaluated for the treatment of overactive bladder with symptoms of urge urinary incontinence, urgency, and frequency in four randomized, double-blind, placebo-controlled, 12-week studies.
Treatment for Urge Incontinence: Tolterodine (PO) is indicated for the treatment of overactive bladder with symptoms of urge urinary incontinence, urgency, and frequency 2, 2.
- Key Points:
- Tolterodine tartrate tablets were evaluated in four randomized, double-blind, placebo-controlled studies.
- The studies demonstrated the efficacy of tolterodine tartrate tablets in reducing the number of incontinence episodes per week.
- Tolterodine tartrate tablets are indicated for the treatment of overactive bladder with symptoms of urge urinary incontinence, urgency, and frequency.
From the Research
Treatment Options for Urge Incontinence
- Pelvic floor muscle training (PFMT) is a recommended first-line treatment for urge incontinence, with moderate to high certainty evidence demonstrating its effectiveness in improving symptoms 3, 4, 5
- Bladder training is also a recommended treatment, with moderate certainty evidence showing its effectiveness in improving symptoms 3, 4, 6
- Electrical stimulation has been shown to be effective in improving symptoms of urge incontinence, with moderate certainty evidence 3, 4
- Lifestyle changes, such as weight loss and fluid intake management, may also be beneficial in managing urge incontinence, although more research is needed to confirm this 7, 6
Comparison of Treatment Options
- PFMT has been shown to be more effective than control in improving symptoms of urge incontinence, with high certainty evidence 3
- Electrical stimulation has been shown to be more effective than sham electrical stimulation in improving symptoms of urge incontinence, although the evidence is not yet conclusive 4
- Bladder training has been shown to be more effective than drug therapy in improving symptoms of urge incontinence, although the evidence is limited 4
Recommendations for Practice
- Women with urge incontinence should be offered PFMT as a first-line treatment, with the option to combine it with other therapies such as bladder training or electrical stimulation 3, 5
- Healthcare providers should educate women on the importance of lifestyle changes, such as weight loss and fluid intake management, in managing urge incontinence 7, 6
- Further research is needed to confirm the effectiveness of different treatment options for urge incontinence and to develop more effective management strategies 3, 4, 6