From the Guidelines
The most effective medication for managing incontinence, particularly urge incontinence, is solifenacin, due to its association with the lowest risk for discontinuation due to adverse effects 1. When considering medications for incontinence, it's crucial to differentiate between the types of incontinence, such as urge incontinence (overactive bladder) and stress incontinence. For urge incontinence, anticholinergic medications like oxybutynin, tolterodine, solifenacin, and darifenacin are commonly prescribed, as they block nerve signals that trigger bladder contractions 1. Another option for urge incontinence is mirabegron, a beta-3 adrenergic agonist that relaxes the bladder muscle.
Key Considerations for Medication Choice
- The choice of pharmacologic agent should be based on tolerability, adverse effect profile, ease of use, and cost of medication 1.
- Solifenacin is associated with the lowest risk for discontinuation due to adverse effects, making it a preferable option for many patients 1.
- Oxybutynin, on the other hand, is associated with the highest risk for discontinuation due to adverse effects 1.
- Darifenacin and tolterodine have risks for discontinuation due to adverse effects similar to placebo, making them viable alternatives 1.
Treatment Approach
- Treatment should start with behavioral techniques like scheduled voiding, pelvic floor exercises, and fluid management.
- Medications should be introduced alongside these behavioral techniques, with the goal of either relaxing the bladder muscle or strengthening the urethral sphincter, depending on the type of incontinence.
- A healthcare provider should evaluate the specific type of incontinence before prescribing medication to ensure the most effective treatment approach and minimize unnecessary side effects.
From the FDA Drug Label
1 INDICATIONS AND USAGE
1.1 Adult Overactive Bladder (OAB) Mirabegron Monotherapy Mirabegron extended-release tablets are indicated for the treatment of OAB in adult patients with symptoms of urge urinary incontinence, urgency, and urinary frequency.
- Mirabegron is a medicine that can help with incontinence due to overactive bladder (OAB) in adult patients.
- The specific type of incontinence it helps with is urge urinary incontinence.
- It is used to treat symptoms of OAB, including urgency and urinary frequency 2.
From the Research
Medications for Incontinence
- Tolterodine and oxybutynin are two medications that have been studied for their effectiveness in treating overactive bladder and incontinence 3, 4.
- Tolterodine has been shown to be equivalent in efficacy to oxybutynin, but with fewer adverse effects, such as dry mouth 3.
- Oxybutynin has been found to be effective in controlling overactive bladder, but its use can be limited by frequent adverse effects, such as dry mouth, which can lead to treatment discontinuation in up to 25% of patients 4.
Treatment Options
- Extended-release oxybutynin has been studied as a treatment option for urinary incontinence, and has been found to have a similar incidence of adverse events as extended-release tolterodine and immediate-release tolterodine 5.
- Transdermal oxybutynin has also been evaluated as a treatment option, and has been found to be effective in reducing incontinence episodes and improving quality of life, with a low incidence of dry mouth 6.
Conservative Management
- The National Institute for Health and Care Excellence guidelines recommend conservative treatments, including lifestyle advice, pelvic floor exercises, and bladder retraining, as a first-line approach for managing urinary incontinence 7.
- Nurses play an important role in conservative management, and may need to access training to provide evidence-based care 7.