Can Drugs be Used for Incontinence?


So let’s talk about drugs.

Any clinician will tell you that all drugs have side effects

If you take disprin or aspirin it will have a side effect

If you take stronger drugs they too will have a generally stronger side effect.

There has been a lot of controversy about different drugs and drugs companies making billions of dollars a year distributing them to doctors and hospitals and medical centres.

In Australia alone for the year 2011 the Pharmaceutical Benefits Scheme (PBS) cost $8.0 Billion dollars up from $6.5Bill. in 2006-07.

188 million prescriptions were paid through PBS for 2011 which averages out at 8 prescriptions per person per year or approximately $347.00 per person per year.

Are there vested interests here –absolutely!

The trick is to determine if the drugs you are taking, be they purchased through PBS or any other scheme in any other country or purchased independently from one’s own funds are really helping or hindering the patient.

Of course most people are afraid to question the effectiveness of the medicines their GP prescribes because doing so may jeopardise one’s health and even the possibility of one’s life.

In other words – don’t question the prescription and completely entrust the benefit of them and the integrity of the doctor prescribing them generally out of fear, because what does one individual know about the drugs he/she is taking?

It’s a little bit like the dark ages with the bible which was banned by the Church of being translated into another language other than Latin because keeping it in Latin meant complete control of the masses by the churches who controlled the common people’s lives.

Most people lived in fear of the religious hierarchies because they could neither read nor understand Latin and consequently had no other choice but to trust the churches. And we know where that got them!

Is this not a perfect environment for vested interests what is?

Well it’s the same today in many respects with medicine. The one difference we have is the power to obtain the information we all should have about the drugs we are prescribed.

It is a perfectly understandable fear and many medicines do in fact keep many people alive, and most doctors have the best of intentions for each of their patients.

The problem it stops many of us from investigating into the effectiveness of other say less dangerous drugs to our own system. And the drugs companies play on this and in fact will deter others from inquiring about alternatives and in some instances declaring an all-out war on competition on the horizon.

Admittedly it is a difficult choice and in some instances a leap of faith, but in the real world a huge level of disenchantment prevails with corporate drug companies and the people who use the drugs.

Therefore if we can study and understand how these prescribed drugs are impacting our lives at least we are not just accepting what someone else tells us is good for us and may on occasion find something that replaces them that actually works.

Incontinencehas a range of drugs when prescribed can mitigate the problems of incontinence.

Medications that relax the bladder can be effective for alleviating symptoms of overactive bladder and reducing episodes of urge incontinence.

A study published in Modern Medicine Magazine maintains drugs for urinary incontinence (UI) were said to have relatively little benefit, as side effects kept compliance low, and long-term safety was still questionable.

In some instances certain types of drugs maybenefit incontinence sufferers, but the problem is the long term reliance on them and not to seek any further remedy because of the drugs taken.

In the U.S., there are several drugs approved to treat urge-type incontinence some more controversial than others

Anticholinergic drugs act to quieten the bladder and may decrease uncontrolled bladder contractions for incontinence.

They fall into two categories:

Type 1. Those that affect muscarinic receptors which are in the heart. If you used antimuscarinic drugs you would be affecting the heart tissue. Anti muscarinic treatments block the muscarinic acetylcholine receptor

Type 2. And nicotinic acetylcholine receptors which affect skeletal muscle and nerve cells. Stimulation of these receptors causes muscular contraction.

In short both are a signaling mechanisms which block or reduce the activity of the detrusor muscle which is the muscle surrounding the bladder that contracts to empty the bladder.

Tolterodine (Detrol), (Detrusitol) This medication is a newer medication more specific to the bladder receptors and as such has less effect on other organs. The result is less side effects occurring less frequently (Anti –muscarinic)

  • Oxybutynin (Ditropan),an oxybutynin skin patch (Oxytrol), Can be used as a slow-release form topical gel under the brand name Gelnique for overactive bladder like nocturia. The skin patch has reported to cause fewer side effects.
  • Trospium (Sanctura), this medication is used to treat an overactive bladder. By relaxing the muscles in the bladder, trospium improves your ability to control to reduce leaking of urine, feelings of needing to urinate right away, and frequent trips to the bathroom. Trospium is an antispasmodic drug. It is also known as an antimuscarinic
  • Solifenacin (Vesicare)is a urinary antispasmodic of the antimuscarinic class. It is used in the treatment of overactive bladder with or without urge incontinence.
  • Darifenacin (Enablex).This medication is commonly used in combination with behavioural interventions. They work by relaxing the bladder and easing the urge to urinate. According to research it improves only a minority of women with incontinence who take it.
  • Hyoscyamine is used to provide symptomatic relief to various gastrointestinal disorders including spasms, peptic ucers,irritable bowel syndrome,diverticulitis, pancreatitis and cystitis.
  • Atropine is used for treating abdominal discomfort that is thought to be due to muscular spasm of the intestinal muscles. Belladonna alkaloids block the action of acetylcholine, a chemical that nerves use to communicate with other nerves and muscles.
  • Cyclobenzaprine,is a muscle relaxant used to relieve muscle spasm, but has no effect on muscle function.
  • Trihexyphenidylalso known as benzhexol is an anti-Parkinson drug and an anti-muscarinic.
  • Orphenadrine acts in the central nervous system to produce its muscle relaxant effects however because it works on the central nervous system it may also be responsible for side effects. It is an antimuscarinic.
  • Fluoxetine (also known as Prozac, Sarafem, Fontex,and other names) is approved for the treatment of depression , obsessive compulsive disorder, nervosa, stress disorder. Fluoxetine is also used to treat cognitve behaviours.
  • Vaginal oestrogen therapy:
    (Vagifem, Ovestin) may be helpful in postmenopausal women to decrease urinary frequency, urgency and the need to pass urine at night (nocturia).
  • Botox (Botulin toxin A) is approved by the FDA in adults with neurological conditions, including multiple sclerosis and spinal cord injury. Botox injections into the bladder wall can suppress involuntary bladder contractions by blocking nerve signals and may be effective for up to 9 months.

According to a British study it halved the numbers of times when women with moderate to severe urinary incontinence urgently needed the lavatory, or ended up having a little accident. It also cut the number of times they needed the bathroom by a quarter.

Researchers reached their conclusions after analysing results from 240 women, 122 of whom had the Botox injection and 118 a salt water placebo.

They found a third of women who received the Botox jab still had significantly improved urinary incontinence six months later.

However for those who had the Botox treatment almost 30% of them developed a urinary tract infection later, compared to 10% in those receiving the placebo.

As mentioned at the beginning all drugs have side effects.

Some of the related side effects with the drugs above can include:

Dry mouth and throat, eye pain, blurred vision, restlessness, dizziness, arrhythmia, flushing, and faintness. Glaucoma,drowsiness,pulpitations,headache,confusion,depression

An overdose may cause headache, nausea, vomiting, disorientation, hallucinations, euphoria, sexual arousal, memory loss, and possible coma in extreme cases.

Researchers also found that for every 1,000 women treated with the drugs, only about 85 to 120 saw their incontinence disappear. That equates to less than 13%.

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