Definition
"Urinary incontinence" is an involuntary loss of urine, which occurs suddenly, usually as a result of a little effort, a cough or an activity; we are talking about a condition that mainly affects the female world, although it can also involve men. This condition is not always an indicator of pathology, despite being an embarrassing, hygienic and relational problem.
Urinary incontinence should not be confused with an overactive bladder, in which there is an urgent and frequent urge to urinate.
Causes
Urinary incontinence can be favored by some physiological conditions (eg menopause, pregnancy, childbirth), by the administration of certain foods / substances (alcohol, caffeine, antihypertensive drugs, muscle relaxants, sedatives) and by certain pathologies, such as infections of the pathways urinary tract, liver stones, prostate or liver cancer, neurological disorders, prostatitis, multiple sclerosis, intestinal obstruction.
Information on incontinence - drugs for the treatment of urinary incontinence are not intended to replace the direct relationship between health professional and patient. Always consult your doctor and / or specialist before taking incontinence - drugs for the treatment of urinary incontinence.
drugs
Urinary incontinence should not be considered a pathology, but a symptom that unites a rather consistent number of diseases or physiological conditions. In menopause, for example, the woman undergoes physical transformations even at the bladder level, such as to modify the structures involved in the expulsion of urine; therefore, the woman may complain of urinary incontinence.
The treatment of urinary incontinence clearly depends on the underlying cause, as well as on the severity of the condition, the age of the subject and the type of incontinence. For example, stress urinary incontinence does not always require drugs to be cured, unlike the form derived from an instability of the detrusor muscle: in the latter case, incontinence results from involuntary contractions of this muscle, also responsible for of uncontrolled nocturnal urinary losses (nocturia). Often times, the patient suffering from this problem must practice specific conservative exercises, aimed at strengthening the bladder and pelvic floor muscles.
Similar exercises are indicated to strengthen both the urinary sphincter and the pelvic floor muscles, involved in the control of urination; these exercises are indicated both for the treatment of stress incontinence and for urgency incontinence.
The exercises to strengthen the pelvic floor muscles are called Kegel exercises : they are performed simply by imagining interrupting the flow of urine, contracting the pubococcygeus muscle for a few seconds. It seems that these exercises can also help to amplify sexual pleasure.
When these exercises are not sufficient to prevent urinary incontinence, some medications may be useful, such as estrogen (topically applied), anticholinergics, imipramine and SSRIs.
If the problem is not solved even by resorting to drugs, the patient is subjected to medical treatments that include the insertion of small disposable devices (urethral inserts) in the urethra, to prevent urine leakage. Also the pessary is useful for this purpose: it is a vaginal ring (not to be confused with the contraceptive one) which, supporting the bladder, prevents urinary losses. Catheterization may also be an alternative to treat severe urinary incontinence.
To alleviate the socio-relational discomfort, by not acting on the cause, it is recommended to wear suitable absorbents or diapers.
Antimuscarinic or anticholinergic-antispastic : particularly indicated for the treatment of urinary incontinence: these drugs, by relaxing the detrusor muscle, increase the functionality of the bladder reducing the uncontrolled contractility of the muscle. It is recommended not to take the same drug for over 3-6 months of therapy.
- Oxybutynin (eg Kentera, Lyrinel, Ditropan): acts with a relaxing effect directed at the level of the urinary smooth muscle. It is advisable to prefer slow release formulations, which are equally effective as standard, but with fewer side effects. The drug is also available as a transdermal patch, to be applied twice a week on dry and cleansed skin. It is recommended to change the position of the patch to each application.
- Darifenacin (eg. Emselex): indicated for the control of urinary incontinence due to urgency and pollakiuria. Available in slow-release tablets; it is recommended to take 7.5 mg of the drug once a day. Possibly double the dose in patients with severe incontinence.
- Solifenacin (eg. Vesiker): the recommended dose for treating urinary incontinence is 5 mg a day, possibly to be doubled in case of particularly heavy incontinence. It is not recommended for children.
- Tolterodina (eg Detrusitol): for the treatment of urinary incontinence, it is recommended to take 2 mg of drug orally twice a day. Alternatively, take 4 mg of the drug, once a day, formulated in slow-release tablets. For the maintenance dose: take 1-2 mg of oral drug (immediate-release tablets), twice a day or 4 mg of drug in graded-release tablets.
- Hyoscyamine: it is a tropane alkaloid (extracted from belladonna) with antispastic activity, indicated for the treatment of childhood urinary incontinence. For children between the ages of 2 and 12, it is recommended to take the drug in slow-release tablets, at a dose of 0.0625-0.125 mg, to be taken sublingually, orally or as chewable tablets. Repeat the administration every 4 hours, as needed. Do not exceed 6 tablets per day. The drug can also be taken in the form of an elixir: 1.25-5 mg every 4 hours for children weighing 10-50 kilos; increase the dose of 1.25 ml every 20 kilos (starting from 50 kilos). Consult your doctor.
- Trospium or trospium chloride (eg Uraplex, Sanctura, Urivesc): an urinary antispasmodic drug used in the treatment of urinary incontinence. When formulated as an immediate release tablet, take 20 mg orally twice a day; for slow-release tablets, 60 mg is recommended, to be taken orally, in the morning, in a single administration. For the treatment of urinary incontinence in the elderly, the recommended dose suggests taking 20 mg (up to 75 years) of drug per day, in slow-release tablets.
Selective serotonin reuptake inhibitors : indicated for the treatment of moderate or severe stress urinary incontinence. It is recommended to combine exercises to reinvigorate the pelvic floor.
- Duloxetine (eg Yentreve, Cymbalta, Xeristar, Ariclaim): it is recommended to take 40 mg of drug twice a day. After 2-4 weeks of treatment, it is advisable to evaluate the response to treatment and tolerance to the drug.
Tricyclic antidepressants : once these drugs were much more used in therapy for the control of stress urinary incontinence; to date, they are used in therapy only rarely, due to the considerable side effects. However, for this purpose imipramine can be taken (eg Imipra C FN, Tofranil). For the treatment of infant nocturnal urinary incontinence (up to 12 years), it is recommended to administer 25 mg of drug per day, one hour before breakfast. For children over 12 years, suffering from nocturnal urinary incontinence, it is possible to increase the dose up to 75 mg per day. Consult your doctor.
