Treatment differs depending on the cause of incontinence

Since there are different forms of urinary incontinence, each of which can be traced back to different physical causes (such as pregnancy or, in men, an enlarged prostate) and underlying diseases, the bladder weakness medications that can be treated also differ.

It is therefore essential that you have the possible causes of your incontinence clarified by your trusted doctor. If necessary, alternatives to drug therapy may also be considered. We would like to strongly advise against self-medication at this point.
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Important active ingredients and drug groups

For the different forms and severity of urinary incontinence, your doctor has various active pharmaceutical ingredients at his or her disposal:

• The active ingredient duloxetine was developed as an antidepressant for the treatment of depression and anxiety disorders. In the meantime, the active ingredient¹ is also used to treat stress/stress incontinence. Simply put, duloxetine strengthens the internal sphincter muscle, which can prevent unwanted urine leakage. However, possible side effects include nausea and dizziness. The drug should therefore be slowly increased in dose and discontinued just as slowly.
• For the drug treatment of urge incontinence caused by an overactive bladder (OAB), so-called anticholinergics such as oxybutynin, tolterodine, propiverine or trospium chloride are used as the most common standard therapy.² Anticholinergics reduce the overactivity of the bladder muscle after a few weeks, resulting in a reduction in the constant urge to urinate during the day and night. Undesirable side effects include dry mouth, blurred vision, nausea, tachycardia or constipation.
• Antibiotics are used to treat urinary tract infections or bladder infections. If the stimulus caused by the infection is removed, the symptoms of urinary incontinence can also  improve.
• Estrogens can be used to treat milder forms of stress/stress incontinence.³ If urinary incontinence in women is related to menopause, an ointment containing estrogen or an estrogen suppository can help in these cases.⁴
• In the case of side effects or insufficiently strong effects of anticholinergics, the active ingredient mirabegron has also been used for several years. It is one of the newer medications for incontinence. An effect can be expected after about 12 weeks, with comparatively few side effects for those affected. It is also possible to take it in combination with an anticholinergic drug.
• In addition, there are some herbal remedies that can alleviate the symptoms of existing urinary incontinence. These are often available over the counter. Nevertheless, it is essential that you seek advice from your doctor or pharmacy in order to prevent possible interactions of such non-drug therapy with other medications.

How do anticholinergics work for urge incontinence?

Our nerves transmit signals that report the increasing bladder filling and the urge to urinate to the brain. When these signals return from the brain to the urinary bladder, they release the messenger substance (also known as neurotransmitter) acetylcholine at the nerve endings. This substance travels to specific areas in the wall of the muscle cells that make up the bladder. There, acetylcholine is bound to so-called receptors, i.e. acetylcholine fits like a key to the keyhole. This compound then causes the muscle cells to contract. If this happens in the entire bladder muscle, urine is emptied.

A certain group of drugs – the Anticholinergics – now work by also fitting into the "keyhole" on the wall of the muscle cells. So they block the receptors and the acetylcholine released by the body can no longer work. The ability of the bladder to contract (contract) decreases and the time intervals between urination are longer. The symptoms of bladder weakness will be fewer.

Side effects of medication for bladder weakness

Basically, it should be noted that all drugs in question have side effects. In order to keep this low, the individually correct dosage is of great importance, which is why you should discuss this with a doctor.

The problem of side effects mainly affects older people who suffer from several diseases at the same time, the so-called multimorbidity. If different medications have to be taken, there can be risky overlaps of the active ingredients – even with herbal remedies. Therefore, self-medication should be avoided at all costs.
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Effect without side effects: pelvic floor training

As an alternative or supplement to treatment with medication, regular pelvic floor training can alleviate the symptoms of existing bladder weakness. Pelvic floor training is particularly promising when it comes to diagnosing stress incontinence. This is because the pelvic floor is a muscle that, like many muscles in our body, can be trained in a targeted manner. A strong pelvic floor can also hold urine better during physical exertion (hence the term "stress incontinence"), such as sneezing or coughing.

Since even a few minutes of daily training can help, you should integrate pelvic floor training firmly into your daily routine. However, it is important to learn the training under expert guidance at the beginning. To do this, contact a physiotherapist in your area with confidence. There are also special courses in larger cities.

You can find some simple exercises for the pelvic floor here

 

Sources:

¹ https://www.das-pta-magazin.de/urologika-von-blase-bis-prostata-2145494.html
² https://www.dr-nabielek.de/gynaekologie/gutartige-erkrankungen/harninkontinenz
³ https://www.aerzteblatt.de/archiv/77029/Harninkontinenz-der-Frau
4 https://www.frauenaerzte-im-netz.de/erkrankungen/harninkontinenz/therapie-behandlungsmoeglichkeiten/