What Drug Works for Urinary Incontinence?

Q. I take care of my 85-year-old aunt, who has urinary incontinence. She had been taking Ditropan, but it didn't seem to help her, so her doctor prescribed Enablex. The drug made her urinate so often and gave her such horrible nightmares, though, that she got no sleep at all. Now he's put her back on the Ditropan. Is there another medication you have had success with that I could ask the doctor about?

A. Urinary incontinence — the loss of bladder control — is a common condition, especially among women and older adults.

Do you have an overactive bladder? The drugs you're taking could be making it worse.

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There are many types of urinary incontinence, the most prevalent being "urge incontinence" — an urge to urinate so sudden and strong that you often can't get to a bathroom in time. When this type of incontinence has no identifiable cause, it's called "overactive bladder."

The drugs typically used to treat this condition include darifenacin (Enablex), fesoterodine (Toviaz); oxybutynin (Ditropan), solifenacin (Vesicare), tolterodine (Detrol) and trospium (Sanctura). These are all anticholinergics — drugs that block the effects of acetylcholine, a neurotransmitter associated with muscle activation, learning and memory.

I'm sorry to say, however, that your aunt long ago reached the age where anticholinergic drugs should almost certainly be ruled out as a treatment option. In older patients, anticholinergics — like the two your aunt has been prescribed — can cause a wide range of adverse effects, including constipation (which, in turn, can cause urinary incontinence), blurred vision, confusion and short-term memory problems, dizziness, anxiety, depression and hallucinations.

When considering how to treat urinary incontinence it's important to remember two things. First, while the muscles in the bladder and urethra lose some of their strength as we get older (and the bladder also loses some of its capacity), incontinence isn't "normal" at any age. Second, urinary incontinence is a symptom, not a disease. Urge incontinence, for example, may be caused by:

• urinary tract infections
• bladder irritants, including coffee, tea, carbonated drinks, alcohol, and many other foods and beverages
• overhydration, especially before bedtime
• constipation and other bowel problems
• Parkinson's or Alzheimer's disease
• nervous system injuries (such as stroke)
• nervous system damage associated with some diseases, such as multiple sclerosis