Urge incontinence therapy may relieve stress incontinence

By Joanna Lyford, Senior medwireNews Reporter

Anticholinergic medication appears to be effective as a treatment for stress and mixed urinary incontinence, results of a small clinical trial indicate.

Writing in the International Journal of Urology, the study authors say they believe the treatment works by increasing urethral closing pressure without increasing blood levels of catecholamines.

Anticholinergic agents are already used to treat urge incontinence, where they act by reducing bladder hypersensitivity, and in a recent animal study were found to elevate urethral closing pressure.

To investigate this effect in humans, Kimio Sugaya (Kitakami Central Hospital, Okinawa, Japan) and co-workers enrolled 22 women with mixed incontinence and 15 with stress incontinence. Their mean age was 69 years.

The women were given once-daily anticholinergic treatment for 8 weeks; those with an inadequate response after 4 weeks had their medication dose increased.

The mean number of episodes of stress incontinence per day decreased significantly, from 2.6 before treatment to 1.3 at 4 weeks and to 0.4 at 8 weeks, and urge incontinence followed a similar pattern.

Secondary endpoints also improved after treatment, Sugaya et al report. Daytime and night-time frequency of urination decreased significantly and quality-of-life score increased significantly. Functional assessments revealed a significant increase in both maximum urethral closing pressure (from 28 to 35 cmH₂O) and urethral length (from 26 to 33 mm).

Levels of plasma catecholamines – adrenaline, noradrenaline and dopamine – did not change significantly with treatment, note the authors, in contrast to the increased levels seen in earlier animal studies.

Blood pressure and pulse rate were also unchanged after treatment, which was well tolerated overall, with no serious adverse events. The most frequent adverse events were constipation and dry mouth, reported by four and three women, respectively.

The researchers conclude that anticholinergic treatment appears to be effective for the treatment of stress incontinence and mixed incontinence. They believe the treatment works by increasing the urethral closing pressure, either by increasing the tone of the urethral smooth muscle or the external urethral rhabodosphincter.

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