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Bladder Dysfunction Medication

  • Author: Gregory T Carter, MD, MS; Chief Editor: Consuelo T Lorenzo, MD  more...
 
Updated: May 24, 2016
 

Medication Summary

Medications used in the management of bladder dysfunction include cholinergic agonists, alpha-adrenergic blocking agents, anticholinergic agents, tricyclic antidepressants (TCAs), and sympathomimetic agents.

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Cholinergics, Genitourinary

Class Summary

Cholinergic agents stimulate cholinergic receptors in the smooth muscle of the urinary bladder and gastrointestinal (GI) tract, resulting in increased peristalsis that treats urinary retention resulting from a neurogenic bladder.

Bethanechol hydrochloride (Urecholine)

 

Bethanechol hydrochloride is used for selective stimulation of the bladder to produce contraction and thereby initiate micturition and empty the bladder. It is most useful in patients who have bladder hypocontractility, provided that they have functional and coordinated sphincters. It is rarely used, because of the difficulty of timing the effect and because of GI stimulation.

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BPH, Alpha Blockers

Class Summary

Alpha-adrenergic blockers are used to decrease bladder overactivity.

Prazosin (Minipress)

 

Prazosin improves urine flow rates by relaxing smooth muscle. This relaxation is produced by blocking alpha1 adrenoceptors in the bladder neck and prostate. When increasing dosages, give the first dose of each increment at bedtime to reduce syncopal episodes. Although dosages higher than 20 mg/day usually do not increase efficacy, some patients may benefit from dosages as high as 40 mg/day.

Phenoxybenzamine (Dibenzyline)

 

Phenoxybenzamine decreases bladder contractions through long-lasting noncompetitive alpha-adrenergic blockade of the postganglionic synapses at the smooth muscle and exocrine glands.

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Anticholinergic Drugs

Class Summary

Anticholinergic drugs inhibit the binding of acetylcholine to the cholinergic receptor, thereby suppressing involuntary bladder contraction of any etiology. In addition, they increase the volume of the first involuntary bladder contraction, decrease the amplitude of the involuntary bladder contraction, and may increase bladder capacity.

Propantheline

 

Propantheline is used for its anticholinergic effect and is given to control symptoms of urinary incontinence secondary to uninhibited bladder contractions related to upper motor neuron lesions.

Oxybutynin (Ditropan XL, Gelnique, Oxytrol)

 

Oxybutynin is a commonly used drug in patients with bladder disorders and is known for its anticholinergic-antispasmodic effects. It has a smooth muscle–relaxing effect distal to the cholinergic receptor site. It is also available in a long-acting form for once-daily dosing.

Tolterodine tartrate (Detrol, Detrol LA)

 

Tolterodine tartrate is a competitive muscarinic receptor antagonist for overactive bladder; however, it differs from other anticholinergic types in that it has selectivity for the urinary bladder over the salivary glands. It exhibits a high specificity for muscarinic receptors and has minimal activity or affinity for other neurotransmitter receptors and other potential targets (eg, calcium channels).

Trospium (Sanctura, Sanctura XR)

 

Trospium is a quaternary ammonium compound that elicits antispasmodic and antimuscarinic effects. It antagonizes the acetylcholine effect on muscarinic receptors. Its parasympathetic effect reduces smooth muscle tone in the bladder. Trospium is indicated for overactive bladder with symptoms of urinary incontinence, urgency, and frequency.

Solifenacin succinate (VESIcare)

 

Solifenacin succinate elicits competitive muscarinic receptor antagonism, which results in an anticholinergic effect and inhibition of bladder smooth muscle contraction. It is indicated for overactive bladder with symptoms of urgency, frequency, and urge incontinence.

Darifenacin (Enablex)

 

Darifenacin is an extended-release product that elicits competitive muscarinic receptor antagonism and reduces bladder smooth muscle contractions. It has high affinity for the M3 receptors involved in bladder and GI smooth muscle contraction, saliva production, and iris sphincter function. Darifenacin is indicated for overactive bladder with symptoms of urge incontinence, urgency, and frequency. It should be swallowed whole; it should not be chewed, divided, or crushed.

Fesoterodine (Toviaz)

 

Fesoterodine is a competitive muscarinic receptor antagonist. Its antagonistic effect results in decreased bladder smooth muscle contractions. Fesoterodine is indicated for symptoms of overactive bladder (eg, urinary urge incontinence, urgency, and frequency). It is available as 4- or 8-mg extended-release tablet.

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Tricyclic Antidepressants

Class Summary

TCAs have central and peripheral anticholinergic effects, as well as sedative effects, and block the active reuptake of norepinephrine and serotonin. The exact mechanisms by which these drugs act in the treatment of incontinence, however, are not fully understood. The Agency for Health Care Policy and Research (AHCPR) guidelines caution that TCAs should be reserved for use in carefully evaluated patients.

Imipramine hydrochloride (Tofranil, Tofranil-PM)

 

Imipramine facilitates urine storage by decreasing bladder contractility and increasing outlet resistance. It inhibits reuptake of norepinephrine or serotonin at the presynaptic neuron.

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Alpha/Beta Adrenergic Agonists

Class Summary

Sympathomimetic drugs increase urethral pressure.

Ephedrine

 

The use of ephedrine in neurogenic bladder is based on its ability to increase urethral pressure, which would help patients with mild-to-moderate stress incontinence by directly stimulating alpha- and beta-adrenergic receptors.

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Contributor Information and Disclosures
Author

Gregory T Carter, MD, MS Medical Director, St Luke’s Rehabilitation Institute, Spokane, WA

Gregory T Carter, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists

Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD Medical Director, Senior Products, Central North Region, Humana, Inc

Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Acknowledgements

Andrew C Krouskop, MD Assistant Professor and Chair, Department of Orthopedics, Division of Physical Medicine and Rehabilitation, University of Tennessee College of Medicine at Chattanooga

Disclosure: Nothing to disclose.

Ramon S Lansang Jr, MD Consulting Staff, Department of Orthopedics, Charleston Area Medical Center

Ramon S Lansang Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Academy of Physical Medicine and Rehabilitation, and American Medical Association

Disclosure: Nothing to disclose.

Teresa L Massagli, MD Professor of Rehabilitation Medicine and Pediatrics, University of Washington School of Medicine

Teresa L Massagli, MD is a member of the following medical societies: American Academy of Pediatrics, American Academy of Physical Medicine and Rehabilitation, and Association of Academic Physiatrists

Disclosure: Nothing to disclose.

Richard Salcido, MD Chairman, Erdman Professor of Rehabilitation, Department of Physical Medicine and Rehabilitation, University of Pennsylvania School of Medicine

Richard Salcido, MD is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American College of Physician Executives, American Medical Association, and American Paraplegia Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Reference Salary Employment

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Pons is major relay center between brain and bladder. Mechanical process of urination is coordinated by pons in area known as pontine micturition center (PMC).
Large stellate urinary bladder stone. Image courtesy of Wikimedia Commons.
 
 
 
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