New drugs help treat urological disorders in women

June 5, 2006

Between 10% and 50% of all women experience urinary incontinence atsome point in their lives, according to Simone N. Vigod, M.D., ofthe University of Toronto and the Women's Health Program,University Health Network, Toronto. Depression is also common,affecting more than 9% of U.S. adults in any given year, accordingto the National Institute of Mental Health. It is imperative,according to the researchers, that women with either condition bescreened for the other, no matter what their age.

A link between urinary incontinence and depression in women may also exist, claimed Vigod and her colleague Donna E. Stewart, M.D. The researchers looked at the relationship between urinary incontinence and major depression through data from the Canadian Community Health Survey and found that the prevalence of depression was 15.5% in women with urinary incontinence (30% in women aged 18-44) and only 9.2% in women without urinary incontinence. The study was published in the April 2006 issue of Psychosomatics.

Urinary incontinence, or the loss of bladder control, is more common in women than men and can happen for a variety of reasons, according to the National Institutes of Health. Urinary tract infections (UTIs), vaginal infection or irritation, constipation, and certain medicines can cause short-term bladder control problems. In other cases, incontinence lasts longer and can be associated with other problems, such as weak bladder muscles, overactive bladder muscles, or damage to nerves that control the bladder from diseases such as multiple sclerosis or Parkinson's disease.

The four types of urinary incontinence are: stress, urge, overflow, and functional. Stress incontinence, the most common type of bladder control problem in younger and middle-aged women, happens when urine leaks during body movements that put pressure on the bladder, such as exercise, coughing, sneezing, and laughing. In some cases, it is related to childbirth or menopause.

Urge incontinence occurs when a patient can't hold her urine long enough to get to the toilet. This often is found in people who have diabetes, stroke, Alzheimer's disease, Parkinson's disease, or multiple sclerosis. In overflow incontinence, which can occur in people with diabetes and spinal cord injury, small amounts of urine leak from a bladder that is always full. Functional incontinence happens in older people who have normal bladder control but may have a hard time getting to the toilet in time.

Drug treatment

Drug therapy is only good for urge incontinence, according to Kristene E. Whitmore, M.D., professor of urology and obstetrics and gynecology at Drexel University College of Medicine, in Philadelphia. "For urge incontinence, there are six anticholinergenic drugs available, which slow down the bladder," she explained.

While the traditional medication, oxybutynin, has been around for 20 years, only 15% of patients have stayed on that therapy after six months because of side effects, such as constipation and dry mouth. Newer drugs include Detrol (tolterodine, Pfizer), oxybutynin, Oxytrol (oxybutynin patch, Watson), Sanctura (trospium, Indevus), Enablex (darifenacin, Novartis), and Vesicare (solifenacin, Astellas).