Treatment options for
urinary incontinence include behavioral techniques, pharmacologic agents, and
surgical procedures. Caregivers use
pharmacotherapy heavily because of its availability, immediacy of results, and convenience. However, only
pharmacotherapy for
urge incontinence has advanced to the level at which several drugs that have undergone rigorous scientific testing using randomized controlled trials have received FDA approval; these are the
antimuscarinic and
anticholinergic/direct smooth muscle relaxant drugs. However, promising new drugs targeting other receptors are under investigation. There is no FDA-approved
drug for stress incontinence or overflow incontinence. Pharmacologic clinical trials for
urinary incontinence are no different than pharmacologic trials in other areas. A randomized controlled trial is the best approach for documenting effectiveness and safety. A rigorous trial should include identification of primary and secondary outcomes. The measurement tools of outcomes must be reliable and validated. Preferably, the severity level of
urinary incontinence should be established, and measurement of effectiveness must include durability. Not only must side effects be identified, but their impact on the quality of life must be quantified. An exciting area in pharmacologic treatment of
urinary incontinence is the method of
drug delivery. In addition to sustained release oral medication, the
transdermal patch and the intravaginal route are starting to be used in clinical practice. The intravesical route is still in the investigational phase. Pharmacologic research for
urinary incontinence is now entering an exciting time because technologic advances are creating new agents with more precise targeting and more sophisticated methods of delivery are being developed and tested.