Health Conditions

What is on the horizon?

Clinical studies have shown that duloxetine (Cymbalta) may be an alternative agent for the treatment of stress incontinence. Currently approved for the treatment of depression and diabetic neuropathy (a complication of diabetes), duloxetine has reduced the frequency and the number of urinations per day for participants in clinical trials. However, the increased incidence of side effects associated with duloxetine may limit its use for urinary incontinence. The most common are nausea, headache, and difficulty sleeping. An increase in blood pressure is also possible with duloxetine use.

Two other drugs that are already approved for other conditions are also being studied for incontinence. Tramadol, a drug approved for pain control, has been tested for individuals with urge incontinence. In general, study participants taking tramadol had to urinate fewer times a day and they had less involuntary urination than patients taking a placebo. A drug used to treat nerve pain and seizures, gabapentin, has also shown some promise for treating incontinence.

Although it is not yet approved for treating incontinence, botulinum toxin type A has been effective for patients whose detrusor muscles contract too much or too often. Inserted into the bladder through a catheter or injected into the detrusor muscle, botulinum toxin type A relaxes the detrusor, allowing the bladder to fill more completely and preventing involuntary urination due to constant detrusor contraction. The effects of one treatment with botulinum toxin type A have lasted as long as 9 months for some patients. A different type of toxin, resiniferatoxin, has shown similar effects when a solution of it is inserted into the bladder through a catheter. Derived from a cactus-like plant, resiniferatoxin is believed to desensitize some of the nerves involved in urination. Some patients who received resiniferatoxin in a clinical study experienced an increase in bladder capacity for at least 3 months after each treatment.

In Europe, researchers have been able to use stem cells taken from an individual with incontinence to grow new muscle cells. The new cells are then injected into weakened sphincter muscles. As the new cells grow, the sphincter regains some of its ability to regulate urination. This technique is not approved and it has not been studied in the United States.