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Drug Shows Promise for Bladder Problems

WebMD Health News

July 22, 2002 -- A new drug looks promising for treatment of stress urinary incontinence, an embarrassing problem for many women. Though the drug duloxetine is still being tested and has not received FDA approval, it seems to provide many women with another option.

Stress urinary incontinence is said to affect one in three American women. It is an involuntary leakage of urine brought on by "stress" or pressure on the bladder. A woman laughs, coughs, sneezes, exercises, lifts something, and there is leakage.

In early studies, duloxetine has significantly reduced the number of episodes -- and improved the quality of life -- for women with this condition.

"There are surgical options, exercise options, but they just don't work for an awful lot of women," Richard Bump, MD, medical advisor for the duloxetine team at Eli Lilly and Company, tells WebMD. His report on the findings appears in the July issue of the American Journal of Obstetrics and Gynecology.

Indeed, behavioral therapy and exercise work in many cases, according to another study in AJOG. In that study, 31% of women who did Kegel exercises (to strengthen the muscles that support the bladder) -- and who established a voiding schedule that best suited their lifestyles -- had a 100% improvement (stayed dry) in their condition; 41% were at least 75% improved, and 52% were at least 50% improved, reports lead author Leslee L. Subak, MD, a researcher at the University of California in San Francisco.

"Clearly, behavioral therapy has a role," says Bump. "However, many women simply don't remember to do the exercises, or their lives are too busy. And some women frankly can't contract those muscles. For women who find it doesn't fit their lifestyle or ability, what we're seeing with duloxetine is that it's the first option for stress incontinence in a medication."

Though doctors have prescribed the antidepressant imipramine and the over-the-counter antihistamine Sudafed for treatment of stress incontinence, there are some negative side effects such as constricting or narrowing blood vessels, a phenomenon that can increase heart rate and blood pressure And these drugs haven't been widely studied and are not recommended for treating stress incontinence.

"[With duloxetine] we really for the first time have something that gives them an option for treatment other than wearing pads and living with their problem," says Bump.

Duloxetine is a type of drug known as a selective reuptake inhibitor; over the last few years, these drugs have been very successful in treating various conditions -- such as depression -- by increasing levels of serotonin and other brain chemicals.

Duloxetine increases the amount of serotonin and norepinephrine, another brain chemical, and seems to stimulate the muscles at the opening of the bladder, helping them contract more effectively. Thus, researchers say, accidental urine leakage is controlled.

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