Management of Urge Incontinence in Patients Taking Tamsulosin for BPH

Initial Assessment

The American Urological Association recommends evaluating the type and severity of incontinence through history, physical exam, and appropriate diagnostic modalities to categorize as stress, urge, or mixed incontinence 1
Common symptoms of urge incontinence include dysuria, frequency, urgency, nocturia, and involuntary loss of urine with feeling of urgency, according to the American Diabetes Association 3
Urinary tract infections should be ruled out through urinalysis and culture, as diabetic and BPH patients are more susceptible, as stated by the American Diabetes Association 3

The American College of Physicians recommends implementing bladder training as the first-line treatment for urge incontinence, which has shown significant improvement in urinary symptoms 2, 4
Pelvic floor muscle training (PFMT) in combination with bladder training may be considered for patients with mixed urinary incontinence, according to the American College of Physicians 2, 5
Lifestyle modifications including weight loss and exercise for obese patients, avoiding bladder irritants such as caffeine and alcohol, and adequate but not excessive fluid intake are recommended by the American Heart Association 4, 5

The American College of Physicians recommends adding antimuscarinic medications while continuing tamsulosin if bladder training is unsuccessful after 8-12 weeks 2, 6
Antimuscarinic options include tolterodine, solifenacin, darifenacin, fesoterodine, and trospium, with tolterodine causing fewer adverse effects than oxybutynin with similar efficacy, as stated by the American College of Physicians 2, 5
Oxybutynin should be avoided if possible due to its high risk for discontinuation due to adverse effects, according to the American College of Physicians 4, 5

Common side effects of antimuscarinic medications, including dry mouth, constipation, and blurred vision, should be monitored, as recommended by the American College of Physicians 5
Discontinuation of treatment due to adverse effects is common with antimuscarinic medications, according to the American College of Physicians 5
Post-void residual urine should be evaluated to avoid precipitating urinary retention when adding antimuscarinic therapy to tamsulosin, as stated by the American Urological Association 1

Regular follow-up visits should be scheduled to assess treatment efficacy and monitor for adverse effects, as recommended by the American Urological Association 1
Urodynamic testing may be considered if symptoms persist despite combination therapy, to better characterize the bladder dysfunction, according to the American Diabetes Association 3
Patients with persistent symptoms despite optimal medical therapy should be referred to a urologist for evaluation of other treatment options, as stated by the American Urological Association 1