# Urinary incontinence - Category: acute - Review status: reviewed (every claim checked against a document named on this page) - Sources: EAU Guidelines on Non-neurogenic Male/Female LUTS 2023 · Vesicare 5mg film-coated tablets SmPC section 4.2 (eMC product 5559) · Urinary incontinence - disease-level clinical article (urinary-incontinence-full.txt) · BETHANECHOL CHLORIDE tablets US prescribing information, Indications and Usage and Dosage and Administration (DailyMed SetID 45285692-de51-413e-8a51-7fb792eccc81) - Verified date: 2026-08 ## Verified against - Vesicare 5mg film-coated tablets SmPC section 4.2 (eMC product 5559) - Urinary Incontinence - disease-level clinical article (urinary-incontinence-clinical.txt) - Urinary incontinence - disease-level clinical article (urinary-incontinence-full.txt) - BETHANECHOL CHLORIDE tablets US prescribing information, Indications and Usage and Dosage and Administration (DailyMed SetID 45285692-de51-413e-8a51-7fb792eccc81) ## Treatment metadata - Solifenacin succinate — 5 mg — oral.solid - Referral & safety-netting (no drug therapy) - Bethanechol — oral.solid ## Complete treatment card ```text URINARY INCONTINENCE Sources: EAU Guidelines on Non-neurogenic Male/Female LUTS 2023 · Vesicare 5mg film-coated tablets SmPC section 4.2 (eMC product 5559) · Urinary incontinence - disease-level clinical article (urinary-incontinence-full.txt) · BETHANECHOL CHLORIDE tablets US prescribing information, Indications and Usage and Dosage and Administration (DailyMed SetID 45285692-de51-413e-8a51-7fb792eccc81) Review status: REVIEWED against Vesicare 5mg film-coated tablets SmPC section 4.2 (eMC product 5559), Urinary Incontinence - disease-level clinical article (urinary-incontinence-clinical.txt), Urinary incontinence - disease- level clinical article (urinary-incontinence-full.txt), BETHANECHOL CHLORIDE tablets US prescribing information, Indications and Usage and Dosage and Administration (DailyMed SetID 45285692-de51-413e-8a51-7fb792eccc81) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (12) - History fixes the type, the severity, the burden and how long it has run; a voiding diary fills in detail - Red flag: hunt emergencies such as cauda equina syndrome, and hunt reversible causes - Stress type: the trigger is predictable, laughing, coughing, straining or sneezing [cough · sneezing] - Urge type: frequency, urgency and nocturia, loss from a trace to a flood, residual usually low [nocturia] - Mixed type carries both pictures, so decide which part is dominant or most troublesome - Overflow type: poor emptying or retention, a very high residual, and straining to pass - Functional type: the story points to physical or cognitive impairment - Ask about COPD or asthma causing cough, heart failure, neurological disease, and joints that block reaching a toilet [cough] - Past surgery alters anatomy and nerves, and in men stress leakage nearly always follows urological surgery - In women ask how many births, vaginal or caesarean, and whether she is pregnant now - Check oestrogen status, since atrophic vaginitis and urethritis give reversible leakage around menopause [atrophy] - Ask about diuretics, alcohol and caffeine, each of which feeds leakage SIGNS - what you find (12) - Let the history steer the examination, chasing emergencies and reversible causes - Look for ankle oedema and a raised jugular venous pressure [oedema · raised JVP] - Listen for crackles, and note a cough [cough · crackles] - Feel the abdomen for masses, and note surgical scars [scarring] - Check for a distended bladder, vaginal atrophy, prolapse, an enlarged prostate, loaded rectum and anal tone [atrophy · genital prolapse · urinary retention] - Assess limb strength, joint movement and overall function - Assess cognition, sensation and reflexes - Cough stress test: ask for a cough and watch for leakage, which shows better standing [cough] - A Valsalva version of that test does the same job - Cotton swab test: on Valsalva an angle change >30° is positive for urethral hypermobility - Between 21° to 49° that reading agrees poorly - Paediatric Foley test: an inflated 8-French balloon that pulls out easily suggests intrinsic sphincter deficiency TESTS (12) - Little laboratory work or imaging is needed, and most tests exist to exclude other harm - Identify reversible causes such as disturbed sleep, fluid overload and diuretic misuse, and review every medicine - A brief three-question set separates stress, urge and mixed types, but its value shifts with the population - Test the urine in everyone for infection, glucose, protein and blood; culture where infection is suspected - Send urea and creatinine when obstruction is suspected - Measure the post-void residual by bladder scan after voiding, above all where overflow is suspected - Finding >200 mL left after voiding suggests overflow and a hypotonic bladder - A low residual fits urge incontinence and overactive bladder instead - Overactive bladder voids little and often; global polyuria voids large amounts day and night - A normal daily total is about 1300 mL, and more than 3000 mL counts as polyuria - Pad weight grades leakage: up to 20 g mild, 21 to 74 g moderate, 75 g or more severe - Renal ultrasound for suspected obstruction or renal failure; urodynamics only for intractable cases or before surgery IF NOT THIS - what else fits (12) - Delirium, dementia or another cognitive impairment - Urinary tract infection - Atrophic vaginitis, or urethritis - Drugs and substances: diuretics, caffeine, alcohol - A psychological disorder - Excess urine output from diabetes, or from diabetes insipidus - Reduced mobility, reversible retention, or impacted stool - Anatomical faults: urogenital fistula, diverticulum, duplex kidney, ectopic ureter - Hydronephrosis, or a mass in the abdomen or pelvis - Interstitial cystitis - Neurological disease: cord injury, cauda equina, multiple sclerosis, stroke, hydrocephalus, spinal stenosis, Parkinson disease, diabetic neuropathy - Pelvic organ prolapse, polyuria, a stone low in the ureter, or vesicoureteric reflux Source StatPearls "Urinary Incontinence" - disease-level clinical article Status traced to the source above Rx: Main treatment | Detrusor stimulant for overflow incontinence - no Egyptian product registered MAIN TREATMENT - choose one 1. SOLIFENACIN SUCCINATE [1st line] Adult 5 mg once daily, may increase to 10 mg once daily if necessary. - As directed, long-term maintenance Peds Safety and efficacy in children have not yet been established. Vesicare should not be used in children. Source Vesicare 5mg film-coated tablets SmPC section 4.2 (eMC product 5559) Why Solifenacin at the standard starting dose is first-line drug treatment for urge-type urinary incontinence/overactive bladder once the type of incontinence is established and red-flag causes excluded. Caution New incontinence with back pain, saddle numbness, or leg weakness suggests cauda equina syndrome, a surgical emergency. Only helps the urge-incontinence/overactive-bladder component; it does not treat stress incontinence (leakage on coughing/sneezing/exertion) or overflow incontinence, so establish the type first. New incontinence with back pain, saddle numbness, or leg weakness needs urgent assessment for cauda equina syndrome, not this drug. CONTRAINDICATED in narrow-angle glaucoma, severe ulcerative colitis, and urinary retention; caution in older patients because of cognitive/fall risk. The indication comes from the condition's own article, which lists the antimuscarinics for urge incontinence - oxybutynin, tolterodine, solifenacin, darifenacin, fesoterodine and trospium. The dose comes from the Vesicare label. THIS CARD IS NOT THE WHOLE PICTURE. Its article also sets out the drugs for STRESS incontinence - "Alpha-adrenergic agonists, such as phenylpropanolamine; duloxetine (not FDA-approved; imipramine; vaginal estrogen cream; and overactive bladder pharmaceutical agents as appropriate." - and those drugs live on the separate STRESS URINARY INCONTINENCE card, which carries duloxetine and vaginal estriol. Establish which type it is first: an antimuscarinic does nothing for pure stress incontinence. Egypt NANOFREQ 5 MG 20 F.C. TAB. MEPACO 37.25 EGP (1.86/unit) IMPRONACIN 5MG 10 F.C. TAB. BORG 25.20 EGP (2.52/unit) URGINAFECT 5 MG 20 F.C. TABS. FUTURE PHARMA... 72.00 EGP (3.60/unit) SLOWURGE 5 MG 30 F.C.TABS. MASH PREMIERE... 111.00 EGP (3.70/unit) SOLITRACT 5 MG 30 F.C. TAB. EVA PHARMA 117.00 EGP (3.90/unit) TORMEEL 5 MG 30 F.C. TAB. EUROPEAN EGYP... 126.00 EGP (4.20/unit) SOFENACIN 5MG 30 F.C. TAB. MARCYRL PHARM... 141.00 EGP (4.70/unit) VESICARE 5 MG 30 F.C.TABS. ASTELLAS PHAR... 377.00 EGP (12.57/unit) SOFENACIN 1MG/ML ORAL SUSP. 120 ML MARCYRL PHARMACEUTICAL INDUSTRIES (MPI) 88.00 EGP -> ? strength differs, ? different route - not oral solid URGINAFECT 1MG/ML ORAL SUSP. 150 ML FUTURE PHARMACEUTICAL INDUSTRIES (FP... 88.00 EGP -> ? strength differs, ? different route - not oral solid 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Urinary Incontinence - disease-level clinical article (urinary-incontinence- clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Overflow incontinence is the only type that is directly physically dangerous (can cause renal failure and permanent bladder damage) - an antimuscarinic such as solifenacin would not treat this and could worsen retention. RED FLAG - The criteria for further evaluation or specialist referral are relapse, recurrent UTI, new-onset neurologic symptoms, marked prostate enlargement, neurogenic bladder, pelvic organ prolapse past the introitus, pelvic pain, persistent or unexplained hematuria, persistent proteinuria, post-void residual >200 mL, previous pelvic surgery or radiation, spinal cord injury, surgical complication, treatment failure, or uncertain diagnosis. DETRUSOR STIMULANT FOR OVERFLOW INCONTINENCE - NO EGYPTIAN PRODUCT REGISTERED 3. BETHANECHOL [2nd line] Adult 10 to 50 mg by mouth three or four times a day, found by titration from a small test dose. US label verbatim: "The usual adult oral dose ranges from 10 to 50 mg three or four times a day. The minimum effective dose is determined by giving 5 to 10 mg initially, and repeating the same amount at hourly intervals until satisfactory response occurs, or until a maximum of 50 mg has been given." Give it on an empty stomach - "Preferably give the drug when the stomach is empty. If taken soon after eating, nausea and vomiting may occur." - Short and conditional: continued use depends on whether residual volumes actually fall. The label notes the effect is brief, lasting only about an hour. Peds No paediatric dose is stated in the label used here. Overflow incontinence in a child means an anatomical or neurological cause until proven otherwise and belongs with paediatric urology. Source BETHANECHOL CHLORIDE tablets US prescribing information, Indications and Usage and Dosage and Administration (DailyMed SetID 45285692-de51-413e-8a51-7fb792eccc81) Why Two documents, and the gap between them is stated rather than hidden. The disease article names bethanechol - a detrusor stimulant - for this subtype, overflow urinary incontinence, alongside the alpha-adrenergic antagonists doxazosin, terazosin and tamsulosin. The US label never uses the word incontinence; its indication covers the underlying state instead: retention that is acute, nonobstructive and functional, following surgery or childbirth, and neurogenic atony of the bladder where retention persists. That underlying mechanism is what the article is drawing on, and the dose given here is the label's. Egypt registers no bethanechol product of any kind, so no brand or price can be shown. Caution RED FLAG - never give it when the bladder cannot empty because something is blocking it. Label verbatim: "Bethanechol chloride should not be employed when the strength or integrity of the gastrointestinal or bladder wall is in question, or in the presence of mechanical obstruction". Obstruction is excluded first; a catheter and a urology referral, not a detrusor stimulant. Contraindicated in a long list of ordinary comorbidities. Label verbatim: "Hypersensitivity to bethanechol chloride, hyperthyroidism, peptic ulcer, latent or active bronchial asthma, pronounced bradycardia or hypotension, vasomotor instability, coronary artery disease, epilepsy and parkinsonism." Cholinergic overdose has an antidote to hand. Label verbatim: "If necessary, the effects of the drug can be abolished promptly by atropine". A high post-void residual with overflow leakage is measured, not guessed - and the article's own conservative arm is clean intermittent catheterisation, an indwelling urethral catheter, and relieving the obstruction. Egypt no Egyptian brand matched - prescribe by generic name Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)