Which medication should be avoided in women with urinary incontinence due to potential aggravation of symptoms?

• A. Non-selective peripheral alpha-1 blockers (doxazosin, prazosin, terazosin)
• B. Oral estrogen
• C. Intravaginal estrogen
• D. Beta-adrenergic agonists

Answer: (A)

In urinary incontinence, drugs that lower outlet resistance can worsen leakage. Non-selective peripheral alpha-1 blockers block alpha-1 receptors in the urethral smooth muscle, relaxing the bladder neck and urethral sphincter. That reduced tone makes urine leakage more likely, so these agents are avoided in older women with incontinence. Oral and intravaginal estrogen are aimed at improving genitourinary tissues and are not known to worsen incontinence; they’re not the class that would aggravate symptoms. Beta-adrenergic agonists affect bladder storage in different ways and aren’t the classic culprits for increasing leakage.