What is the role of capsaicin in urinary incontinence treatment?

Updated: Sep 23, 2019
  • Author: Sandip P Vasavada, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

Intravesical capsaicin, the main pungent ingredient of hot peppers, has been evaluated for the treatment of detrusor overactivity and neurogenic detrusor overactivity. [82] The proposed mechanism is through desensitization of capsaicin-sensitive unmyelinated afferents. Neuronal damage through osmotic swelling also may occur.

Improvement rates of 40-100% have been reported. Observation has ranged from 1-60 months. In the largest of these series, 44% of patients with neurogenic detrusor overactivity secondary to multiple sclerosis were dry.

Positive findings from an ice water test indicating bladder hypersensitivity have been suggested as a method of selecting patients for capsaicin therapy. Lidocaine, 1%, is administered intravesically 5-15 minutes before capsaicin is administered. Approximately 50-100 mL of 1-2 mmol capsaicin is mixed in 30% ethanol with saline. The solution is left in the bladder for approximately 30 minutes. A small urethral catheter and balloon occlusion of the vesical neck are used to minimize spillage and leakage.

Adverse effects can include transient worsening of irritative symptoms or incontinence, perineal pain, a burning sensation, hematuria, and UTI. Administration in the office or hospital, continuous blood pressure monitoring, and the ability to treat acute hypertension are recommended in patients with spinal cord injuries due to the rare possibility of exacerbation of autonomic dysreflexia. At times, administration of capsaicin is best accomplished under general anesthesia.

Resiniferatoxin, a naturally occurring pungent substance from the Euphorbia resinifera plant, has been shown to have very potent capsaicinlike activity. This substance has been used successfully to treat detrusor overactivity and neurogenic detrusor overactivity. In one small study, some patients who failed capsaicin therapy responded to resiniferatoxin. More research is underway to clarify the role of these therapies in the treatment of urge incontinence disorders, sensory urgency, and interstitial cystitis.

Intravesical oxybutynin has been used in patients who are nonresponsive to the oral form or have severe adverse effects. The medication is self-administered following clean catheterization. This therapy has been shown to be safe and efficacious. Studies have shown that tissue and plasma concentration of the drug are higher after intravesical administration than after oral administration.

Despite higher plasma levels, adverse effects appear to be minimal. This finding suggests that a hepatic metabolite may be responsible for many of the adverse effects observed after oral administration.


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