Which medication is FDA approved for severe stress incontinence?

• A. Oxybutynin
• B. Imipramine
• C. Duloxetine
• D. Finasteride

Answer: (C)

Duloxetine is the FDA-approved medication for stress urinary incontinence because it increases the tone of the external urethral sphincter. It is a serotonin-norepinephrine reuptake inhibitor that boosts signaling in the spinal cord circuits (Onuf’s nucleus) that control the sphincter, helping to close the urethra during moments of increased abdominal pressure and thereby reduce leakage with actions like coughing or lifting.

Oxybutynin targets detrusor overactivity to treat urge incontinence, not stress incontinence. Imipramine has been used off-label for SUI in the past but is not FDA-approved for this indication. Finasteride is used for prostate enlargement or certain hair loss conditions, not incontinence. So duloxetine stands out as the approved option for this specific problem.