Pharmacological Therapies for Urinary, Bowel, and Erectile Dysfunction

Urinary, bowel, and erectile functions require a complex network of signals between the nervous system and the target organs. Overactive bladder (OAB) is a common symptoms syndrome characterized by urgency, with or without urge urinary incontinence, usually with frequency and nocturia. The main aim of pharmacotherapy is to restore normal control of micturition, inhibiting the emerging pathological involuntary reflex mechanism. Currently, antimuscarinics represent the first-line treatment in cases of overactive bladder. Stress urinary incontinence (SIU) is a symptom mainly caused by sphincteric incompetence. Pharmacological treatment of SUI aims to increase endourethral pressure either by increasing the tone of the urethral smooth muscle or by acting on the striated muscles at both the urethral and pelvic floor sites. Chronic constipation is a common, persistent condition presenting significant economic burdens and resulting in substantial healthcare utilization. Laxatives are the mainstay of pharmacological treatment for potential long-term therapy in patients who do not respond to lifestyle or dietary modification. Colonic microbiota may also play a role in the pathophysiology of slow-transit constipation by regulating the intestinal environment. Fecal incontinence is a devastating disease for those whom it affects. Conservative medical management consists of patient education, fiber supplements, or antidiarrheals. In patients with irritable bowel syndrome, a strong, reassuring physician-patient relationship is crucial, followed by patient education, dietary advice, and stress reduction. For nonresponding patients, the therapeutic approach may include nonpharmacological therapies and/or pharmacotherapy. Medications for erectile dysfunction (ED) treatment include oral, injection, and topical therapies. Currently, oral phosphodiesterase type 5 inhibitor (PDE5I) therapy represents the mainstay first-line treatment of ED and constitutes one of the most prescribed medications for men’s health.