Urinary Incontinence Drugs May Be More Trouble Than
MONDAY, April 9 (HealthDay News) -- For women with urinary
incontinence, the available treatments may cause more problems than
they solve and many stop taking the medications because of side
effects that can include dry mouth and constipation, a new analysis
Urge incontinence is marked by frequent, sudden urges to urinate
that can result in leakage and accidents. Standard treatment
includes lifestyle changes, pelvic floor exercises, bladder
training and/or medication. There are several types of medications
that may be used alone or together for the condition. Generally,
these medications relax bladder contractions and help improve
Researchers from the University of Minnesota School of Public
Health analyzed data from 94 studies to see how well the available
drugs worked. A given medication was deemed effective if women
achieved a 50 percent or more reduction in daily episodes of urge
incontinence. Researchers also compared side effects and
discontinuation due to side effects of the drugs. Overall, drugs
were more effective than a placebo in helping women stay dry, but
the improvements were small and treatment discontinuation due to
side effects was frequent, the review showed.
There were few head-to-head comparisons in the literature. One
study showed that Toviaz (festerodine) bested Detrol (tolterodine)
in helping people stay dry. More women stopped taking Ditropan or
Urotrol (oxybutynin) due to side effects than Detrol. The lowest
rates of treatment discontinuation was seen with 5 milligrams of
Vesicare (solifenacin). The review was funded by the Agency for
Healthcare Research and Quality.
"Since all drugs for urgency incontinence have comparable effectiveness, therapeutic choice should consider the harms profile, and women should be informed about all possible adverse effects," the researchers concluded. Their report appears in the April 10 issue of the Annals of Internal Medicine.
Dr. Elizabeth Kavaler, a urologist at Lenox Hill Hospital in New
York City, said she always starts with behavioral changes to help
women manage urge incontinence. "Kegel exercises, fluid restriction
and staying way from bladder irritants such as coffee, tea juices
and alcohol are the first-line treatments, and if they don't
improve, we move to medication."
"Some women find these drugs work great and don't have any side effects," she added.
Dr. Yvonne K. P. Koch, an assistant professor of urology at the
University of Miami Miller School of Medicine, said the findings
run counter to what she sees in her practice. "Some women may not
be 100 percent dry, but are 50% improved and are pretty happy with
that." She said she always starts women at the lowest dose of the
drug with the fewest side effects.
"There is a lot of trial-and-error," she said. "Most people do try two or three before they find one that works."
Learn more about the causes and treatments of urge incontinence
U.S. National Institutes of Health.
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Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.