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Overactive bladder drugs do little to ease incontinence

Consumer Reports News: April 09, 2012 06:18 PM


Many women with incontinence are likely better off trying lifestyle changes first--such as cutting back on caffeinated beverages, along with bladder-training exercises--before turning to a drug, according to an analysis in the Annals of Internal Medicine released today.

Researchers found that drugs used to treat incontinence, such as fesoterodine (Toviaz), solifenacin (Vesicare), tolterodine (Detrol, Detrol LA), and trospium (Sanctura, Sanctura XR), work only slightly better than a placebo. And the side effects of these drugs are so bothersome that many women stop taking them shortly after they begin.

The new analysis of 94 clinical trials, which was funded by the Agency for Healthcare Research and Quality, found only about 20 percent of women who take an overactive bladder medication had their incontinence episodes cut by half or more.

The side effects of these medications, which include dry mouth, constipation, blurred vision, and dizziness, are also a concern. In fact, they can be so bothersome that one study found that more than half of people who take these drugs stopped after one year.

Read our Overactive Bladder Drug Report to find out which medicines offer effective treeatment.

Overactive bladder and incontinence are common conditions, and affect about 11 to 16 million U.S. women. Men can develop the conditions too, but it's unclear how many do since in some cases, their symptoms are due to an enlarged prostate.

Other conditions that can cause incontinence, an urgent sense of needing to urinate, and going to the bathroom more frequently than normal include diabetes, heart disease, kidney stones, multiple sclerosis, Parkinson's disease, and urinary-tract infections. Certain medications such as diuretics (water pills) can also cause urinary problems. If you're experiencing such symptoms, the first question your doctor might ask is whether you take medicines for other disorders, such as high blood pressure.

Bottom line: If your overactive bladder or incontinence symptoms are relatively mild and don't interfere with your daily activities, try lifestyle changes first, such as cutting back on caffeinated and alcoholic beverages and drinking less before bedtime, along with bladder-training exercises, including Kegel exercises, to strengthen the pelvic muscle that help control urination.

If those don't work or your symptoms are so bad they restrict your activities--for example, some people are reluctant to leave the house for fear they'll be unable to find a bathroom when they need one--then it may be time to see your doctor to determine if a medication is worth a try.

Although the benefits of these drugs are indeed marginal for treating both incontinence and overactive bladder, if you and your doctor decide to try one, our Best Buy Drugs recommendation is tolterodine (Detrol) or tolterodine extended-release (Detrol LA). Both have lower rates of side effects. Another drug, oxybutynin (Ditropan) is available as a less-expensive generic, but has higher rates of side effects.

For detailed information on overactive bladder medications, see our free Best Buy Drugs report.

[Benefits and harms of pharmacological treatment for urinary incontinence in women: A systematic review]

Steve Mitchell

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