Few medical conditions are as embarrassing as urinary incontinence, so no wonder that its victims often are desperate to try anything that might help. A new study in the Annals of Internal Medicine concludes that for many women, drugs are inadequate and can produce side effects that may be worse than the disorder.
As described in a story last week by Reuters Health, the medical journal reviewed 94 clinical trials that tested drugs for women’s “urge” incontinence—that’s the diagnosis for urine that leaks after experiencing a sudden, strong urge to urinate. It’s less common than “stress” incontinence, when urine leaks because of pressure on the bladder from coughing, lifting or exercise.
Drugs prescribed in the U.S. to treat urge incontinence include Toviaz (fesoterodine), Ditropan (oxybutynin), Vesicare (solifenacin), Detrol (tolterodine) and Sanctura (trospium). They mitigate the urge to urinate by relaxing the bladder. As the review showed, however, they do so only for a minority of women. Fesoterodine was the most effective, and tolterodine the least.
But incontinence was resolved for only 85 to 130 of every 1,000 women using the drugs. Most did not become continent, and 13 to 63 of every 1,000 stopped taking their medication because of side effects, which included dry mouth, constipation, blurred vision and dizziness.
The most troublesome drug for side effects was oxybutynin.
The study’s lead author, Dr. Tatyana Shamliyan of the University of Minnesota School of Public Health, said patients first should try lifestyle changes. If they don’t work, she told Reuters, medication “should be seen as a treatment option. But they are not magic pills."
One unknown is the long-term effect of taking drugs for incontinence. The trials under review in the Annals of Internal Medicine were only two to three months in duration.
The drugs range in cost from about $100 to more than $200 a month. The generic version of oxybutynin costs only about $10 a month.
Urinary incontinence is more common in women. It can be part of the gift that keeps on giving—vaginal childbirth is a major risk factor. Others are obesity and diabetes, the latter because it increases urine production and can cause nerve damage affecting the bladder.
A Reuters story last year noted that more than half of all women older than 20 had reported problems with urine leakage in the last year.
Shamliyan said first-line treatments should include:
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exercise and a healthful diet to maintain optimal weight;
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giving up cigarettes—nicotine can compromise bladder control;
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limiting the consumption of caffeine and alcohol, and not drinking much at night.
Other measures are described as “bladder training,” when patients follow a bathroom schedule even if they don’t feel the urge to urinate. Kegel exercises, which strengthen the pelvic muscles that control urination, also should be practiced daily. They’re simple—identify the relevant muscles by starting and stopping your stream of urination. Then, several times a day, practice flexing and relaxing these muscles, which you can do almost anywhere, and no one will notice.
