Drugs help some women with incontinence

New York: Some women with a leaky bladder can get better using approved medications, but a new research review finds that inadequate relief and side effects may prevent many others from benefiting.

The study, published online in the Annals of Internal Medicine, reexamined 94 clinical trials testing drugs for women`s urge incontinence -- when urine leaks after a sudden, strong urge to urinate.

It`s less common than so-called stress incontinence, when urine leaks because of pressure on the bladder from things like exercise, coughing or heavy lifting.

In the US, there are several drugs approved to treat urge-type incontinence: fesoterodine (Toviaz), oxybutynin (Ditropan), solifenacin (Vesicare), tolterodine (Detrol) and trospium (Sanctura).

They work by relaxing the bladder and easing the urge to urinate. But that clears up incontinence episodes in only a minority of women, the new review shows.

Researchers found that for every 1,000 women treated with the drugs, anywhere from 85 to 130 saw their incontinence go away.

Fesoterodine was the most effective drug, and tolterodine the least.

But overall, the benefit of medication was modest, since most women in the studies did not become continent, said lead researcher Dr. Tatyana Shamliyan, of the University of Minnesota School of Public Health in Minneapolis.

And that modest effectiveness needs to be balanced against the risk of side effects, Shamliyan said.

She and her colleagues found that for every 1,000 women treated, between 13 and 63 stopped taking their incontinence medication because of side effects. The highest rate was among women on oxybutynin.

Dry mouth and constipation are the most common side effects of incontinence medications. Others include blurred vision and dizziness.

Shamliyan said women should try lifestyle changes and non-drug treatments first. "If you still can`t find relief, then talk with your healthcare provider," Shamliyan told Reuters Health.

Medication, she said, "should be seen as a treatment option. But they are not magic pills."

Urinary incontinence is very common among women -- in large part because vaginal childbirth is a major risk factor.

One recent study of U.S. adults found that about 53 percent of women older than 20 said they`d had problems with urine leakage in the past year. That was up from less than half of women surveyed several years earlier. (See Reuters Health story of July 1, 2011.)

Researchers on that study said the increase was partly explained by rising rates of obesity and diabetes; diabetes is thought to contribute for a few reasons -- by causing nerve damage that affects the bladder, and by boosting the body`s urine production, for example.

Shamliyan said the relatively small benefits of drug treatment make preventing urinary incontinence even more important.

Women can cut their risk, she said, by eating well and exercising to maintain a healthy weight, and by not smoking -- another risk factor for bladder-control problems.

There are also conservative treatments, Shamliyan pointed out.

One is "bladder training" -- tactics like going to the bathroom at fixed times, even if you don`t feel like you need to go. It often includes Kegel exercises to strengthen the pelvic muscles that control urination.

Changing your lifestyle habits can also help. That often means cutting down on caffeine and alcohol, and limiting your beverages at night.

Shamliyan said there are still questions about drugs for incontinence. One is, how do women on the medications fare in the long term? The trials in this review typically lasted two to three months.

Women may also want to consider the drugs` cost, which ranges from around $100 to more than $200 a month. There is, though, a generic version of oxybutynin that is only about $10 a month.

Bureau Report