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Comparing Drugs for Overactive Bladder Syndrome

How do anticholinergics compare in treating overactive bladder syndrome?

PubMed Clinical Q&A [Internet] - National Center for Biotechnology Information (US).

Version: October 1, 2010

Non-surgical Treatments for Urinary Incontinence: A Review of the Research for Women

The information in this summary is from a report that reviewed 905 studies between January 1990 and December 2011 on treatments without surgery for urinary incontinence. You can use the information from research to understand what is known about the possible benefits and side effects of each treatment option. This information will help you talk with your doctor about what option may be best for you.

Comparative Effectiveness Review Summary Guides for Consumers [Internet] - Agency for Healthcare Research and Quality (US).

Version: April 9, 2012

Which anticholinergic drug for overactive bladder symptoms in adults

Many adults have symptoms of overactive bladder. A person with overactive bladder syndrome feels a very strong urge to pass urine and they may not make it to the toilet before they leak urine. Other common problems are a feeling of needing to urinate often during the day or night, or both. This problem seems to be caused by an overactive bladder muscle, and it becomes more common with ageing. Treatments are conservative measures, such as bladder training or drugs. Anticholinergic drugs can reduce the overactivity of the bladder muscle and the feeling of urgency. The review found that there are several anticholinergic drugs prescribed for adults with overactive bladder symptoms. The two most studied drugs are oxybutynin and tolterodine. These two drugs have similar effects but, on average, those taking oxybutynin were more likely to withdraw from the studies because of adverse effects, mainly dry mouth. However, both drugs can give dry mouth and this problem is less likely if an extended release formulation of either drug is used. Two newer drugs are solifenacin and fesoterodine. Solifenacin has a better effect and less risk of dry mouth compared to tolterodine. Fesoterodine has a better effect than extended release tolterodine but withdrawal from studies due to adverse effects and dry mouth was more likely.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Drug treatment for children with bedwetting (nocturnal enuresis) but not including the drug types desmopressin or tricyclics

Bedwetting (nocturnal enuresis) is the involuntary loss of urine at night without an underlying organic disease as the cause. It can result in social problems, sibling teasing and lowered self esteem. It affects around 15% to 20% of five‐year olds, and up to 2% of adults. Many different types of drugs have been used to treat children with bed wetting. There is not enough reliable evidence to show that drugs other than desmopressin or tricyclics reduce bedwetting in children during treatment when used in isolation, despite their risk of unwanted side effects. In other Cochrane reviews, alarms triggered by wetting, desmopressin and tricyclic drugs have been shown to work during treatment. However, alarms have a more sustained effect than desmopressin and tricyclics after treatment has finished. The adverse effects of alarm therapy (tiredness and waking other members of the family) are relatively benign and self limiting compared with the adverse effects of drugs. One class of drugs (anticholinergic drugs) appears to improve the efficacy of other established treatments such as tricyclics, bedwetting alarms and desmopressin. The cost of treating children with bedwetting with alarm therapy or drugs may vary in different countries.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Timed voiding for the management of urinary incontinence in adults

This review examined the use of a fixed interval of voiding for the management of urinary incontinence in adults. This approach to urinary incontinence is thought to be common in aged care homes for people who require assistance from other people for toileting and continence care. The reviewers found two trials that had evaluated timed voiding. They included 298 elderly women who were living in aged care homes and had reduced cognition and impaired mobility. Reductions in the number of incontinence episodes were reported in each trial. The reviewers found insufficient data for these findings to be combined. Hence, at this point in time, there is not enough evidence on the effects of timed voiding for the management of urinary incontinence.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Naftopidil for the treatment of benign prostatic hyperplasia

Benign prostatic hyperplasia (BPH) can cause bothersome lower urinary tract symptoms such as increased frequency, urgency, night‐time urinations, straining and hesitancy. BPH is common in older males and its symptoms can affect quality of life. This review of eight trials evaluated naftopidil for the treatment of BPH. Current evidence is sparse. We did not identify any placebo‐controlled trials. Naftopidil had a similar short‐term efficacy and adverse‐effect profile compared to low‐dose tamsulosin, and better efficacy than phytotherapy (eviprostat). Adverse effects of naftopidil were few, most commonly dizziness and hypotension. Prior to wide‐spread use, more long‐term, randomized, controlled studies compared to standard therapy are needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Anticholinergic drugs in patients with overactive bladder syndrome.

An overactive bladder is a condition in which bladder contracts suddenly without any control, resulting in feeling to urinate and or leakage of urine. This is a common condition in adults and is also called as 'irritable' bladder or detrusor instability, urge or urgency‐frequency syndrome. Overactive bladder becomes more common with advancing age. Anticholinergic drugs mainly by their muscle relaxant action can help adults with symptoms of urinary frequency, urgency and urge incontinence.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Pelvic floor muscle training added to another active treatment versus the same active treatment alone for urinary incontinence in women

Involuntary leakage of urine (urinary incontinence) affects women of all ages, particularly older women who live in residential care such as nursing homes. Some women leak urine during exercise or when they cough or sneeze (stress urinary incontinence) and this may occur as a result of weakness of the pelvic floor muscles such as damage during childbirth. Other women leak urine before going to the toilet when there is a sudden and compelling need to pass urine (urgency urinary incontinence) and this may be caused by involuntary contraction of the bladder muscle. Mixed urinary incontinence is the combination of both stress and urgency urinary incontinence. Pelvic floor muscle training is a supervised treatment and it involves muscle‐clenching exercises to strengthen the pelvic floor muscles. It is a common treatment used by women to stop urine leakage. Other treatments are also available which can either be used alone or in combination with pelvic floor muscle training.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Bladder training for urinary incontinence in adults

Urinary incontinence is the inability to control the leakage of urine and is a common and distressing problem. Urge incontinence is leakage of urine when a person is unable to control the strong desire to pass urine (void). Stress incontinence is the leakage of urine when a person coughs or undertakes physical exertion. Bladder training encourages people to extend the time between voiding so that continence might be regained. This can take months to achieve but may help people who are physically and mentally able to use this method. The review of trials did not find enough rigorous evidence and concluded that more research is needed. The limited evidence available suggests that bladder training may be helpful in treating urinary incontinence but this is not definite.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Traditional sling operations for urinary incontinence in women

Traditional sling operations are used to treat women with stress urinary incontinence. This is loss of urine when coughing, laughing, sneezing or exercising due to damage to the muscles that hold up the bladder, and injuries to the nerves that may occur during childbirth. Sometimes stress incontinence occurs together with "urge incontinence" ‐ known as "mixed incontinence". The sling operation aims to hold up the bladder with a strip of material which may be biological or synthetic. The results showed that there is not enough information on which to judge whether traditional sling operations are better or worse than any other treatments. Long term results are awaited. In this review there were few trials, of high quality, comparing slings with other forms of surgery and only one study comparing sling operations with non‐surgical treatment.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

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