Treatments for overactive bladder

Treatments for overactive bladder
Specialtyurology

Treatments for overactive bladder are therapies used to treat overactive bladder or related conditions, such as urinary incontinence and frequent urination. Behavioral modification and medications are commonly used to treat this condition.

Efficacy of treatments

Studies have shown that few people get complete relief from overactive bladder drugs and that all available drugs are no more than moderately effective.[1] A typical person with overactive bladder may urinate 12 times per day.[1] Medication may reduce this number by 2-3 and reduce urinary incontinence events by 1-2 per day.[1]

A 2009 literature review on women found that no drug seemed better than others, and paid special attention to comparing newer drugs to older ones.[2] There is not sufficient evidence to guide the choices doctors and patients make in treating overactive bladder with experimental treatments including sacral nerve stimulation, oxybutynin instillation, and botulinum toxin injections.[2] The research literature shows that in alternative medicine, acupuncture has shown some efficacy while reflexology and hypnosis have not.[2] Oxybutynin is sometimes used in combination with Kegel exercises and Functional electrical stimulation.[3]

A 2019 systematic review of studies related to urinary incontinence in women found that behavioral therapy, alone or combined with other treatments, is generally more effective than any other single treatment alone.[4] Some behavior modification practices were associated with benefits comparable to any other treatment.[2]

Non-drug treatments

Non-drug treatments for overactive bladder include sacral nerve stimulation, acupuncture, and behavior modification. Findings from a 2018 systematic review update suggest that behavioral therapy results in better outcomes than using drugs or medications.[5] Behavioral therapy as a treatment has been used to improve or cure urge incontinence while also improving patient satisfaction.[6]

Drugs

Classification of drugs

Most drugs used to treat overactive bladder are muscarinic antagonists.

Comparison of drugs

Comparison of overactive bladder medication
agent[1] traits[1]
Oxybutynin (short-acting)
  • well-known by physicians
  • available in market longer than other drugs for OAB
  • many studies provide support of effectiveness
  • available as generic in places including the United States
  • more side effects than alternatives, including dry mouth and constipation
  • severe dry mouth more often reported
  • user takes 2-3 pills a day
Oxybutynin (extended release)
  • fewer side effects than short-acting Oxybutynin
  • 1 pill per day
Oxybutynin (transdermal patch)
  • no pill
  • patch changed every 3–4 days
  • lower rate of dry mouth as compared to pill form
  • patch commonly causes skin irritation which can be severe
Oxybutynin (Topical medication)
  • fewer side effects than short-acting Oxybutynin
  • topical gel applied to abdomen, arms, or thighs daily
  • new on market
  • little existing research on this drug
Tolterodine (short-acting)
  • fewer side effects than short-acting Oxybutynin
  • 2 pills per day
  • 10% of Caucasians and 19% of black people have a genetic difference which causes them to lack a certain enzyme. Lack of this enzyme makes the drug less effective.
Tolterodine (extended release)
  • fewer side effects than short-acting Oxybutynin
  • 1 pill per day
  • 10% of Caucasians and 19% of black people have a genetic difference which causes them to lack a certain enzyme. Lack of this enzyme makes the drug less effective.
Solifenacin
  • 1 pill per day
  • More effective for some symptoms than Tolterodine
  • higher rates of constipation and dry mouth than tolterodine
  • less researched for safety and efficacy than Tolterodine and Oxybutynin
Trospium (short acting)
  • severe dry mouth less common than with oxybutynin
  • less researched for safety and efficacy than Tolterodine and Oxybutynin
Trospium (extended release)
  • 1 pill per day
  • little existing research on this drug
Darifenacin
  • 1 pill per day
  • less researched for safety and efficacy than Tolterodine and Oxybutynin
Fesoterodine
  • same metabolite as Tolterodine, but does not require that enzyme to be active
  • it may avoid drug interactions of Tolterodine
  • little existing research on this drug

References

  1. 1 2 3 4 5 Consumer Reports Health Best Buy Drugs (June 2010). "Evaluating Prescription Drugs to Treat: Overactive Bladder - Comparing Effectiveness, Safety, and Price". Best Buy Drugs. Consumer Reports: 10. Retrieved September 18, 2012., which cites other reports but primarily
  2. 1 2 3 4 Hartmann, K. E.; McPheeters, M. L.; Biller, D. H.; Ward, R. M.; McKoy, J. N.; Jerome, R. N.; Micucci, S. R.; Meints, L.; Fisher, J. A.; Scott, T. A.; Slaughter, J. C.; Blume, J. D. (2009). "Treatment of overactive bladder in women". Evidence Report/Technology Assessment (187): 1–120, v. PMC 4781496. PMID 19947666.
  3. ↑ Arruda, R. M.; Castro, R.; Sartori, M.; Girão, M. J. (2009). "Comparison between oxybutynin, functional electrical stimulation and pelvic floor training for treatment of detrusor overactivity in women: A review". Current Opinion in Obstetrics and Gynecology. 21 (5): 412–414. doi:10.1097/GCO.0b013e32832fd28f. PMID 19593131. S2CID 38511861.
  4. ↑ Balk, Ethan M.; Rofeberg, Valerie N.; Adam, Gaelen P.; Kimmel, Hannah J.; Trikalinos, Thomas A.; Jeppson, Peter C. (2019). "Pharmacologic and Nonpharmacologic Treatments for Urinary Incontinence in Women: A Systematic Review and Network Meta-analysis of Clinical Outcomes". Annals of Internal Medicine. 170 (7): 465–480. doi:10.7326/M18-3227. ISSN 0003-4819. PMID 30884526. S2CID 83458685.
  5. ↑ Balk, Ethan; Adam, Gaelen P.; Kimmel, Hannah; Rofeberg, Valerie; Saeed, Iman; Jeppson, Peter; Trikalinos, Thomas (2018-08-08). "Nonsurgical Treatments for Urinary Incontinence in Women: A Systematic Review Update". doi:10.23970/ahrqepccer212. S2CID 80659370. {{cite journal}}: Cite journal requires |journal= (help)
  6. ↑ Balk, Ethan; Adam, Gaelen P.; Kimmel, Hannah; Rofeberg, Valerie; Saeed, Iman; Jeppson, Peter; Trikalinos, Thomas (2018-08-08). "Nonsurgical Treatments for Urinary Incontinence in Women: A Systematic Review Update". doi:10.23970/ahrqepccer212. S2CID 80659370. {{cite journal}}: Cite journal requires |journal= (help)
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