Overactive Bladder

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Overactive Bladder

About Overactive Bladder

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Overview

Overactive bladder is a condition characterized by the sudden need to urinate. You may also have leaking urine (incontinence) or experience the need to go to the bathroom many times each day—more than eight times—or two times or more each night.

Could your overactive bladder be something else?

If you believe you may have an overactive bladder, it’s important to see your doctor to get an accurate diagnosis, because a host of other conditions can cause symptoms—especially frequent bathroom trips—similar to those associated with overactive bladder. These include diabetes, heart disease, and a variety of neurologic disorders, such as multiple sclerosis, Parkinson’s disease, spinal cord injuries, and strokes.

Other conditions that can also cause urine leakage. For example, “stress incontinence”—leaking urine when you cough, sneeze, run, jump, or even laugh—is sometimes confused with overactive bladder. It’s caused by a weakness of the muscles that help keep the bladder closed. Some people have a combination of overactive bladder and stress incontinence.

Another bladder disorder called “overflow incontinence” can have symptoms similar to overactive bladder. This condition is usually caused by an obstruction that does not allow all the urine to be expelled.

Urgency, incontinence, and urinary frequency can also be caused by urinary tract infections (UTI), kidney stones, prostate infection or enlargement, or medicine you take to treat other conditions, such as high blood pressure. The first question your doctor might ask if you’re having urinary problems is what medicines you’re taking.

Common Symptoms

  • Urinating eight or more times per day
  • Waking up more than twice a night to go to the bathroom
  • An overwhelming and sudden need to urinate, even if you’ve recently gone to the bathroom
  • Leaking urine before you’re able to make it to a bathroom (about half of the people with overactive bladder have urge-related leakage)

It’s important to note that overactive bladder symptoms are not always permanent and may go away. Studies show that the condition resolves after a year in up to 35 percent of women who develop it. However, for the majority of women, the condition persists for years.

What Causes it?

In people with overactive bladder, it is thought that bladder muscles contract at the wrong time, making it feel like you urgently need to go to the bathroom. It can also lead to urine leakage. Drugs used to treat the condition relax the bladder muscles, which can increase the storage size of the bladder and reduce the urge to urinate.

Some known causes of overactive bladder include neurological disorders, such as spinal cord injury, multiple sclerosis, Parkinson’s disease, and stroke. Often, however, the cause is unknown.

Am I at Risk?

The symptoms of overactive bladder and related incontinence are very common. Between 11 and 16 million women in the U.S. experience overactive bladder and incontinence, according to the Agency for Healthcare Research and Quality. Some estimates indicate that an equal number of men also experience overactive bladder, although these symptoms can be caused by prostate problems. The condition can develop in men or women of any age, but is more likely to occur in older adults. It’s important to note that overactive bladder symptoms are not always permanent and may go away. Studies show that the condition resolves after a year in up to 35 percent of women who develop it. But for the majority of women, the condition persists for years.

Consumer Reports Best Buy Pick

Tolterodine (generic of Detrol)

Cost: $167-$183/mo

The short-acting form of tolterodine costs more than generic oxybutynin, but we chose it as a Best Buy because it offers the advantages of fewer side effects and a lower rate of people who stop using it due to adverse events. Tolterodine might be more convenient, too, because it is rarely prescribed for use more than twice a day, whereas some people might need to take oxybutynin three times per day. That could be a convenience advantage for some people, such as seniors, who take multiple medicines per day.

The long-acting form of tolterodine (Detrol LA) might also be a good option because it has a low risk of side effects and offers once-a-day convenience. But we did not choose it as a Best Buy because it is not available as a generic, so it is significantly more expensive than generic tolterodine.

Other Prescription Drugs Evaluated

  • Enablex (darifenacin)
  • Toviaz (fesoterodine)
  • Myrbetriq (mirabegron)
  • Ditropan XL, Oxytrol skin patch, Gelnique gel (oxybutynin)
  • Vesicare (solifenacin)
  • Detrol, Detrol LA (tolterodine)
  • Sanctura, Sanctura XR (trospium)

The short-acting form of tolterodine costs more than generic oxybutynin, but we chose it as a Best Buy because it offers the advantages of fewer side effects and a lower rate of people who stop using it due to adverse events. Tolterodine might be more convenient, too, because it is rarely prescribed for use more than twice a day, whereas some people might need to take oxybutynin three times per day. That could be a convenience advantage for some people, such as seniors, who take multiple medicines per day.

The long-acting form of tolterodine (Detrol LA) might also be a good option because it has a low risk of side effects and offers once-a-day convenience. However, we did not choose it as a Best Buy because it is not available as a generic, so it is significantly more expensive than generic tolterodine.

The short-acting form of oxybutynin has higher rates of people who experienced dry mouth and any side effect, and more people stopped the drug due to side effects compared with the other overactive bladder medications. Short-acting tolterodine has lower rates of dry mouth or constipation than oxybutynin (short-acting). Tolterodine extended-release (Detrol LA) might also have lower rates of dry mouth compared with the extended-release form of oxybutynin (Ditropan XL) and the short-acting tolterodine, although this evidence is less consistent.

The oxybutynin patch (Oxytrol) poses less risk of dry mouth than the oxybutynin pill, but the incidence of skin reactions was fairly high (26 percent), leading 11 percent of people to stop using the patch.

The newer drug, fesoterodine, improved some symptoms better than tolterodine extended-release, but people who took fesoterodine were more likely to develop dry mouth or stop the medication due to side effects. Solifenacin improved some symptoms and caused less dry mouth than immediate release tolterodine, but caused more dry mouth and constipation than the extended-release form of tolterodine. Studies have found that darifenacin (Enablex) is about equally effective at relieving overactive bladder symptoms as oxybutynin, but it might have a better safety profile. Darifenacin has lower rates of overall side effects, dry mouth, and severe dry mouth than oxybutynin, but a higher rate of constipation.

There is no head-to-head evidence comparing the newest drug mirabegron (Myrbetriq) to the other drugs. Side effects associated with Myrbetriq include increased blood pressure, cold-like symptoms, urinary tract infection, headache, rapid heartbeat, and rash and itching.

Is it Effective?

The overactive bladder drugs are only moderately effective. Studies have found that just a small proportion of people get complete relief from symptoms while taking the medications, particularly over longer periods of time. But most people can expect some relief—a decrease in the number of times a day they feel a strong urge to urinate, and a decline in the number of leakage episodes.

Each of the seven drugs has strengths and weaknesses. But overall, studies that have compared the drugs with each other have found little difference among them in terms of effectiveness. That includes studies that compared the immediate-release (or short-acting) forms of these drugs to the long-acting or extended-release forms.

Even fewer studies have evaluated how the drugs affect the highly subjective symptom of urgency. As you might imagine, that’s more difficult to measure than the number of times you urinate. Here, too, the studies point to a modest success for the overactive bladder drugs, with a wide range of individual responses. So, depending on your own body chemistry and response, you might notice a meaningful decrease in urgency or very little change.

Because the benefits of overactive bladder medicines can often be marginal, many doctors and experts think they’re not worth continuing if people experience bad side effects. That said, if your doctor thinks your condition is severe enough to warrant one of these medicines, it might be worth trying. The response to these drugs varies; you might tolerate it well and be able to adapt to the side effects. But you should discuss with your doctor any side effects you experience.

Is it Safe?

Many doctors are hesitant to prescribe drugs for overactive bladder because of the risk of side effects. Dry mouth and constipation are common, can be very annoying, and for some people, can be quite severe. Blurred vision and dizziness can also occur. Mental confusion is a possibility with many of the drugs, especially in older people.

Since older people are more likely to have overactive bladder, doctors are especially alert to any mental confusion they might experience. If you (or a loved one) has Alzheimer’s disease or another form of dementia (for example, dementia that develops after a stroke), your doctor might be reluctant to prescribe a drug for overactive bladder. We’d go a step further and suggest that you not take one unless your doctor feels strongly about prescribing it.

Your doctor will want to know if you have “narrow angle” glaucoma, an eye condition. The overactive bladder medicines are not recommended for people with this type of glaucoma because they can harm their vision—this does not apply to mirebegron (Myrbetriq). But most people with glaucoma have what is called “open angle” glaucoma and can safely take overactive bladder drugs.

That is a very high level of treatment dropout. Some of it is for a good reason: Lifestyle changes and nondrug measures have been successful at reducing their symptoms, so the drug is no longer needed. Some dropout may be due to cost, especially for people taking the newer, more expensive drugs. But about a third to one-half of the dropout is due to side effects. Patients simply can’t tolerate the drug or decide it’s not worth the minimal benefit they get.

Oxytrol for Women patch and Botox injections

Our medical advisers recommend caution before using either the Oxytrol for Women patch or Botox injections for an overactive bladder.

The symptoms of overactive bladder can be caused by other conditions, such as bladder infections and bladder cancer, so it’s important to see a doctor to get an accurate diagnosis before trying the patch on your own. In addition, the patch can cause skin reactions at the site of application in about a quarter of patients—in 11 percent of people the reactions are so severe, they stop using the patch.

Botox has downsides, too. While clinical trials showed that Botox injections improved overactive bladder symptoms, the possible side effects include painful urination, incomplete emptying of the bladder (which could require the insertion of a catheter), and urinary tract infections. The FDA says you should take an antibiotic along with the shot to reduce the risk of developing a UTI.

Moreover, Botox is only approved for use in people who can’t take or haven’t gotten relief from other overactive bladder medications, and it can be expensive. A single treatment can cost more than $800 and might need to be repeated every 3-8 months.

Are there Over-The-Counter Options?

  • Oxytrol for Women (oxybutynin) skin patch

Are there Non-Drug Options?

If your overactive bladder symptoms are mild to moderate, and you only have rare or occasional “accidents,” your doctor will probably recommend that you try nondrug measures before you try a medication. If they don’t work, he or she might suggest that you also try one of the drugs we discuss.

The most important nondrug treatments are often called “bladder training.” For example, you might be taught how to time urination at regular intervals and hold your urine for progressively longer periods of time.

You’ll also likely learn how to do Kegel exercises to strengthen the pelvic muscles that control urination. Once you learn how to do them, they can be worked into your daily routine. For example, you could do a set of Kegels in your car while stopped at a red light. Lifestyle changes can also help. These include cutting back on certain drinks and foods, including caffeinated and alcoholic beverages, and drinking less fluid between dinner and bedtime.

Studies have found that behavioral treatments and lifestyle adjustments, when practiced diligently, can help relieve symptoms. They decrease the number of trips to the bathroom and incontinence episodes.

There are other procedures used to treat severe overactive bladder or overactive bladder that does not respond to medication, including surgery and Botox injections, but those also are not evaluated in this report.

Source

Consumer ReportsDrugs to treat overactive bladder. Comparing effectiveness, safety, and price. Published November 2013.

FDANeed Relief from Overactive Bladder Symptoms? Published July 2015.

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