How Common Is Urinary Incontinence
Losing bladder control doesnt commonly occur in younger men, but if youre an older man especially over the age of 60 your chances of developing urinary incontinence increases due to associated prostate issues. The National Institutes of Health reports that between 11% and 34% of older men experience incontinence at least occasionally and 2-11% report it is a problem daily.
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It can affect your everyday life because if you strain physically, or even sneeze or cough, you could find yourself with leakage in your pants. As a result, you might stop doing things you enjoy, such as socializing or sporting activities. Even sexual encounters can be affected, as position and pressure during intercourse can cause bladder spasm or leakage.
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What Is Overactive Bladder
- Overactive bladder is a bladder disorder that results in an abnormal urge to urinate, urinary frequency, and nocturia . Some patients may also experience urinary incontinence .
- OAB usually caused by abnormal contractions of the muscles of the urinary bladder , resulting in a sudden, uncontrollable urge to urinate with or without actual leakage of urine, even thought only small amounts of urine may be in the bladder.
- The symptoms of OAB may have other causes such as urinary tract infection, diabetes, medication use such as diuretics , prostate disease, bladder tumors, or interstitial cystitis .
- Overflow incontinence results from accumulation of excessive amounts of urine in the bladder.
- Overactive bladder can occur at any age, but it is most common in the elderly population. Recent surveys have suggested a prevalence of 10%-20% in the population over 40 years of age with similar numbers in men compared to women. It is worth mentioning, however, that men tend to develop this condition later in life than do women.
- Even though overactive bladder is a benign condition, it impacts the quality of life of those who suffer from it. Fear and embarrassment from urinary urgency, frequency, and incontinence in public and among family and friends may result in social isolation, guilt, depressive symptoms, and intimacy issues. Family members of the elderly with OAB are often dealt the burden of assisting their loved ones with toileting, cleaning, hygiene, and personal distress.
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Treating Overactive Bladder With Anticholinergic Drugs
The largest class of drugs used for the treatment of overactive bladder is anticholinergic drugs. These medications work by blocking a chemical known as acetylcholine in the body. Acetylcholine is a chemical that sends a message to the bladder to contract. The medications block the release of this chemical, thus reducing the contractions that cause the bladder to release urine. In studies that carried out a comparison of various medications, all the anticholinergic drugs were found to work equally well in treating overactive bladder.
Anticholinergic drugs are sold under many different brand names. Some of them are also available as generic drugs. These drugs include:
- Darifenacin
Older adults are at the highest risk of suffering from the side effects of these medications. These drugs are also known to cause drowsiness, which increases the risk of falls in seniors. The drug oxybutynin is known to also cause more side effects than the other anticholinergic drugs. However, taking oxybutynin in the extended-release form is likely to reduce some of these side effects. Anticholinergics are also known to worsen the symptoms of dementia, which is why these medications should be used with caution in people who have dementia or another form of mental health condition.
What Did We Find
Efficacy
Overall, the agents were similar in efficacy and most of the drugs were better than placebo for reducing symptoms of OAB. No agent was significantly better than oxybutynin immediate release .
Safety
All of the drugs are relatively safe , but most cause dry mouth and constipation, which may result in a patient discontinuing the drug. Oxybutynin IR is not as well tolerated as other medications whereas mirabegron was generally better tolerated than all the other oral drugs. Additionally there is some concern about the use of these drugs in the elderly due to risk of falls and effects on cognition.
Solifenacin is the most cost effective therapy for the treatment of OAB however, if solifenacin is not effective for a patient, then oxybutynin IR is also a cost-effective option.
With the introduction of generic solifenacin, overall expenditures for the OPDP are expected to decrease about 3% .
Accessibility
There were no accessibility issues identified as all of the drugs used to treat OAB are available on the ODB formulary. There were over 73,000 users of drugs for management of OAB in 2014-15.
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Medications For Urinary Incontinence
If your problem is overactive bladder, a medical professional will likely prescribe you anticholinergic/antispasmodic medications such as Ditropan XL, Detrol, Enablex , VESIcare, Sanctura and Toviaz . The most common side effects of these are dry mouth, blurred vision, constipation, nausea, dizziness, drowsiness and joint pain.
Avodart and Proscar , known as 5-alpha reductase inhibitors, are also commonly prescribed for overactive bladder. However, they are associated with sexual side effects, such as erectile dysfunction. A recent study also found that men on Avodart had a higher risk of developing diabetes and high cholesterol compared to those taking another overactive bladder drug, Flomax, which is known as an alpha blocker.
Although an older class, many doctors look to alpha blockers as an initial treatment. However, side effects with them include dizziness, headache, stomach problems and reduced semen during ejaculation.
For stress incontinence, you may be prescribed a tricyclic antidepressant such as Tofranil and Elavil or selective serotonin reuptake inhibitors such as Cymbalta . Antidepressants come with some nasty side effects, from constipation to vomiting, weight changes and decreased sex drive.
Alpha-adrenergic agonists are another option and include ProAmatine and Sudafed , which is available over the counter. Common side effects include loss of appetite, insomnia and skin rashes or itching.
Natural Treatment For Overactive Bladder
Bladder training and pelvic floor exercises are just two natural treatments for overactive bladder. Research suggests that these nondrug remedies can be very effective for many women, and they have almost no side effects.
But before starting any OAB treatment, itâs important to understand bladder function and what things may cause overactive bladder.
Another way to strengthen pelvic floor muscles is electrical stimulation, which sends a small electrical pulse to the area via electrodes placed in the vagina or rectum.
Until you get your overactive bladder under control, wearing absorbent pads can help hide any leakage.
Other lifestyle tips for preventing incontinence include:
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Medications For Overactive Bladder Caused By Unspecified Reasons
If your doctor is unable to find the exact underlying cause for your overactive bladder, there is no need to worry as there are still medications that will help relieve your symptoms. Some of these medicines function by relaxing the bladder. The drugs work to stop any involuntary contractions that set off the urge to urinate urgently. Some other medicines are available that help strengthen the tissues around the bladder that might have gotten weak and caused the symptoms associated with an overactive bladder. Once the tissue is strengthened, it can help improve the bladder control.
In Case Of Emergency/overdose
In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at . If the victim has collapsed, had a seizure, has trouble breathing, or can’t be awakened, immediately call emergency services at 911.
If someone swallows oxybutynin gel, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.
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What To Expect From Your Doctor
Your doctor may use an overactive bladder questionnaire to make an assessment of your symptoms, asking questions such as:
- How long have you had these symptoms?
- Do you unexpectedly leak urine? How often?
- What do your symptoms keep you from doing that you like to do?
- During daily activities, such as walking or bending over, do you leak urine?
Try To Avoid Caffeine Carbonated Drinks Sugar Alcohol And Spicy Or Acidic Foods
- Caffeine is a diuretic which makes you need to use the bathroom more often.
- Carbonated drinks and sugar are thought to stimulate the bladder.
- Alcohol switches off the ability of your body to concentrate urine. This means you tend to urinate more dilute, watery urine, which dehydrates you. Since you are dehydrated, you may drink more.
- Acidic or spicy food may aggravate your overactive bladder and worsen your symptoms. Certain acidic fruit and juices like orange, grapefruit, lemon and lime can aggravate your bladder, too.
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Types Of Urinary Incontinence
Urgency incontinence, also known as overactive bladder, is involuntary urination or a very strong desire or urgency to urinate.
Stress incontinence is a weakness of the bladder or sphincter muscles.
Overflow incontinence, also known as after-dribble, is a consequence of not emptying the bladder properly.
Functional incontinence happens when you know you need to urinate, but due to mental or physical reasons, such as dementia or impaired mobility, cannot make it to the bathroom in time.
Overactive Bladder Symptoms And Signs
The hallmark of OAB is urinary urgency, a sudden urge to urinate that may be difficult to control. Actual loss of urine is not a defining symptom of overactive bladder, but it can happen as a result of urgency. Urinary incontinence tends to be more common in women with OAB compared to men.
The other symptoms of overactive bladder are urinary frequency and nighttime urination or nocturia .
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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.
To compare the effects of different anticholinergic drugs for overactive bladder symptoms.
What Medications Cause Overactive Bladder
An overactive bladder involves an uncontrolled urge or sudden need to urinate. Most of us have increased our fluid intake at some point, which led to more trips to the bathroom. But an overactive bladder is different. It does not occur due to an increase in fluids. Although, some medications can cause this. So, what medications cause overactive bladder? We will take a look shortly.
An overactive bladder is not the same thing as urinary incontinence. Urinary incontinence occurs when urine leaks out involuntary. Either condition can develop on its own, but they can also occur together. An overactive bladder can often lead to urinary incontinence.
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Best Medications For Overactive Bladder
Having an overactive bladder causes an urgent urge to urinate. It can also trigger involuntary leakage of urine, known as urinary incontinence. Overactive bladders affect over 30 million Americans, with women being more affected than men. Having an overactive bladder is not only uncomfortable, but it can also be painful. There are many causes for an overactive bladder, and the treatment for this condition depends on the underlying cause. Once your doctor finds the reason for your overactive bladder, you will begin to receive targeted treatment to treat the cause. There are many medications available for the treatment of overactive bladder. Here are some of the best medications for overactive bladder.
Drug Therapy With Antimuscarinics
Antimuscarinics or Muscarinic receptor antagonists are a group of drugs which reduce the abnormal contractions of the bladder and improve urgency symptoms.
There are several MRAs. These work similarly, but they may have different side effects and be more or less tolerated by patients.
Taking antimuscarinics
Most antimuscarinics are taken by mouth once daily with or without food, although they can also be administered through a transdermal patch. The recommended dose for adults differs by the type of MRA. Start with the minimum dosage that gives you the beneficial effects of the drug with as few side effects as possible.
Antimuscarinics are not recommended for patients who are pregnant or those who suffer from conditions like:
- glaucoma
- severe constipation
Possible drug interactions
When antimuscarinics are taken by mouth, interactions with other drugs can occur. Ask your doctor about drug interactions. Read the prescription instructions for your drug treatment carefully to make sure you take medications correctly.
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Take Charge: Seek Your Doctors Advice
Approximately 80% of those affected by urinary incontinence can be cured or improved, yet only one in 12 people with incontinence issues seek help. Talk to your doctor about your bladder control as it can dramatically improve your lifestyle.
Your doctor can investigate and establish a cause for your overactive bladder. Treatment can then be tailored to this cause and may involve medications, bladder retraining, pelvic floor exercises, absorbent products, surgery, or combinations of these options.
Plus, consider joining the Drugs.com Overactive Bladder Support Group. Here, you can connect with people with similar questions and concerns, share your experiences, and keep up with the latest new drug approvals, ongoing research, and medical news.
Cholinergic Drugs For Bladder Problems
This class of drugs includes bethanechol . Cholinergic refers to nerve cells or fibers that use a certain type of chemical to send signals within the body. Cholinergic drugs are used when the bladder is not emptied completely following urination. This problem is known as residual urine in the bladder.
- How cholinergic drugs work: These drugs contract the bladder, thus allowing complete emptying.
- Who should not use these medications: Individuals with the following conditions should not use cholinergic drugs:
- Parkinson’s disease
- Bladder or bowel obstruction
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Summary Of Drug Class Review Findings: Overactive Bladder Agents
Download a PDF of this Research Summary
The Ontario Drug Policy Research Network conducted a drug class review on the effectiveness, safety, and accessibility of drugs used in the management of overactive balder as part of an initiative to modernize the public drug formulary in Ontario. OAB is a common condition that increases with age. The most frequent symptom of OAB is a sudden urge to urinate, that may or may not result in incontinence.
Anticholinergics are the main medications used to treat OAB there are six of them available in Canada and their listing and formulations on public drug plans vary, some also have generic versions available. Another drug, mirabegron, has also recently become available and is increasingly being used.
How Should This Medicine Be Used
Topical oxybutynin comes as a gel to apply to the skin. It is usually applied once a day. Apply oxybutynin gel at around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Apply oxybutynin gel exactly as directed. Do not apply more or less of it or apply it more often than prescribed by your doctor.
Oxybutynin gel may help control your symptoms but will not cure your condition. Continue to use oxybutynin gel even if you feel well. Do not stop using oxybutynin gel without talking to your doctor.
Oxybutynin gel is only for use on the skin. Do not swallow oxybutynin gel and be careful not to get the medication in your eyes. If you get oxybutynin gel in your eyes, wash them with warm, clean water right away. Call your doctor if your eyes become irritated.
You can apply oxybutynin gel anywhere on your shoulders, upper arms, stomach, or thighs. Choose a different area to apply your medication every day, and apply the entire dose to the place you choose. Do not apply oxybutynin gel to your breasts or your genital area. Do not apply the medication to skin that has recently been shaved or that has open sores, rashes, or tattoos.
Keep the area where you applied oxybutynin gel dry for at least 1 hour after you apply the medication. Do not swim, bathe, shower, exercise, or get the area wet during this time. You may apply sunscreen during your treatment with oxybutynin gel.
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