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Consumer Reports Insights: Drugs may not be needed to ease urinary incontinence

Urinary incontinence is more common than you might think. But it’s hardly as common as drug companies want us to believe. And drugs aren’t always needed to treat it, according to internist John Santa, director of the Consumer Reports Health Ratings Center.

You’ve seen the ads: An animated figure in a Detrol LA commercial comments on a rushing woman’s “dash of desperation”; in a recent Toviaz ad, a soccer coach looks concerned about “where to go.”

“The less you gotta go, the less you gotta worry,” Detrol LA’s Web site says. But it’s not just about going less; if you have incontinence symptoms, they need evaluation and possible treatment.

Although urinary incontinence is most common among women over 50, it can also affect younger people, especially women who have recently given birth. Sometimes a laugh or a sneeze can cause urine loss or bring on a strong urge to urinate. That temporary loss of bladder control might not warrant drug treatment, but ads for medicines such as Detrol LA (tolterodine) and Toviaz (fesoterodine) seem to suggest that having to go less often is worth the cost and risks of taking a prescription medication.

Risks and treatment: Incontinence is sometimes caused by adverse drug effects or infection, both of which can be easily managed. If the problem is stress incontinence, which occurs when you sneeze or bear down, it can be managed with Kegel exercises to strengthen pelvic muscles to help prevent the bladder from pushing down on the urethra. An overactive bladder can be taught to tolerate a larger volume with various techniques, such as urinating at regular intervals and biofeedback to strengthen muscles.

But if exercises and retraining don’t help, medicines such as Detrol might, though they might address just the symptoms instead of the problem. Detrol and Detrol LA (extended release) are Consumer Reports Best Buy Drugs for those with health insurance or enough funds to cover the cost.

The generic drug oxybutynin costs less but has an increased risk of side effects, including dry mouth, constipation and blurred vision. Consumer Reports’ analysis shows that both versions of Detrol have a lower rate of side effects. That’s important because all overactive-bladder drugs can cause significant side effects, especially in seniors, people with a type of glaucoma and men with enlarged prostates, which can impede urine flow. You might “gotta go” less, but your concern shouldn’t wane.

If you’re going more than you’d like, don’t immediately turn to medication. See an expert who can put you back in control with exercise and behavioral changes. Consider drugs and surgery when such methods don’t work. For more on those drugs, see Consumer Reports’ AdWatch video on Toviaz at www.consumerreportshealth.org. (Search for “adWatch Toviaz.”)

Copyright 2010. Consumers Union of United States Inc.

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