The advertising of drugs for what is often called “overactive bladder” can make it seem as though medication is the key to curbing frequent bathroom breaks and bladder leaks. But is taking a drug the best solution for regaining control of your bladder?
Drug ads may leave out information you need before deciding whether to use a certain therapy, says Michael Hochman, an assistant professor of clinical medicine at the Keck School of Medicine at the University of Southern California. In particular:
Symptoms may be addressed without drugs. About one-third of the time, leaks and strong urges to go resolve in women within a year without treatment. In many cases, simple lifestyle changes, such as cutting back on certain fluids or doing exercises to strengthen muscles supporting the bladder, can greatly improve control.
The drugs often don’t work well. According to an analysis by Consumer Reports Best Buy Drugs, most people who take these medications can expect only modest relief. Medication reduces the number of daily bathroom trips from 12 to nine or 10, on average. People who experience bladder leaks can expect one or two fewer episodes per day.
They cause side effects. More than half of those who take drugs for what’s been dubbed overactive bladder stop taking medication within six months, often because of side effects such as dry mouth, blurry vision, constipation and dizziness. Also, most of these drugs belong to a class of medication called anticholinergics, a class of medication that commonly causes mental confusion, especially in older adults, and has been linked to an increased risk of dementia.
What should you do if you’re experiencing bladder problems? Start by working with a general practitioner, who can determine whether there may be an underlying cause for your symptoms. Urgency, incontinence and urinary frequency can be caused by urinary tract infections, kidney stones or, in men, a prostate infection or prostate enlargement. Medication you take to treat other conditions, such as anxiety, depression, high blood pressure, insomnia and pain, can also lead to bladder leaks.
Lifestyle changes that improve your overall health — shedding a few pounds if you’re overweight and stopping smoking — can also reduce incontinence. In addition, get your fiber, because constipation puts pressure on your bladder.
Other lifestyle changes depend on your particular symptoms and the type of incontinence you’re experiencing. Some people have both of these:
Stress incontinence. This is marked by urine leaks when you laugh, cough, sneeze or lift heavy objects. Exercises called Kegels, which strengthen the muscles that control urine flow by repeatedly tightening and relaxing them, can be very effective at reducing related bladder leaks.
In addition, research shows that a pessary, a small device that fits into the vagina to support the bladder and uterus, improves symptoms for about half the women who try it.
Urge incontinence. The most notable sign of urge incontinence (that’s the formal term for “overactive bladder”) is a sudden, urgent need to urinate (with or without leaks). Kegels can help with that, too, as can cutting back on bladder irritants such as alcohol, caffeine and carbonated drinks.
Your doctor can help you establish a schedule for bladder training, where you urinate at set times, gradually increasing the intervals between bathroom trips.
If you have urge incontinence, you’ve tried nondrug measures for several months and symptoms of urge incontinence are still interfering with your quality of life, you might consider adding medication. (It won’t work for stress incontinence.)
How do they work? In some people with urge incontinence, the bladder muscles contract at the wrong time, causing the uncomfortable feeling of urgency and, often, causing leaks. 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.
If you and your doctor conclude that one is worth trying, consider generic prescription extended-release oxybutynin. It costs about twice as much as the short-acting drug if you’re paying out-of-pocket, but it offers the convenience of once-a-day dosing. In addition, research suggests that it has a somewhat lower risk of side effects than other forms of the drug.
Watch closely for side effects, particularly memory problems or confusion, which can be subtle, Hochman says. If symptoms haven’t improved after eight weeks, ask your doctor about adjusting the dose or trying a different option.
Surgery may be an option for stress incontinence. The most common procedure is midurethral-sling surgery, where strips of synthetic mesh are implanted to support the neck of the bladder. It can be effective, but the surgery carries significant risks, including infection, difficult urinating and an increase in the severity of incontinence.
Clarification: The Feb. 21 column (“Genetic Tests: Some Aren’t Worth It”) may have caused some confusion. In the section on age-related macular degeneration (AMD), readers may have thought our advice was to avoid all tests and vitamin supplements for the condition. We advise avoiding genetic tests that claim to help people with AMD determine the specific supplement formulation they should take. Our medical experts also say the standard AREDS eye supplement — which contains vitamins C and E, copper, lutein, zeaxanthin and zinc — is worth considering for those with AMD.
For further guidance, go to www.ConsumerReports.org/Health, where more detailed information, including CR’s ratings of prescription drugs, treatments, hospitals and healthy-living products, is available to subscribers.