Best Treatments for Overactive Bladder Syndrome

The symptoms of overactive bladder syndrome were most improved when patients used anticholinergic drugs either alone or in combination with bladder training exercises, according to the results of an intervention review and meta-analysis conducted by the Cochrane Incontinence Group.¹
   
Overactive bladder syndrome, more common in women and older persons, affects more then 22 million people and causes a significant reduction in quality of life because of urinary urgency or urgency urinary incontinence. Treatments include anticholinergic drugs and nonpharmacological interventions, such as pelvic floor exercises and bladder training techniques (a form of behavioral therapy). However, it is unclear which treatments are most efficacious, cause the fewest adverse effects, and are cost-effective.
   
Researchers identified randomized and quasi-randomized controlled trials involving treatment with anticholinergic drugs for overactive bladder syndrome that had at least one study arm centering on a nonpharmacological therapy. None of the trials included patients with neurogenic bladder dysfunction. A total of 23 trials representing 3685 participants were included. The researchers reported that the follow-up periods in the included trials varied from 2 to 52 weeks and that the sample sizes generally were small and the methodological quality was poor.
   
When anticholinergic drugs were compared with bladder training, symptom improvement occurred more often with anticholinergic drugs alone. When anticholinergic therapy was augmented with bladder training exercises, there was more symptomatic improvement than that occurring with bladder training alone. However, it was unclear whether augmentation of anticholinergic therapy with bladder training was more effective than anticholinergic therapy alone.
   
The evidence showing any benefit to combining behavioral modification strategies with anticholinergic therapy was inconclusive, as was whether behavioral strategies alone were associated with more symptom improvement than anticholinergic drugs alone. One study found that percutaneous posterior tibial nerve stimulation (PTNS) was associated with significant subjective improvement rates, but the finding was unsupported by significant differences in overall improvement, urinary frequency, urgency, nocturia, incontinence episodes, and quality of life. Of the various types of electrical stimulation modalities, PTNS was the only one that showed any benefit over anticholinergic medication. However, PTNS should be considered solely in patients refractory to anticholinergic therapy until additional evidence better supports the benefits of PTNS, suggest the authors.¹
   
About one third of all patients who use anticholinergic drugs report dry mouth, an adverse effect that is unlikely to continue after treatment has ended. The authors advise that all reported results should be viewed with caution because of the various types and doses of anticholinergic drugs that were used in the included trials.

Pertinent Points:
- For overactive bladder syndrome, anticholinergic drugs were associated with more symptom improvement than bladder training alone.
- Augmentation of bladder training techniques with anticholinergic therapy more effectively improved symptoms of overactive bladder syndrome than bladder training techniques alone.
- Percutaneous posterior tibial nerve stimulation was the only type of electrical stimulation modalities associated with statistically significant subjective improvement rates.
 

References:

1. Rai BP, Cody JD, Alhasso A, Stewart L. Anticholinergic drugs versus non-drug active therapies for non-neurogenic overactive bladder syndrome in adults. Cochrane Database Systematic Rev. 2012;12:CD003193. DOI: 10.1002/14651858.CD003193.pub4.