The Minster Practice, Lichfield

14% of women aged 30 -70 admitted to incontinence in a MORI poll. This is likely to be an underestimate. One third of sufferers report it to their GP soon, one third after a delay and one third suffer in silence.

Stress Incontinence

Small losses of urine without warning throughout the day and related to coughing and exercise. The main cause is prostatectomy in men and childbirth in women. Pelvic floor exercises help 60%.

About one sixth of adults report symptoms of overactive bladder, which can include urgency, urge incontinence, frequency, and nocturia. The 2 main recommended treatments are bladder retraining and anticholinergic drugs. In particular, use of anticholinergics is increasing. Investigators from New Zealand and Australia conducted this systematic review of the literature to define more clearly the value of anticholinergic drugs for overactive bladder.

The researchers analyzed data from 32 trials that involved 6800 participants. Anticholinergic agents were shown to be significantly more effective than placebo for all key outcome measures. By the end of treatment, self-reported improvement was 1.4 times more likely in the anticholinergic group than in the placebo group. Anticholinergic patients averaged 0.6 fewer incontinence episodes and 0.6 fewer voids per 24 hours. Their cystometric capacity was 54 mL greater and volume was 52 mL greater at first contraction. Dropout rates were similar for the 2 groups, but active treatment was 2.6 times more likely to be associated with dry mouth.

Comment— Keith I. Marton, MD Published in Journal Watch May 30, 2003
This analysis reveals statistically significant improvements with anticholinergic therapy; however, the clinical effect is not compelling. What we're missing is a comparison of anticholinergic therapy with bladder retraining and measurement of the effect of such therapies on quality of life. At the time of publication, the full text of the original article was available at http://bmj.com/cgi/content/full/326/7394/841 free of charge.
Source Herbison P et al. Effectiveness of anticholinergic drugs compared with placebo in the treatment of overactive bladder: Systematic review. BMJ 2003 Apr 19; 326:841-4.

Send mail to webmaster @minster.org.uk with questions or comments about our website. N.B. Website is for practice patients ONLY.
Copyright © 1997-2007 Dr Michael Causer Click here for full copyright notice & site warning.
Homepage last modified: August 25, 2008.