A new National Institutes of Health clinical trials network study evaluated two urge incontinence treatments in women and found that there are both plusses and minuses to each. Urge incontinence is defined as the unpredictable release of urine shortly after you get the urge to go (stress incontinence wasn’t evaluated in this study). This unpredictability means relying on incontinence supplies, like adult diaper pads, to absorb any leaks and protect clothes, but also often forces lifestyle changes that can harm quality of life.
This year long study looked at two treatments of urinary incontinence, oral anticholinergic medications and injections of Botox into the bladder muscle. The cause of urge incontinence is usually unknown, but results from the unpredictable activity of the bladder muscles. Anticholinergic medications reduce bladder contractions by targeting bladder muscles via the nervous system. Botox injections work by relaxing the overactive muscles directly. This NIH study included close to 250 women with an average age of 58 years old. The women received treatment for six months and then were monitored for another six months.
First the good news. After the intial six months, women in both treatment groups said that their average number of incontinence incidents dropped from 5 to just 1 or 2 a day. About 90 percent of the women in each group responded to treatment within one month; at the end of six months, about 70 percent of the women in each group said their symptoms were adequately controlled.
The Botox group did fare better: 27 percent of the women receiving Botox said their urinary leakage completely went away six months after starting treatment compared to 13 percent of those taking the oral medication. Nine months from the starting point, 52 percent of the women in the Botox group reported adequate symptom control, compared with 32 percent in the drug group. At the 12-month mark, the figures were 38 percent and 25 percent.
"Previously, Botox was reserved for women who had tried oral medications, but found them ineffective. Because we included some women who had not been treated with oral medication before, these results suggest that Botox could be discussed as an option for first line treatment," said study senior author Susan F. Meikle, MD, MSPH, of the Contraception and Reproductive Health Branch of the NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development and Program Director of the Pelvic Floor Disorders Network.
Now for the drawbacks. Anticholinergic medications often have side effects such as constipation, dry mouth, and dry eyes, and nearly half the women who took it in this study did experience some dry mouth. Women in the Botox group were more likely to experience incomplete bladder emptying or bladder infections; two months after the start of treatment, they needed to use a catheter more often to empty their bladders completely (5 percent compared to 0 percent) and one third (compared to 13 percent) were more likely to get a UTI.
The bottom line? Talk to your doctor about which of these options might be worth trying to reduce your reliance on incontinence supplies and help you maintain a more active lifestyle.