Do Medications for Urinary Incontinence Cause More Harm Than Good?

Urinary incontinence plagues as many as 17% of women in the United States. Although women with urgency urinary incontinence are generally treated with lifestyle changes and pelvic floor muscle and bladder training, there are some medications available that claim to ease the disease burden. But how well do these medications work?

To answer this question, Dr. Tatyana A. Shamliyan, senior research associate in the division of health policy and management in the University of Minnesota School of Public Health, and colleagues  conducted a systematic literature review of randomized, controlled trials of drugs for urgency urinary incontinence in women (N=94).

Overall, Shamliyan and colleagues found that while the drugs were more effective than placebo in achieving continence and improving incontinence issues, the medications did so with low magnitude of effect. Specifically, they found that continence could be attributed to benefits of pharmacological agents in less than 20% of cases. Fesoterodine was found to the most effective medication, with continence achieved in 130 per 1,000 women treated. Tolterodine was found to be the least effective, with only 85 per 1,000 achieving continence.

Meanwhile, the drugs were more often associated with adverse events than placebo. Shamliyan et al. found that dry mouth was the most commonly reported adverse effect. Other adverse effects included dizziness, constipation, and blurred vision. Of the drugs studied, oxybutynin had the highest rate of discontinuation due to adverse events, with 63 women per 1,000 women discontinuing. Solifenacin appeared to have the least bothersome adverse events associated with it, with only 13 per 1,000 discontinuing due to adverse events.

 However, there were some limitations associated with the study. For instance, there was limited evidence of quality-of-life improvements. Similarly, comparative effectiveness with the medications was limited, and the study was unable to completely analyze effects of race, baselines severity, and comorbid conditions on treatment success.

“Overall, drugs for urgency UI [urinary incontinence] showed similar small benefit,” Shamliyan and colleagues concluded. “Therapeutic choices should consider the harms profile. Evidence for long-term adherence and safety of treatments is lacking.”

References:

Shamliyan T, Wyman JF, Ramakrishnan R, et al. Systematic review: benefits and harms of pharmacologic treatment for urinary incontinence in women. Ann Intern Med. 2012; Apr 9 [Epub].