September 18, 2009

Therapies offer only modest bladder relief

Therapies offer only modest bladder relief

Drug therapy and behavior interventions can provide some relief from overactive bladder symptoms, according to a new evidence report written by researchers at Vanderbilt University Medical Center and funded by the Agency for Healthcare Research and Quality.

But, researchers caution, the benefits are modest and the long-term effectiveness of drug treatments is unknown.

More than 11 million women in the United States cope each day with overactive bladder syndrome. Women with this condition suffer from sudden strong urges to urinate, difficulty delaying going to the bathroom, and, in many cases, involuntary loss of urine when the urge strikes.

Investigators Daniel Biller, M.D., Renée Ward, M.D., Katherine Hartmann, M.D., Ph.D., and Melissa McPheeters, Ph.D., M.P.H., and their team at Vanderbilt's Evidence-based Practice Center reviewed 232 clinical studies evaluating the treatment of overactive bladder in women.

These treatments included prescription medications, such as pills and patches, surgeries and procedures, behavioral interventions, and complementary and alternative medicine.

A key overactive bladder symptom, frequent voiding, is defined as urinating eight or more times a day. The investigators found that drugs reduced the number of times women had to urinate by an average of 1.8 to 2.2 times each day. Placebos, or inactive pills, were almost as good as active drug, reducing voids about 1.5 per day. Behavioral therapies had similar results and came with fewer side effects.

“Although the effects were not large, women in studies of drug treatments did report improved quality of life, and that is important information for clinicians” said Biller, assistant professor of Obstetrics and Gynecology at Vanderbilt University.

Some recourse does exist for women who fail drug therapy. Researchers found that surgical interventions and procedures can improve symptoms, but there was a higher rate of complications.

“Procedural and surgical interventions can help, but they also have more risks,” said Ward, assistant professor of Obstetrics and Gynecology at Vanderbilt. “We owe it to women and their providers to get more information about risks and benefits of these interventions.”

Some women turn to complementary and alternative therapies such as acupuncture, hypnotherapy and herbs in hopes of curbing their symptoms, but the research team found little evidence to support the effectiveness of these treatments.

“Current treatments are not a cure. Women and their providers clearly need more options,” said Hartmann, director of the Vanderbilt Evidence-based Practice Center.

To view the report, go to: