Overactive bladder symptoms common with pelvic organ prolapse

by Lori Solomon

Seven in 10 women with pelvic organ prolapse (POP) report overactive bladder (OAB) symptoms, according to a study published online July 13 in the International Journal of Women's Health.

19 sept 2023--Komkrit Aimjirakul, M.D., from Mahidol University in Bangkok, and colleagues examined the prevalence and risk factors for OAB symptoms in women with POP and compared the improvement of OAB symptoms among treatment groups: pelvic floor exercise, pessary, and surgery. The analysis included 754 patients seen at a urogynecology clinic (2016 through 2020).

The researchers found that the incidence of OAB symptoms was 70 percent and two-thirds of patients (65 percent) reported moderate-to-severe bother. Significant risk factors included: the lowest points of the anterior wall (odds ratio [OR], 0.60; P = 0.01), longer perineal body (OR, 0.78; P = 0.02), and previous vaginal delivery (OR, 2.10; P = 0.02). Just over one-third of women experienced improvement in OAB symptoms (36.6 percent) with treatment. Pessary (OR, 1.40; 95 percent confidence interval [CI], 0.94 to 2.07; P = 0.10) and surgery (OR 1.30; 95 percent CI, 0.80 to 2.12; P = 0.28) trended toward a larger effect compared with pelvic floor exercise.

"This information can be useful for patient counseling and to guide patient expectations," the authors write. "Other treatment modalities should be considered in women whose OAB symptoms persist despite POP correction."

More information: Komkrit Aimjirakul et al, A Retrospective Cohort Study on the Prevalence, Risk Factors, and Improvement of Overactive Bladder Symptoms in Women with Pelvic Organ Prolapse, International Journal of Women's Health (2023). DOI: 10.2147/IJWH.S413670

Behavioral therapy first step for overactive bladder in men

Among men with overactive bladder, combined behavioral and drug therapy is superior to drug therapy alone, but not behavioral therapy alone, for symptomatic improvement, according to a study published online Jan. 13 in JAMA Internal Medicine.

16 jan 2020--Kathryn L. Burgio, Ph.D., from the University of Alabama at Birmingham, and colleagues conducted a three-arm randomized clinical trial in which participants aged 40 years or older with urinary urgency and nine or more voids per 24 hours were randomly assigned to six weeks of behavioral therapy alone, drug therapy alone, or combined therapy, followed by step-up to six weeks of combined therapy for all groups. A total of 183 men completed treatment.

The researchers found that in all three groups, the mean voids per 24 hours decreased significantly from baseline to six-week follow-up (behavioral therapy: change, 2.9; percentage change, 24.7 percent; drug therapy: change, 1.5; percentage change, 12.7 percent; combined therapy: change, 13.6; percentage change, 30.5 percent). Posttreatment mean voiding frequencies were significantly lower for those receiving combined therapy versus drug therapy alone (8.2 versus 10.3) but not compared with those receiving behavioral therapy alone (8.2 versus 8.8); frequencies were significantly lower for those receiving behavioral therapy alone versus drug therapy alone (8.8 versus 10.3).

"Behavioral therapy can be implemented by nurses, nurse practitioners, and physical therapists and has potential for widespread application in a variety of outpatient settings," the authors write.

Several authors disclosed financial ties to the pharmaceutical, medical technology, and personal care industries.

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More information: Abstract/Full Text (subscription or payment may be required)

Journal information: JAMA Internal Medicine 

Botox injections can significantly improve quality of life for people with overactive bladders

Botox is well known for its cosmetic uses, but researchers have now found that it can also significantly improve people's quality of life if they suffer from another problem that increases with age, an overactive bladder (OAB).

11 june 2009--A study published in the June issue of BJU International shows that patients who had Botox injections to control bladder problems reported significant improvements in their lives as well as their symptoms for at least 24 weeks.

UK urologists from Guy's Hospital and King's College London carried out a randomised, double-blind placebo trial on 34 patients with an average age of 50. Seven men and nine women received the Botox injections while eight men and ten women received the placebo.

"The Botox or placebo injections were administered using a flexible injection needle inside a cystoscope, a long tube that enables urologists to see inside the bladder" explains consultant urological surgeon Prokar Dasgupta from Guy's Hospital and King's College London School of Medicine.

"This minimally invasive technique involved 20 injections – five in the midline posterior bladder wall, five in the left lateral wall, five in the right lateral wall and five across the dome of the bladder. In all, 200ml of Botox or placebo was administered."

Patients in both groups were assessed when they started the study and at four, 12 and 24 weeks after they received the injection. All the patients who took part in the study had failed to tolerate or respond to anticholinergic drugs, which, along with lifestyle modifications and bladder training, are traditionally used to manage OAB.

Patients who received the Botox injections reported significant improvements when it came to a number of quality of life factors. These were measured using the King's Health Questionnaire, a zero to 100 scale, which was developed in the late 1990s to assess women with urinary incontinence. High scores recorded on the scale indicate a lower quality of life.

All the factors the researchers studied showed a reduction.

The median (mid point) improvements from baseline to 12 weeks were:

• Incontinence impact – from 100 to 65
• Role limitations – from 83 to 50
• Physical limitations – from 75 to 42
• Social limitations - from 72 to 39
• Emotions – from 100 to 65
• Severity measures – from 67 to 34
• Sleep/energy – from 83 to 58
• Personal relationships – from 67 to 50.

Symptom severity in the Botox group fell from 17 to 12 when it was measured on a zero to 30 scale.

The only improvement in the placebo group was role limitations, from a median level of 83 to 66. The rest of the categories showed no improvement.

At 12 weeks the study was unblinded so that both the clinicians and patients knew who was receiving the Botox injections. Further improvements were noted in all categories during this extended period, including sleep and energy and personal relationships, which had not performed as well as the other categories in the first 12 weeks.

Previous research has shown that as many as one in six people over the age of 40 suffer from an overactive bladder and that the condition can have a very adverse affect on people's quality of life.

"Our study showed a significant relationship between the overall improvement in OAB symptoms and improved quality of life scores" says Mr Dasgupta.

"For example, at four weeks urgency and urge urinary incontinence were statistically correlated with improvements in quality of life and the same was true at 12 weeks for frequency and urgency.

"The overall benefits lasted at least 24 weeks after the injections were administered, with patients reporting both a reduction in bothersome bladder symptoms and an improved quality of life."

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Notes to editors

Improvement in quality of life after botulinum toxin-A injections for idiopathic detrusor overactivity: results from a ranzomized double-blind placebo-controlled trial. Sahai et al. BJU International. 103, 1509-1515. (June 2009)

Gel effective for women with overactive bladder

CHICAGO, 05 may 2009- Applying a gel containing the anti-spasmodic agent oxybutynin to the skin is safe and effective for women with overactive bladder, according to a study reported here at the annual meeting of the American Urological Association.

Overactive bladder can be disabling and is associated with a marked decrease in health-related quality of life as well as higher rates of depression, Dr. Roger Dmochowski noted. The condition affects both men and women, but women experience more severe symptoms earlier in life than men.

The gel, which goes by the brand name Gelnique, is applied "once daily to rotating sites on the abdomen, upper arm/shoulders and thigh." Dmochowski of Vanderbilt University Medical Center in Nashville, Tennessee, and others tested it in some 700 women with symptoms of overactive bladder.

The women were randomly assigned to treatment with the oxybutynin gel or an inactive placebo, which they applied once a day for 12 weeks.

By the end of the study period, 27 percent of the women treated with oxybutynin gel achieved complete continence compared with 15.6 percent treated with placebo.

The average daily number of mean urinary episodes dropped by 2.8 episodes with active treatment compared with 2.0 episodes with placebo.

There was also a greater reduction in incontinence, which dropped by 3.0 episodes a day with oxybutynin and by 2.5 episodes a day with placebo.

There were no serious treatment-related adverse events. The most common side effect with oxybutynin gel was dry mouth, occurring in 7.4 percent of the women compared with 2.8 percent with placebo. Itchiness occurred at the application site in 2.3 percent of the study group and 0.9 percent of the placebo group.

The results confirm that the oxybutynin gel "is a novel treatment approach with strong efficacy and excellent tolerability" for women with overactive bladder, Dmochowski commented during the presentation of his team's findings.

"Women with overactive bladder often experience severe symptoms at a young age, so it's important that we have an effective treatment that is both well tolerated and convenient for our female patients," he said.

FDA Approves Drug Treatment for Overactive Bladder

09 nov 2008--The FDA has approved Toviaz (fesoterodine), an anticholinergic agent, to treat overactive bladder in adults. The drug relaxes smooth muscle in the bladder, thereby reducing urinary frequency, urgency, and incontinence. Available doses are 4 and 8 mg daily.
Contraindications include severely reduced kidney function, urinary or gastric retention, uncontrolled narrow-angle glaucoma, severe liver impairment, and use of medications (e.g., ketoconazole) that block fesoterodine metabolism. The FDA also recommends caution in prescribing fesoterodine for patients with decreased gastric motility.
LINK(S):
FDA announcement (Free)