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Intervention Review

Anticholinergic drugs versus placebo for overactive bladder syndrome in adults

  1. J Hay-Smith,
  2. P Herbison,
  3. G Ellis,
  4. K Moore

Editorial Group: Cochrane Incontinence Group

Published Online: 22 JUL 2002

DOI: 10.1002/14651858.CD003781

How to Cite

Hay-Smith J, Herbison P, Ellis G, Moore K. Anticholinergic drugs versus placebo for overactive bladder syndrome in adults. Cochrane Database of Systematic Reviews 2002, Issue 3. Art. No.: CD003781. DOI: 10.1002/14651858.CD003781.

Author Information

*Dr Jean Hay-Smith, Lecturer, Rehabilitation Teaching and Research Unit, Department of Medicine, Wellington School of Medicine and Health Sciences, University of Otago, PO Box 7343, Wellington, NEW ZEALAND. jean.hay-smith@otago.ac.nz.

Publication History

  1. Published Online: 22 JUL 2002

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Abstract

  1. Top of page
  2. Abstract
  3. Synopsis

Background

Around 16% of adults have symptoms of overactive bladder (urgency with frequency and/or urge incontinence). The prevalence increases with age. Anticholinergic drugs are commonly used to treat this condition.

Objectives

To determine the effects of anticholinergic drugs for the treatment of overactive bladder syndrome.

Search strategy

The Cochrane Incontinence Group trials register was searched to January 2002.

Selection criteria

Randomised or quasi-randomised trials in adults with overactive bladder syndrome that compared an anticholinergic drug with placebo treatment or no treatment.

Data collection and analysis

Two reviewers independently assessed eligibility, trial quality and extracted data. Data were processed as described in the Cochrane Collaboration Handbook.

Main results

Fifty one trials, 32 parallel designs and 19 crossover designs were included (6713 adults). Most trials were described as double-blind, but were variable in other aspects of quality. The crossover trials did not present data in a way that allowed inclusion in the meta-analysis. Seven medications were tested: darifenacin; emepronium bromide or carrageenate; oxybutynin chloride; propiverine; propantheline; tolterodine; and trospium chloride. One trial included the newer, slow release, formulation of tolterodine.

After treatment, cure/improvement (RR 1.41, 95%CI 1.29 to 1.54), changes in leakage episodes in 24 hours (WMD -0.56, 95%CI -0.73 to -0.39), number of voids in 24 hours (WMD -0.59, 95%CI -0.83 to -0.36), maximum cystometric volume (WMD 53.85 ml, 95%CI 42.28 to 65.41), and volume at first contraction (WMD 52.25 ml, 95%CI 37.45 to 67.06), were significantly in favour of medication. Medication was associated with significantly higher residual volumes (WMD 4.06 ml, 95%CI 0.73 to 7.39) and more than two and a half times the rate of dry mouth (RR 2.61, 95% CI 2.27 to 3.00). Sensitivity analysis, while limited by small numbers of trials, showed little likelihood that these effects were modified by age, sex, diagnosis, or choice of drug.

Authors' conclusions

The use of anticholinergic drugs by people with overactive bladder syndrome results in statistically significant improvement in symptoms. However, the clinical significance of these differences is uncertain, and the longer-term effects are not known. Dry mouth is a common side effect of therapy.

 

Synopsis

  1. Top of page
  2. Abstract
  3. Synopsis

Plain language summary

Anticholinergic drugs can help adults with overactive bladders, but may not make a big difference and may cause dry mouth.

Many adults have overactive bladders (needing to urinate often and/or leaking urine when there is a strong urge to pass urine). This is also called urge or urgency-frequency syndrome, and becomes more common with age. Treatments are drugs or conservative measures such as bladder training. Anticholinergic drugs can reduce the overactivity of the bladder muscle. The review of trials found that on average, this means saving one trip to the toilet or one leakage every 48 hours. A dry mouth was reported by about one in three people taking the drugs.