Treatment of overactive bladder in women
Strong EvidenceIn Plain Language: urinary tract problems, explained
The Vanderbilt Evidence-based Practice Center systematically reviewed evidence on treatment of overactive bladder (OAB), urge urinary incontinence, and related symptoms. We focused on prevalence and incidence, treatment outcomes, comparisons of treatments, modifiers of outcomes, and costs. We searched PubMed, MEDLINE, EMBASE, and CINAHL. We included studies published in English from January 1966 to October 2008. We excluded studies with fewer than 50 participants, fewer than 75 percent women, or lack of relevance to OAB. Of 232 included publications, 20 were good quality, 145 were fair, and 67 poor. We calculated weighted averages of outcome effects and conducted a mixed-effects meta-analysis to investigate outcomes of pharmacologic treatments across studies. OAB affects more than 10 to 15 percent of adult women, with 5 to 10 percent experiencing urge urinary incontinence (UUI) monthly or more often. Six available medications are effective in short term studies: estimates from meta-analysis models suggest extended release forms (taken once a day) reduce UUI by 1.78 (95 percent confidence interval (CI): 1.61, 1.94) episodes per day, and voids by 2.24 (95 percent CI: 2.03, 2.46) per day. Immediate release forms (taken twice or more a day) reduce UUI by 1.46 (95 percent CI: 1.28, 1.64), and voids by 2.17 (95 percent CI: 1.81, 2.54). As context, placebo reduces UUI episodes by 1.08 (95 percent CI: 0.86, 1.30), and voids by 1.48 (95 percent CI: 1.19, 1.71) per day. No one drug was definitively superior to others, including comparison of newer more selective agents to older antimuscarinics. Current evidence is insufficient to guide choice of other therapies including sacral neuromodulation, instillation of oxybutynin, and injections of botulinum toxin. Acupuncture was the sole complementary and alternative medicine treatment, among reflexology and hypnosis, with early evidence of benefit. The strength of the evidence is insufficient to fully inform choice of these trea
Key Findings
- ✓Overactive bladder affects more than 10-15 percent of adult women, with 5-10 percent experiencing urge urinary incontinence monthly or more often.
- ✓Six available medications demonstrated effectiveness in short-term studies for treating overactive bladder based on meta-analysis findings.
- ✓Of 232 included publications, only 20 were rated as good quality, 145 as fair, and 67 as poor, indicating limited high-quality evidence in the overactive bladder treatment literature.
What This Means for You
This study found strong evidence that prescription medications effectively reduce overactive bladder symptoms, but it does not evaluate reflexology or complementary approaches for this condition.
What This Means for Practitioners
This systematic review establishes medication as evidence-based treatment for overactive bladder; reflexologists should be aware of this standard of care and refer clients to medical evaluation rather than positioning reflexology as a primary treatment.
Study Design: how this systematic review was run
Urinary tract problems: common questions
What does this study say about urinary tract problems?
This study found strong evidence that prescription medications effectively reduce overactive bladder symptoms, but it does not evaluate reflexology or complementary approaches for this condition.
What did this study find?
Overactive bladder affects more than 10-15 percent of adult women, with 5-10 percent experiencing urge urinary incontinence monthly or more often. Six available medications demonstrated effectiveness in short-term studies for treating overactive bladder based on meta-analysis findings. Of 232 included publications, only 20 were rated as good quality, 145 as fair, and 67 as poor, indicating limited high-quality evidence in the overactive bladder treatment literature.
How strong is this evidence?
This is a systematic review and we rate its evidence strong. It covers 232 participants. It was published in Evidence report/technology assessment. This study is indexed here for context; it did not test reflexology itself.
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