Study shows benefits, drawbacks, for women's incontinence treatments

Oral medication for treating a type of incontinence in women is roughly as effective as Botox injections to the bladder, reported researchers who conducted a National Institutes of Health clinical trials network study, with each form of treatment having benefits and limitations.

After six months, women in both treatment groups said that the average number of daily episodes had declined from about five per day to about 1-2 per day.

In the study, the researchers compared the effectiveness of Botox injections to oral anticholinergic medications for treating urge urinary incontinence in women. Nearly 250 women participated in the trial comparing Botox injections with anticholinergic medications. On average, the women were 58 years old. Anticholinergic medications reduce bladder contractions by targeting the bladder muscle through the nervous system. Many women who take anticholinergic medications relate having unpleasant side effects, including constipation, dry mouth and dry eyes

The proportion of women receiving Botox whose urinary leakage completely went away six months after starting treatment (27 percent) was twice that of the group taking oral medication (13 percent). Women in the Botox group were more likely to experience incomplete bladder emptying or bladder infections, while the women taking the medication were a little more likely to report that they had dry mouth - a common side effect of the medication.

The study focused on treatment for urge urinary incontinence-- the unpredictable release of urine shortly after feeling the urge to urinate. Information on urge incontinence as well as other kinds of incontinence is available from the National Institute of Diabetes, Digestive, and Kidney Diseases at http://kidney.niddk.nih.gov/kudiseases/pubs/uiwomen/index.aspx.

Women are twice as likely as men to experience urinary incontinence, and older women are more likely to experience it than are younger women. An estimated 15.7 percent of U.S. women experience urinary incontinence. Pregnancy and childbirth, menopause, and the structure of the female urinary tract account for this difference.

"This is the first study to compare the effectiveness of Botox treatments to oral medication," said study senior author Susan F. Meikle, M.D., M.S.P.H., of the Contraception and Reproductive Health Branch of the NIH's Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and Program Director of the Pelvic Floor Disorders Network (PFDN). "Previously, Botox was reserved for women who had tried oral medications but found them ineffective. Because we included some women who had not been treated with oral medication before, these results suggest that Botox could be discussed as an option for first line treatment."

First author Anthony G. Visco, M.D., of Duke University Medical Center, in Durham, N.C., was the principal investigator of the study. He collaborated with Dr. Meikle and researchers affiliated with Loyola University Chicago; University of Alabama at Birmingham; University of Utah, Salt Lake City; Cleveland Clinic; Kaiser Permanente San Diego; University of Texas Southwestern Medical Center in Dallas; University of Pittsburgh; Oakwood Hospital and Medical Center, Dearborn, Mich.; Oakland University, Royal Oak, Mich.; University of Michigan, Ann Arbor; RTI International, Research Triangle Park, N.C.; and other researchers associated with the NICHD-supported PFDN.