Tag Archive | "urge incontinence"

Weight Loss Eases Urinary Incontinence in Heavy Women

Leslee L. Subak, MD, of the University of California, San Francisco, and colleagues, reported in a January issue of the New England Journal of Medicine that weight loss may significantly improve urinary incontinence for overweight and obese women.  A loss of about 17 pounds in an extensive six-moth diet and exercise program reduced the average number of weekly incontinence episodes by 47% compared with 28% for the control group.

Losing weight was particularly effective against stress incontinence in the randomized trial, and was as effective overall as behavioral treatments, such as pelvic muscle exercises.  Dr. Subak reports that these findings may help motivate incontinent patients to overcome the common fear of episodes occurring during exercise.  The researchers’ Program to Reduce Incontinence by Diet and Exercise (PRIDE) study included 338 overweight and obese women with at least 10 urinary incontinence episodes per week, with an average of 24 episodes per week.  Participants were randomized to an intensive six-month weight-loss program of reduced-calorie diet, exercise, and behavior modification (226 participants) or to four group classes on the benefits of exercise, a healthy diet, and weight loss (112 participants). By the end of the program, the average weight loss from baseline was 8.0, compared with 1.6% among controls.

More women in the weight-loss group had a clinically relevant reduction of at least 70% in total weekly incontinence episodes, stress-incontinence episodes per week, and urge-incontinence episodes per week.  The primary effect of weight loss was on stress incontinence, which dropped by 57.6% compared with 32.7% among controls.

Urge incontinence, which was more common in both groups at baseline, tended to also decrease with weight loss, but the effect was not significant compared with other controls.

Limitations of the study include the fact that it relied on self-reports, the lack of blinding, and the fact that participants were selected by potential for adhering to behavioral modification, which might limit generalizability.

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Urinary Incontinence is More Frequent Among White than Black Women

Elisa R. Trobridge, MD, of the University of Virginia, and colleagues have found that urinary incontinence occurs in more than twice as many white women as black women.  The reasons are not known; neither frequency of symptoms nor risk factors explained the difference.  The results were reported in the April issue of the Journal of Urology and were based on a survey of about 3,000 women.

Black women, however, with incontinence experienced significantly more urine loss.  Half of black incontinent women described their urine loss as enough to wet their underwear or pads, compared with 37.7% of white incontinent women.  Also, while black women had more urge incontinence, white women had more stress incontinence.

Previous studies derived from surveys and clinical evaluations have suggested differences between black and white women in the prevalence and type of urinary incontinence, but those studies had problems with design, population, and other factors.

This study, on the other hand, was a population-based cross-sectional one.  Dr. Trowbridge and colleagues examined racial differences in prevalence, frequency, quantity, and type of urinary incontinence in community dwelling women ages 35 to 64.  They also investigated demographic, medical history, lifestyle, and obstretric/gynecologic factors that might influence continence status.  Estimates were weighted to reflect probability and nonresponse characteristics of the sample, and to increase generalizability of the findings.

The survey was conducted by telephone and included 1,922 black women and 892 white women living in three counties in southeast Michigan.  The overall prevalence of urinary incontinence was 26.5%.  White women had a significantly higher prevalence (33.1%) than black women (14.6%).  There were no differences in incontinence frequency (about 15 episodes each month).

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Generic Urologic Drugs Less Effective

Two small observational studies suggest that switching from branded to generic urologic drugs led to deterioration of efficacy and more side effects.

In one study, investigators studied 257 men with lower urinary tract symptoms (LUTS) that was treated for at least 6 months with branded medication – alpha-blocker in 169 men and 5 alpha-reductase inhibitor (5ARI) in 88 men. The patients were switched from a branded drug to generic substitute as required by the patient’s insurance company or by the patient’s primary care physician.  After the switch the men were followed for a year.

The mean baseline symptom score (IPSS) for patients on alpha-blocker was 8.9, after the switch to generic drug it increased to 12.9 at six months and 13.2 at 12 months.

For 5ARI, the mean IPSS was 11.3 which increased to 14.7 at six months and 16.2 at 12 months after the switch.

The mean PSA value increased from 1.1 to 1.7 ng/mL in the 12 months after switching from Avodart (dutasteride) to generic finasteride and from 1.2 to 1.5 ng/mL in men switched from Proscar to generic finasteride.

A third of patients in the Avodart group had more than a 0.75 ng/mL rise in PSA after the switch, as did 14% of the Proscar group.

Dr. Steven Kaplan, M.D. of Weill Cornell Medical College in New York said “The PSA changes after the switch to generic finasteride could have been sufficient to trigger unnecessary biopsies.”

Side effects which include dizziness, nasal congestion, and ejaculatory dysfunction also increased by 2% to almost 5% after the switch from branded to generic alpha-blocker.  Because of adverse effects, 26 men were switched back to the branded alpha-blocker.

In the second study, 87 women and 69 men with overactive bladder were switched from a branded anticholinergic drug to generic oxybutynin.  After the switch, the women had 29.4% increase in the rate of urge incontinence and similar increases in frequency and nocturia.  Men had increased rates of urge incontinence, nocturia and frequency. Postvoid residual increased by 15 mL in women and by 18.9 mL in men after the switch.

Following conversion from branded to generic drugs, the frequency of dry mouth and constipation increased in women by 36.4% and 23.01%, respectively, and by 39.5% in men.

“These findings should not consider generic drugs as bad or that it should go away.  People should understand what generic drugs are and make their decisions accordingly.” said Dr. Kaplan.

Generics drugs have been gaining popularity. Prescriptions of generic drugs increased by 12% a year from 2004 to 2008 whereas prescriptions for branded drugs decreased by 6% a year.  In 2008, generic drugs accounted for 2.4 billion prescriptions compared to 1.4 billion branded drugs.

Manufacturers of generic drugs only need to demonstrate the bioequivalence of their drugs vis a vis the branded version.  In the U.S. the definition of bioequivalence encompasses the range from 80% to 125% of the active compound.

That definition means that generics within a specific drug class can vary substantially in the bioavailability of the active compound and that generic versions of individual drugs within the class may exhibit just as much variability.

“The bottom line is that bioequivalence does not mean therapeutic equivalence,” said Dr. Kaplan.

Note that these studies were published as abstracts and presented orally at a conference.  These data and conclusions should be considered to be preliminary.

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The Relationship between Menopause and Bladder Control

Some women have bladder control problems after they stop having periods (menopause or change of life).

After your periods end and you have been “period-free” for 12 consecutive months, your body stops making the female hormone estrogen. Some scientists believe estrogen may help keep the lining of the bladder and urethra firm and healthy. A lack of estrogen could contribute to weakness of the bladder control muscles.

In some women there is only a slight change but for others the muscles weaken to the point where holding back even small amounts of urine is very difficult. The result is urinary incontinence or quite simply, urine leaking from the body before it should.

There are two kinds of urinary incontinence – stress incontinence and urge incontinence. Pressure from coughing, sneezing or lifting can push urine through the weakened muscle. This kind of leakage is called stress incontinence. Urge incontinence means the bladder muscles squeeze at the wrong time or all the time and cause leaks.

According to the National Institute of Diabetes, Digestive, and Kidney Diseases (NIDDK) taking estrogen does little to counter the effects of weakened bladder muscles. There are also concerns about taking estrogen for too long and during your post-menopausal years as there are added risks from taking estrogen for many years. Taking estrogen in small does may help thicken the bladder lining and decrease the incontinence although estrogen will not repair the weak muscles or reverse the effects of declining hormonal levels. Your doctor can suggest many other possible treatments to improve bladder control.

Talk to your health care team. You may have stress or urge incontinence, but other things could also be happening. Medicines and exercises can restore bladder control in many cases. Your doctor will give you a checkup first.

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