How to End the Tyranny of an Overactive Bladder: Amid Concerns About a Top-Rated Incontinence Drug’s Dementia Risk, Our Top Doctor’s Guide to What YOU Can Do Instead

Incontinence is one of the most common problems I see in my clinic. And in many cases, it’s due to a condition called overactive bladder syndrome, which causes patients to constantly need to go to the bathroom.

It is caused by muscle spasms in the bladder, and sufferers often say they feel trapped at home, for fear of being caught while out and about.

Millions of people with overactive bladder syndrome are prescribed daily anticholinergics, tablets that can reduce the frequency of spasms.

But research has linked anticholinergics with an increased risk of dementia. This must be worrying reading for those who suffer from it.

However, not only are alternative medicines available, but simple steps can also be taken to reduce the distressing symptoms of an overactive bladder.

I am taking these tablets for my overactive bladder; Now I’m worried about the risk of dementia. Should I take them off?

There is no simple answer to this; It really depends on the patient and the circumstances.

A study published in the British Medical Journal concluded that taking anticholinergics increases the risk of dementia by 18 percent. This can’t be ruled out (and I wouldn’t say “don’t worry”), but it’s not a foregone conclusion either.

If someone already suffers from cognitive impairment, they probably should not take anticholinergics. And we are cautious about this in those over 65 years of age in general. They are likely to be more at risk. But that doesn’t mean they have to give up drugs.

As with all pills, it’s about weighing the pros and cons.

Concerns about dementia aside, if a patient has been taking pills for years and their incontinence is well controlled, it might be time to reduce the dose or take a break. In some cases, symptoms do not return, meaning the medication is no longer needed. However, they may be taking anticholinergics and doing other things to help control overactive bladder, such as pelvic floor exercises and avoiding caffeine and alcohol, but they are still having problems.

Therefore, we might suggest periodic reviews. And if there is a real concern about dementia (for example, due to family history), we could discuss alternative medicines and treatment options.

So what are the alternative medicines I can take?

First, we believe that only certain anticholinergics increase the risk of a dementia diagnosis.

Patients prescribed oxybutynin hydrochloride, tolterodine tartrate, or solifenacin succinate are approximately one-third more likely to develop dementia.

But those taking darifenacin, fesoterodine fumarate, flavoxate hydrochloride, propiverine hydrochloride, and trospium chloride are not at increased risk. Darifenacin is one of the first drugs that NHS guidance recommends GPs prescribe.

Unfortunately, oxybutynin hydrochloride, tolterodine tartrate, and solifenacin succinate (all three linked to dementia) are considered the most effective medications for treating overactive bladder.

If patients are concerned about taking these tablets, they can ask their GP to switch them to a different anticholinergic.

But they may have already tried it, without success, or may see their symptoms worsen after switching to the new pill.

Crucially, anticholinergics should not be taken long term without review and many patients will be advised to take them for a while.

If I want to stop taking pills, are there non-drug ways to control overactive bladder?

The short answer is yes. Caffeine and alcohol should be avoided as they can irritate the bladder and worsen symptoms.

Patients also cite green tea (many people don’t know it has caffeine), spicy food, citrus fruits, tomatoes, and soft drinks as triggers. Obesity increases the risk of overactive bladder syndrome, and patients who lose weight often see their symptoms disappear.

This can’t be done overnight, but other research suggests that regular exercise also relieves symptoms.

For many women, overactive bladder is a sign of an underlying menopause-related condition called genitourinary syndrome. This is due to low estrogen levels, which causes vaginal and vulvar dryness, itching, pain during sex, and overactive bladder symptoms.

This can be treated with an estrogen cream that is applied to the vagina. This is why it is important for any woman with an overactive bladder to be examined by a GP for signs of genitourinary syndrome of menopause. A common mistake patients make is to avoid drinking water in the hopes that this will mean they will need to urinate less.

However, not only does this not work, it can also mean that the urine is more concentrated, further irritating the bladder.

I have heard that you can retrain your bladder to stop the urge to urinate. Is this true?

Yes, GPs should be able to refer patients with overactive bladder to bladder drilling, also known as bladder retraining, on the NHS. A physical therapist or women’s health specialist will prescribe exercises that train the bladder to hold larger volumes.

At first, patients may be advised to urinate every hour. Little by little they will increase to five or 15 minutes until they can last up to four hours.

This usually involves learning coping techniques, such as squeezing your pelvic floor when the urge to go arises and then counting to a certain number, crossing your legs, or sitting on a rolled towel.

It may take several months before patients notice improvement, but many people’s lives have improved thanks to bladder retraining.

I’ve tried everything but nothing seems to help. Could surgery be the answer?

Yes, but there are other less invasive options that patients should try first.

One is regular Botox injections into the bladder, which help relax the organ and relieve symptoms. However, some patients have difficulty completely emptying their bladder as a result of the injections.

Another is nerve stimulation, in which an electrical shock is used to stimulate the nerves in the ankle or lower back, which can improve bladder function in some people.

In extreme cases, patients may be offered cystoplasty, a procedure in which the bladder is enlarged to relieve symptoms.

However, the surgery is only offered to a limited number of NHS patients, who often have to wait years. For most sufferers, lifestyle changes and bladder retraining (not surgery or medications) are key to solving the problem.

What is the difference between a rotator cuff injury and a frozen shoulder?

Rotator cuff injury occurs when the muscles and tendons surrounding the shoulder joint are damaged or torn. This can occur suddenly or gradually due to overuse, particularly in repetitive overhead activities. Symptoms include pain when raising or lowering the arm and weakness in the shoulder.

Treatment ranges from rest and physiotherapy to surgery in severe cases.

Frozen shoulder is a condition in which the shoulder joint begins to feel thick and tight, causing progressive stiffness and reduced range of motion. The condition usually resolves on its own within one to three years, although physical therapy and steroid injections can help control symptoms.