Although drug therapy proved more effective than placebo in achieving continence and improving urinary incontinence (UI) in women, the improvements were small, and treatment discontinuation due to bothersome adverse effects was frequent. 


A research team led by Tatyana Shamliyan, MD, MS, concluded 
in Annals of Internal Medicine that overall, agents for urgency UI (the sudden, compelling urge to urinate, as opposed to stress incontinence, which is the involuntarily loss of urine during such acts as coughing or sneezing) showed similar small benefit. The group based this information on their analysis of 94 randomized controlled trials centering on drugs used for urgency UI in women. 


For every 1,000 women treated with drugs for urgency UI, continence was achieved in: 130 with fesoterodine (Toviaz); 114 with oxybutynin (Ditropan); 114 with trospium (Sanctura); 107 with solifenacin (Vesicare); and 85 with tolterodine (Detrol). 



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Adverse effects led to treatment discontinuation in 63 per 1,000 treated with oxybutynin, 31 per 1,000 treated with fesoterodine, 18 per 1,000 treated with trospium, and 13 per 1,000 treated with solifenacin. 


Inconsistent definitions of improvement in UI and quality of life among studies hampered synthesis of evidence. 


Women who do suffer from UI are often advised to avoid caffeine, but in a recent study, long-term caffeine intake over the course of one year was not associated with risk of progression of either urge UI or stress UI over two years of follow-up in women with moderate incontinence (Obstet Gynecol. 2012;119:950-957).