hey guys welcome back to my channel dr rena malik urologist and pelvic surgeon
here today we are going to be talking about
bladder medications specifically medications for
overactive bladder are they safe? are they effective?
well stick around because you're going to find out
so first off what exactly is overactive bladder well overactive bladder is a
constellation of symptoms or group of symptoms
that include urgency or the sensation that you have to rush to the bathroom
and you can't hold off frequency having to go to the bathroom
more often than usual and what the definition that we use in urology is
more than eight times in 24 hours and urgency urinary
incontinence or leakage of urine that occurs with that
sudden desire to go to the bathroom that you can't delay
and nocturia or waking up at night to urinate
i've talked about five easy things you can do for your overactive bladder
without medication before i've also talked about bladder irritants
which are things that can cause symptoms of
overactive bladder so make sure you check those two videos out
if you've done all those things and you're still having some of these
symptoms the next step in the pathway of
treatment is to try some medications so i'm going to talk about the two
classes of medications for overactive bladder
and the two different types of medication that you might see
are a group of medications called anticholinergics some names you might
see are oxybutynin tropsium, tolterodine, solifenicin
and there's lots of different kinds and then there's beta-3 agonists and the
only one that we have out on the market right now
is called mirabegron so i'm going to talk about each of these medications
and i'm going to talk about at the very end the latest research
linking these anticholinergics to dementia is it real is this something
you need to worry about make sure you stick around to the end of the video to
find out so the way anticholinergics work is they
bind to a receptor on the bladder wall and when they do that they inhibit
anything in the body from binding to that receptor
and normally when the body does bind a molecule to that receptor it causes the
bladder to contract so this is inhibiting bladder
contractions or squeezing so what you can imagine then is if this
receptor is not able to be activated you're having less strong contractions
so you're decreasing the contractions which will subsequently decrease the
amount of urgency that you feel or that strong
desire to go and how severe that urge is when you get it
it will also give you more time to get to the bathroom so you have less
accidents and it will increase the size of your bladder
and it will give you more time between voids so if you're going very often
during the day it will give you some more space between needing to rush to
the bathroom and so does it really work well when you
look at the studies they compared giving these medications
compared to placebo or like a sugar pill and indeed they found that people taking
anticoagulants did have less incontinence less urgency episodes less
frequent voids and had a larger volume voided per micron which means that when
they go to the bathroom they're emptying more volume of their bladder so that
kind of is a surrogate for telling you how big your bladder is or how much
urine your bladder can hold great so these medications work so why
aren't people with overactive bladder taking these medications
all the time well there are some really significant side effects
these can include blurry vision constipation
dry eyes dry mouth and some cognitive changes
so people may have decreased attention and reaction time
and may have a little bit of decrease in their short-term memory
so this doesn't happen to everybody but it certainly can
happen so these medications are not given to people who already have some
baseline signs or symptoms of changes in their
cognition or their brain activity also you can't get these medications if
you have any sort of urinary retention you can check out my last video on
urinary retention where i react to house to learn a little bit more about that
also if you have narrow angle glaucoma and i'm not the right person to tell you
about narrow angle glaucoma so ask your
ophthalmologist if you have that because that would preclude you
from having getting this medication if you potentially needed it
or if you have what's called gastroparesis and gastroparesis
is when your gut is slow in digesting the food you eat
so when you look at the data on anticholinergics you'll find that almost
60 percent of people will stop taking anticholinergics by six months so why is
that well one maybe it's not efficacious two
because of the side effects that they might notice
the one that i just talked about three because they feel like
they wanted to try to get by without it and they felt fine without it so they
did four because they don't want to take
medications forever or five because they didn't really know there were other
treatment options so they just stopped and they didn't ask for anything else
so i think the big take home from that is if you get put on a bladder
medication it's important you follow up because there are other treatment
options and there are other ways that we can help improve your
overactive bladder without medication so moving on to the second kind of
medication which is called a beta-3 agonist or again the
name is mirabegron of the only medication
that's on the market in the united states right now
and how this medication works is it actually binds to a receptor
and it mimics what would normally bind to that receptor and it causes the
bladder to relax so this medication works by
causing a decrease in what we call sensory urgency or the sensation or
feeling that you gotta go gotta go and also increases your bladder capacity
or makes it bigger and allows it to hold more
this medication has very few side effects the one that we caution
all patients on are making sure you check your blood pressure about a week
after starting it can increase your blood pressure very
slightly by about 10 millimeters of mercury but we do want you to check and
make sure that you don't fall into a category
where your blood pressure is too high other side effects can include a stuffy
nose or headaches you do want to check with your doctor if
you're on any medications that you might need to adjust with this medication
the most common medication that does sometimes require some adjustment of the
dose you're taking is a medication called a beta blocker or
metoprolol toprol things like that generally
speaking this medication is really well tolerated a lot of people do pretty well
on it the issue is that it is still a brand
name medication which sometimes makes it costly based on insurance
and so despite having a little bit of a better side effect profile sometimes
people can't afford it and have to try the other class of medications
okay so i promise at the beginning of this video that i would talk about the
linkage of anticholinergics with dementia where
does that come from does that hold any weight and should you be concerned about
it well there were two major studies that
were published relatively recently that go into some
significant detail on the linkage of dementia with anticholinergic
medications and i'm going to go through both of them
so the first study was published in the british medical journal in
2018 and what they did was they looked at a big
research database that they had and they found 40
000 people with dementia age 65 and above and they paired them up with
other people in that same database who were very similar to them in
age other medical problems other conditions that were important
and they matched them up and they compared the two groups either with
dementia and without dementia and what they specifically looked at was
the medications they were on anywhere between 4 and 20 years before
getting the diagnosis of dementia they did try to control for what's
called confounding factors and confounding factors are
basically things that could actually be causing or related to the dementia that
might also be commonly seen in people who are taking
anticholinergic so they looked at things like age
smoking medications other things that might also
cause dementia and what they found specifically
was that bladder medications were associated with a higher risk of getting
dementia if they took bladder medications anytime
between the four and 20 years prior to getting diagnosed
with dementia i think the big criticism of this study
is one it's retrospective meaning it's looking at a database it's not
prospective two we also don't know if they were able
to control for all confounding factors because
really we don't know what causes dementia
and we also can't control for if they took the medication or if they took any
over-the-counter anti-cholinergic medication so there are
over-the-counter anticholinergic medications available at
least in the united states and so some people could be taking them
who were in the not dementia group the other theory that goes along with a
lot of this data is that there may be something similar
in the group of people who get anticholinergics and the group of people
who get dementia meaning that the actual cause for
example bladder symptoms might be preceding their dementia
because we do know that bladder symptoms are sometimes a very first sign of
a neurologic problem in some conditions like multiple sclerosis so
it might be that this is actually an indicator of dementia and if your
bladder symptoms are bad enough it may be that this is the first
symptom that you're going to see so again we don't know enough i think it's
hard to really say that one causes the other all we
know is that there is a correlation so should that stop you from
taking medications that might improve your quality of life
i think it's up to you to decide that but i tell people if your quality of
life is really that poor then you should really consider taking
medications that might help you the next study was actually very similar
to this first one it was published in the journal of the american medical
association and they again were a group out of
england that looked at nearly 60 000 people who
had dementia and compared them with a bunch of control so
nearly 250 000 controls who were again matched to the people with dementia and
so then they again compared them and what was different
about the study was they looked at total standardized daily dosing so they said
how much anticholinergic do you need to take for their correlation to exist with
dementia again i'm not saying causation because we don't know
if it's causing dementia or not but we do know that there is a
correlation and so how much and what they looked at and found was that
actually three years or total standardized daily
dosing of equivalent of three years was correlated
with dementia again this study was limited in the
older population above 65 years of age and they looked at again using
anti-clinics for any period of time from 11 years prior to the diagnosis up
until the diagnosis while these both are really excellently
in well done studies i think ultimately we still don't know
what causes dementia and it's really hard to say if
anticholinergics specifically are causing dementia or there's some
combined confounding factor that is common in both groups so again i
think that the same take-home applies is that yes
there is a correlation so you want to use it with caution
i would tell you if you notice any changes in yourself or your family
member who's taking an anticholinergic like they're forgetful
they're they've changed some factor in their cognitive
mindset then i would try to take them off those medications
and you should review your medications every time you see your doctor and say
hey why am i on this what is this doing for me do i really
need this medication because there are certain medications
like anticoagulants which people will put you on for bladder symptoms
you'll forget why you're on it and you may not even be really receiving
that much benefit from it so you do need to kind of reevaluate your medications
every time you see your doctor and lastly what i want to let you guys all
know is that there are third line therapies for overactive
bladder these include botox injections in the bladder a
bladder pacemaker called sacral neuromodulation
or there are treatments based in acupuncture called posterior tibial
nerve stimulation which is basically similar to
acupuncture that helps improve overactive bladder
and so these things i can talk about in future videos if you are interested
please let me know down below thank you so much for watching i really
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every monday and always remember to take care of yourself because you're
worth it