Signs of OAB
Urinating more than eight to 10 times a day, getting up several times a night, or leaking urine because your loved one can’t get to the restroom soon enough are all signs of OAB and UI.
With a range of symptoms, including an urgent need to urinate, incontinence, frequent urination, and more, overactive bladder (OAB) affects 30 million Americans—mostly middle-aged and older adults.
While common, OAB is not a normal part of the aging process, and finding effective treatment can be a game-changer for both you and your loved one.
Unfortunately, a treatment commonly used for OAB – known as anticholinergic medications – has been linked to cognitive decline and dementia in older people.
Anticholinergic medications are often a first-line treatment
Prescription and over-the-counter anticholinergic medications are marketed under a variety of names you might recognize, including Detrol, Enablex, Vesicare, Ditropan and Oxytrol for Women. Although OAB can’t be cured, anticholinergic medications may improve OAB symptoms by relaxing bladder muscles.
Anticholinergic medications also interfere with a chemical messenger, called acetylcholine, which plays a role in nerve and muscle function, as well as memory, arousal, learning and thinking.
Side effects of anticholinergic medication
By blocking acetylcholine, anticholinergic medications can and do have effects beyond their targets—and the brain is not exempt. Far-reaching side effects range from annoying to potentially harmful—dry eyes and dry mouth to dizziness and confusion.
Anticholinergic side effects can be more severe in older people, in those taking more than one anticholinergic medication, or in those taking anticholinergics for longer periods of time. Beyond dizziness and confusion, two worrisome side effects include cognitive decline and a higher risk of dementia in this population.
Adverse cognitive side effects
Studies show anticholinergic medications are associated with cognitive decline in older people, especially in those with a family history of dementia or those with genetic markers for Alzheimer’s disease. An observational study also showed the risk of developing dementia increases by nearly 50% in people with OAB or other medical conditions who took strong anticholinergics daily for more than three years. Because this study was observational, however, it’s impossible to know if the anticholinergic medication was directly responsible for the dementia.
Stopping anticholinergic medications under the supervision of your health care provider may provide short-term improvement in cognitive impairment.
“Unfortunately, if the underlying disease is Alzheimer’s, these patients are going to get worse,” said Dr. Richard Stefanacci, DO, a practicing geriatrician and lead author of a recent survey on urinary incontinence in long-term care facilities. “Patients shouldn’t get worse from something we give them. It’s not like we don’t have safer alternatives for treating overactive bladder.”
Stefanacci joins other researchers and clinicians when he said the risks and benefits of anticholinergic medications should be weighed before prescribing them to older adults. If needed, they should be used in the smallest effective dose, and health care providers should seek alternative treatments especially in older, vulnerable populations.
Of course, age is relative.
“The age keeps changing as I get older,” he said. “I have a few 100-year-old patients in relatively great shape. And I have some 65-year-old patients that are in awful shape.”
More importantly, he said anyone already experiencing cognitive impairment shouldn’t be given anticholinergic medications.
Unfortunately, older people are often the ones who need treatment for OAB the most. In the nursing homes Stefanacci recently surveyed, two-thirds of patients 65 and over were incontinent. Urinary incontinence puts these patients at higher risk for falls related to urgent trips to the bathroom, at higher risk of urinary tract infections, and at risk for skin infections due to wetness.
Older people with OAB and UI living in the community have these same risks. For them, OAB tends to affect lifestyle, limit outings and cause isolation.
Alternative OAB and UI treatments
With the heightened risk of cognitive impairment associated with anticholinergic medications, finding an alternative treatment is important for older people.
“We have safer alternatives,” Stefanacci said. “There’s no excuse for not taking advantage of them.”
- Vibegron (Gemtesa) – oral medication that relaxes bladder muscle
- Mirabegron (Myrbetriq) – oral medication that relaxes bladder muscle
- Botox injections into the bladder
- Nerve stimulation – a way to reroute nerve impulses to improve bladder function
How to get alternative OAB and UI treatment
Stefanacci’s study showed even though most residents had UI, only 14% of them were being treated with medications—which leaves room for improvement for both the nursing home setting and for those being cared for at home.
Urinating more than eight to 10 times a day, getting up several times a night, or leaking urine because your loved one can’t get to the restroom soon enough are all signs of OAB and UI. These symptoms warrant a visit with a health care provider.
“By bringing issues of overactive bladder and urinary incontinence to the attention of their physician or nurse practitioner, caregivers can help in three key areas,” Stefanacci said.
First, you can reduce work for yourself. Second, treatment may reduce falls because most occur between the bed and the bathroom. Finally, caregivers can advocate for treatment of their loved one’s OAB with safer alternatives, avoiding medications that can make cognition worse.
“OAB affects everybody’s quality of life,” Stefanacci said. “Treating OAB not only improves the life of your loved one, but it helps you out as well.”