Anticholinergic Therapy

Content written by Irwin Goldstein MD

Overactive bladder (OAB) is a disorder characterized by urinary urgency, frequency, nighttime urination, and urge incontinence. It is caused by a spasm of the bladder wall too often, or at inappropriate times. OAB is a common problem, with estimates that 1 in 6 adults have some symptoms. Several studies have shown that these issues can lead to impairment of quality of life and sexual dysfunction (1;2).

Overactive bladder is managed by a combination of behavioral modification, adjustments in volume and type of fluid intake, pelvic floor muscle reeducation, estrogen replacement, and medications known as anticholinergics.

Several anticholinergics are available by prescription to treat overactive bladder. They generally work the same way- by blocking acetylcholine. Acetylcholine is a neurotransmitter in the body; blocking its’ function increases bladder capacity and reduces the likelihood of bladder spasms. However, anticholinergic medications do not only impact the bladder. Potential side effects include dry mouth and eyes, constipation, drowsiness and cognitive dysfunction. The commonly used anticholinergics for OAB include oxybutynin, tolterodine, trospium, darifenacin, solifenacin and fesoterodine fumarate. Oxybutynin is available in a topical gel and as a generic. All of the medications have been studied extensively and are effective for symptoms of overactive bladder.

Unfortunately there is little information in the literature regarding use of anticholinergics and female sexual symptoms. Hajebrahimi and colleagues evaluated sexual function in a group of 30 women given tolterodine IR for 3 months; all parameters improved significantly (3). Rogers et al performed a randomized controlled trial of tolterodine ER and placebo. In 12 weeks greater improvements were seen in sexual quality of life and sexual function in the tolterodine group (4). Further analysis of the treatment group was performed over a 24-week period. During that time sexual function remained stable, other than continued improvements in physical symptoms (5). These studies are supportive of tolterodine use to improve sexual function in women with OAB.

Although we do not know if other anticholinergics provide the same benefit to sexual symptoms, it may be reasonable to assume some positive impact if they are effective in reducing complaints of OAB. Further research on other available medications would be useful to inform patients and providers about this important quality of life problem.