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Overactive bladder is characterized by the strong urge to urinate, often frequently and sometimes accompanied by leakage (incontinence). Some 15 million to 20 million people in the U.S. have overactive bladder. That includes one in four women and one in 10 men aged 65 or older.

The report - the 15th in a series on widely used medicines and available free at www.CRBestBuyDrugs.org - recommends that people with only mild symptoms try nondrug measures first, such as lifestyle changes and learning Kegel exercises to strengthen pelvic muscles.

People with more severe symptoms usually benefit from learning such techniques as well but may also get added symptom relief from taking a medicine. The drugs work better in tandem with non-drug measures than on their own, the report says.

Studies show that self-help treatments and lifestyle adjustments - when practiced diligently - reduce the urge to urinate, decrease frequent urination, and restore a sense of control, in 80 percent of people who try them. One in four people get complete relief.

The report finds that none of the five drugs - oxybutynin (Ditropan, Ditropan XL and Oxytrol, a skin patch); tolterodine (Detrol, Detrol LA); trospium (Sanctura); solifenacin (Vesicare); and darifenacin (Enablex) - is any more effective than the others.

People taking any of the five drugs can expect the number of times per day they need to urinate to decline from an average of about 12 a day to an average of seven to 10 a day, with response being highly variable. People with severe overactive bladder may have to go up to 20 times a day, and get a reduction to around 15 to 18 times a day. People without overactive bladder urinate six to 10 times a day, on average.

For people who have incontinence, too - about half those with overactive bladder - the drugs reduce the number of episodes from three to five per day, on average, to two to four per day.

The overactive bladder drugs differ notably in the side effects they cause, and their cost. The side effects include dry mouth, constipation, and mental confusion. All can be quite severe. In studies, more than half of patients stopped taking their overactive bladder drug within six months. In some cases people stopped because non-drug measures relieved their symptoms. But a sizable portion stopped because of adverse side effects.

In studies, Ditropan XL, Detrol LA, Oxytrol, Sanctura, Vesicare, and Enablex have caused fewer side effects.

The report chose four Best Buys for people whose doctors have suggested they try a drug. Based on the lower risk of side effects they pose, dosing convenience, cost, and other factors, the Best Buys are:

Tolterodine (Detrol) - two pills per day Tolterodine extended release (Detrol LA) - one pill per day Trospium (Santura) - one pill per day Oxybutynin patch (Oxytrol) - two patches per week

Tolterodine could soon become available as a generic drug. The report advises people who have no health insurance or drug coverage to try generic oxybutynin (Ditropan) first. Some people tolerate the side effects well and it is much less costly.

The report is based on an independent, scientific review of the available medical evidence by the Drug Effectiveness Review Project, a 15-state initiative based at the Oregon Health & Science University. The initiative compares drugs on effectiveness and safety for state Medicaid programs.

Consumer Reports Best Buy Drugs combines those reviews with available medical and pricing information to identify Best Buys in each category. Every drug report is peerreviewed by medical experts. The free public education project is designed to help patients, working with their doctors, find effective, safe, and affordable medicines. It is supported by grants from the Engelberg Foundation, a private philanthropy, and the National Library of Medicine.

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