Urinary Leakage Problems

AN UNDERLYING THREAT FOR WOMEN HEALTH

Overactive Bladder (OAB)
Overactive bladder is defined by International Continence Society (ICS) as:

“Urgency, with or without urge incontinence, usually with frequency and nocturia”
 Overactive Bladder (OAB)
“Urgency, with or without urge incontinence, usually with frequency & nocturia”

Symptoms
Prevalence of Urinary Incontinence in
Pakistan
A Worldwide problem

About 50–100 million people worldwide are estimated to be affected by

overactive bladder (OAB) syndrome.

It is more common than diabetes mellitus or peptic ulcer

Similar prevalence to asthma or chronic bronchitis

2 0 0 5 B J U I N T E R N A T I O N A L | 9 5 , 8 1 – 8 5 |doi:10.1111/j.1464-410X.2005.05255.x
A Not So Discussed Problem

Urinary Incontinence is observed as frequent health problem among women in

Pakistan 2

40% of Pakistani women face hindrance in daily life by experiencing once or

more leakages during a day 1

Overactive Bladder is perceived as part of ageing process rather than disease

thus goes untreated despite of affecting quality of life and restricting mobility of
patient 3

Despite burdening billions of rupees globally, Overactive Bladder goes

unrecognized due to reluctance to seek medical attention 4

Check notes for the references

An Underlying Threat

Only 15% (approx.) women consult

doctors for urinary leakages

More than 84% women say they have never consulted a doctor for urinary leakage problems 1

Check notes for the reference

Impacting Quality of life

Social cutoff Religious hindrances

Social cutoff Religious hindrances

Barriers to Treatment

Due to social barriers and misperceptions women do not discuss the urinary leakage
problem with the doctors

Thus…

Affecting quality of life, causing hindrance, limiting social activities and restricting
mobility

These reasons make it a hidden, unreported yet bothersome

problem for women
Myths… Barriers to Treatment

•Part of normal aging or

everyday life
•Not severe or frequent
enough to treat
•Too embarrassing to discuss
•Treatment won't help

Patient
misconceptions and
fears
The way out - Joint collaboration

Lets stand together

Doctors Solifen

Getz

Help them
Medical part
Urinary Incontinence

Sudden increase in intra-

abdominal pressure Uninhibited Detrusor
contractions

Urethral pressure
Urge Incontinence
Urine loss accompanied by
urgency resulting from abnormal
Stress Incontinence bladder contractions
Urine loss resulting from
sudden increased intra-
abdominal pressure (e.g.
laugh, cough, sneeze) Sudden increase in intra-abdominal
pressure

Uninhibited detrusor contractions

Incontinence Urethral pressure
Sudden & involuntary leakage of urine
 Distribution of Muscarinic Receptors

Detrusor Muscle

M2 (80%)

M3 (20%)
Etiology
Treatment Options: Pharmacotherapy

Antimuscarinics are the • Oxybutynin

mainstay of oral medical • Tolterodine
treatment • Solifenacin (Solifen)

• Flavoxate
Other oral treatments • Imipramine
• Oestrogens

BUT
Other oral treatments may help but no large randomised, controlled, double-blind studies that show they
are more beneficial than placebo
Flavoxate classification is ambiguous since it possesses anticholinergic, local anesthetic as well as
spasmolytic actions
Managing OAB

Preferred anti-muscarinic pharmacotherapy???

M3 Muscarinic Receptor Selective Antagonist

Safe
Effective

Selective
Mode of Action

Muscarinic receptors play an important role in contractions of urinary bladder

smooth muscle

Solifenacin is a competitive inhibitor of the muscarinic M3 subtype receptor and

prevents Ach. to bind with M3 receptors, preventing contraction of the detrusor
smooth muscle

19
 Solifenacin VS
Effective Bladder Placebo

Control
80% 75.20%
% Mean improvement from base line

70% 64.60%
60%
52.90%
50%
41.80%
40%
30%
20% 15.60%
12.30%
10%
0%
Urgency Incontinence Frequency

Solifenacin Placebo

Solifenacin (Solifen) shows significant improvement in key symptoms of overactive bladder

UROLOGY 73: 14 –18, 2009
 Solifenacin VS
Tolterodine
Significant reduction in Urinary Symptoms versus Tolterodine
Micturition Urgency Urge
Frequency Episodes Incontinence Incontinence Nocturia
0
-0.2
Mean change from base line

-0.4
-0.4
-0.6 -0.5
-0.8
-1 -0.9 -0.9
-1.2
-1.2
-1.4 -1.3
-1.6 -1.5
-1.8 -1.7 -1.7
Solifenacin 5mg
-2 Tolterodine ER 4mg
-2

Solifenacin 5mg provided 44% additional improvement in resolving OAB symptoms as compared to Tolterodine
ER 4mg European Urology, Volume 52 Issue 4, October 2007, Pages 1195-1203
 COMPARISON OF SOLIFENACIN 5 MG AND TOLTERODINE ER 4 MG IN THE STAR OAB STUDY
 Solifenacin VS Flavoxate

A Better Treatment Option than Flavoxate

Recommends NOT to use Flavoxate for Urinary Incontinence or Overactive Bladder
treatment in women

  Solifenacin Flavoxate
  Anti muscarinic Drug with mixed action

Level of evidence for OAB management 1 (Randomized control clinical trials) 4 (Case studies)
Grade of recommendation A (Highly recommended) D (Not recommended)
Dose frequency O.D. T.i.d.

Based on meta-analysis findings and OD dose benefit Solifenacin has strong evidence and level of
recommendation as a treatment option in Overactive Bladder management than Flavoxate.

 NICE. Urinary incontinence in women pathway, 11 Oct 2016

 Chapple C. The contemporary pharmacological management of overactive bladder. BJOG 2006;113(Suppl. 2):19–28
 Drugs.com
Better Safety Profile
Solifen in a nutshell

Selective
• Selective M3 receptor antagonist

Safe
• Proven safety and tolerability profile
• No interaction with food
• No interaction with oral contraceptive

Effective
• Documented efficacy profile in treating urgency,
frequency, nocturia & urinary leakages