Anticholinergic drugs versus non-drug active therapies (e.g. bladder training, pelvic floor muscle training or electrical stimulation) in the management of over active bladder syndrome in adults.

Over active bladder syndrome is defined as urgency, with or without urge incontinence, usually with frequency and nocturia. It is a major health problem giving an estimated prevalence of over 22 million people affected. It affects both sexes with a female preponderance and its prevalence increases with age. There is also a significant economic and quality of life implication. The exact disease process is yet to be fully elucidated and the treatments are varied from drugs to non-drug modalities, with various efficacy, tolerability and side effect profiles and treatment remains empirical at its best.
The aim of this review is to examine the evidence of the above treatment modalities. Thirteen trials with 1770 participants were included; symptomatic improvement was more common amongst those on an anticholinergic drug compared with bladder training and more symptomatic improvement was seen amongst those on combination therapy with an anticholinergic plus bladder training than bladder training alone. Dry mouth being the main adverse effect was reported in about a third of those taking an anticholinergic drug. The included trials are generally small and of moderate quality, with no data addressing long-term performance are the main limitations of this review.