Women may get better sleep after overactive bladder treatment

Women with overactive bladder who take medication to address the problem may feel the urge to urinate less often and also sleep better at night as a result, a U.S. study suggests.

For the study, researchers examined data on 645 women with overactive bladder who were randomly assigned to take one of two doses of fesoterodine (Toviaz) to treat the condition or received a placebo, or dummy pill.

After 12 weeks, women taking medication experienced greater decrease in so-called urge urinary incontinence than women on the placebo, and medication was also associated with less voiding at night and greater improvements in sleep duration, researchers report in Obstetrics & Gynecology.

“Overactive bladder and urgency incontinence can disrupt sleep by causing overnight urgency, incontinence, bedwetting and getting up to urinate,” said senior study author Dr. Leslee Subak, a researcher at Stanford University School of Medicine in California.

“If we can treat the underlying problem, a woman (or man, but we only included women in this study) may experience less frequent symptoms and have less disruptions of sleep,” Subak said by email.

Women are particularly prone to stress urinary incontinence, when the pelvic floor muscles are too weak to support the bladder. As a result, urine leaks during coughing, sneezing or exercise. Childbirth is a common reason for weak pelvic muscles and obesity worsens the problem.

Urge incontinence, in contrast, doesn’t have a clear cause, although it can sometimes happen as a result of neurological problems, the authors note.

Some women may get both types of incontinence at once or develop bladder problems from a urinary tract infection.

In the current study, all of the women had urge incontinence and more than half of them reported poor quality sleep, defined as a score above 5 on a sleep-quality questionnaire. The participants were 56 years old on average and the majority were white.

At the start of the study, women were having an average 4.6 episodes per day of all types of urinary incontinence, and 3.9 daily episodes of urge urinary incontinence in particular.

After 12 weeks, women on the drug and in the placebo group experienced fewer episodes of incontinence, but for women on the drug the decrease was greater - they had about one less episode per day of urge urinary incontinence than the women receiving a placebo, the study found.

With medication, women also reported greater improvements in overall sleep quality, sleep duration and what’s known as sleep efficiency, or how much time people spend in bed asleep instead of awake.

One limitation of the study is that it included generally healthy women, and results might be different for people who were elderly, frail or suffering from a variety of chronic medical problems.

Even so, the findings offer fresh evidence of the potential for medications for urinary incontinence to help improve sleep, said Donald Bliwise, director of the Program in Sleep, Aging and Chronobiology at
Emory University School of Medicine in Atlanta.

“Any drug that decreases bladder activity or decreases the production of nighttime urine might improve sleep quality,” Bliwise, who wasn’t involved in the study, said by email.

Beyond making people tired during the day, waking frequently during the night can lead to a variety of health problems, noted Dr. Karel Everaert of Ghent University Hospital in Belgium. When treating overactive bladder improves sleep, other benefits may follow.

“Sleep is extremely important to our health,” Everaert, who wasn’t involved in the study, said by email. “Lacking it kills people through cardiovascular disease and diabetes, and it is bothersome, sometimes also for our partners.”