Anticholinergic Therapy

Content Written By: Rachel N Pauls, MD, FACOG

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.

Reference List

(1) Hansen BL. Lower urinary tract symptoms (LUTS) and sexual function in both sexes. Eur Urol 2004; 46(2):229-234.

(2) Salonia A, Zanni G, Nappi RE, Briganti A, Deho F, Fabbri F et al. Sexual dysfunction is common in women with lower urinary tract symptoms and urinary incontinence: results of a cross-sectional study. Eur Urol 2004; 45(5):642-648.

(3) Hajebrahimi S, Azaripour A, Sadeghi-Bazargani H. Tolterodine immediate release improves sexual function in women with overactive bladder. J Sex Med 2008; 5(12):2880-2885.

(4) Rogers R, Bachmann G, Jumadilova Z, Sun F, Morrow JD, Guan Z et al. Efficacy of tolterodine on overactive bladder symptoms and sexual and emotional quality of life in sexually active women. Int Urogynecol J Pelvic Floor Dysfunct 2008; 19(11):1551-1557.

(5) Rogers RG, Omotosho T, Bachmann G, Sun F, Morrow JD. Continued symptom improvement in sexually active women with overactive bladder and urgency urinary incontinence treated with tolterodine ER for 6 months. Int Urogynecol J Pelvic Floor Dysfunct 2009; 20(4):381-385.

Find a Doctor

Enter your city, state or zipcode and find the nearest doctor in your area who specializes in treating: Excessive Pubic Fat/ Enlarged Mons Pubis

diagnostic tool teaser

Share your Story

shareDo you have a personal health story that you would like to share with others? Many people, especially when newly diagnosed, find comfort in knowing that others are having a similar experience. Our story areas are a place to share experiences about living with and treating sexual health issues.

Join the Forums

joinDo you have a question, want to share medical advice, or just need to discuss your situation with someone else having a similar experience?

The forums are a resource for everyone to share and discuss their health and medical needs with others, and get answers to medical questions from the leading experts in the field of sexual medicine

Stay updated with our monthly newsletter

Sign up to receive our monthly newsletter—Get updates about advances in the field, new products and medical trials in your area. Your information will never be shared without your consent.

Leave this field empty