Pharmacologic Therapy

The anticholinergic/antimuscarinic agents are the most commonly used drugs to treat OAB and urge incontinence (Table 7-1.1). This class of drugs remains the standard of care, and is recommended as the first line pharmacologic therapy for patients with detrusor overactivity by the Agency for Health Care Policy and Research (AHCPR) (www.ahrq.gov/clinic/uiovervw.htm). These agents suppress muscarinic receptors on the bladder smooth muscle, but the relative lack of selectivity for the bladder over other organ systems accounts for significant adverse side effects such as xerostomia, constipation, and blurred vision. These adverse effects result in a high rate of discontinuation that has led to a search for receptor subtype-specific antimus-carinic agents with improved tolerability profiles. When reduction of urge incontinence episodes is used as the primary outcome, anticholinergics have been shown to be significantly efficacious in 50% to 80% of cases.

As with all pharmacologic therapy, medication should be initiated with the lowest dose of a single agent and titrated to the desired clinical effect whereas minimizing adverse effects. The two most frequently prescribed pharmacologic agents for the treatment of OAB are oxybutynin (available in immediate- and extended-release oral formulations and a transdermal delivery system), and tolterodine (available in extended-release oral formulation). Both agents can be effective in the treatment of OAB.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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