Many people take medication to treat overactive bladder (OAB) with great success. Whether out of embarrassment or denial, some put off seeing their doctor to get a prescription that might bring relief. And still others start medication and then stop it without ever getting the full benefit. The more you know, the better able you’ll be to make smart choices about medication for OAB.
In a recent study, researchers asked more than 1,300 OAB patients who had stopped taking their medication about their reason for stopping. Nearly half said the medication didn’t help as much as they expected. In fact, while medication can often reduce urine leaks or extreme urges to urinate, it may not stop them completely. Side effects—such as dry mouth, constipation, and dry eyes—may also occur. It's important that you and your doctor select a treatment that best controls your individual symptoms.
Many of the available medication options for OAB are powerful drugs with significant side effects. Unwanted complications can occur if these drugs are accidentally combined with other medications. Be sure you inform your health care provider about all of your prescription and nonprescription medications and supplements.
Having realistic expectations is one key to success. Combining medication with nondrug treatments—such as scheduled bathroom breaks and pelvic muscle exercises—can also boost effectiveness. If a medication still doesn’t improve your symptoms or if it causes bothersome side effects, a different drug might work better for you. Fortunately, there are several types of medication available for treating OAB. Be sure to discuss all your options with your doctor before stopping any medication.
These drugs (also known as anticholinergics) are the first-choice medications for treating OAB. They include:
Oxybutynin (Ditropan, Ditropan XL, Oxytrol, Gelnique)
Tolterodine (Detrol, Detrol LA)
Trospium (Sanctura, Sanctura XR)
Medications in this group reduce OAB symptoms by relaxing the smooth muscle of the bladder. All of them can be taken orally. In addition, oxybutynin is sold in patch and gel form. The most common side effect of antimuscarinics is dry mouth, which affects almost one-third of people who take the drugs. Other possible side effects include constipation, dry eyes, blurred vision, aggravation of narrow angle glaucoms, and trouble emptying the bladder.
Oxybutrin is available as an over-the-counter patch called Oxytrol. No prescription is required. It shares a similar safety profile and precautions as other antimuscarinic products. Be sure to notify your physician whenever you begin or adjust the dosage of any over-the-counter medication.
If antimuscarinics don’t work well for you, your doctor might prescribe another type of medication, such as:
Botulinum toxin. Botox injections in the bladder are being studied as a treatment for OAB. The injections stop excessive contraction of the bladder muscles. Research on this approach is ongoing.
Duloxetine. This is an antidepressant that may decrease OAB symptoms. It blocks two body chemicals—serotonin and noradrenaline—that affect bladder function.
Desmopressin. This is an antidiuretic—a drug that reduces urine output. It may decrease waking at night to urinate. There’s also limited evidence that it might help daytime OAB.
Estrogen. In women, tissues of the vagina and urethra are affected by low levels of estrogen after menopause. The tissues become thin and easily irritated. And that irritation, in turn, may worsen OAB symptoms. Topical estrogen applied to the vagina helps some women.
Imipramine. This antidepressant reduces urine production and may decrease nighttime urination. However, it can also cause side effects, such as sleep problems, loss of appetite, and upset stomach. In addition, there is a small risk of more serious side effects, including heart-related problems and increased thoughts of suicide. As a result, imipramine usually isn’t prescribed for OAB unless other drugs have been tried unsuccessfully.