Find the Best Overactive Bladder Medications for Your Body and Lifestyle
With contributions from Olivia.
It’s helpful when overactive bladder (OAB) can be traced to a specific disease or ailment; once you begin to treat the root problem, bladder issues often clear up as the disease is brought under control. On the other hand, many cases of OAB have no distinct root or cause, and that calls for a different approach to medication and therapy.
Most doctors will suggest making some key lifestyle changes before turning to medication for relief. But if bladder training, adjusting your fluid intake, and creating a bathroom schedule aren’t bringing you the improvements you need, it might be time to try one of the leading OAB medications.
How Overactive Bladder Medications Work
The aim of every OAB medication is the same: to restore your bladder control. However, different types of medications can accomplish this goal in different ways.
Relaxing the Bladder Muscle
In many cases, the extreme urge to urinate comes from abnormally strong and frequent bladder contractions, and since those are involuntary contractions, it can be nearly impossible to suppress them. In these cases, relaxing the major muscle in the bladder wall (the detrusor muscle) can quell that intense urge that leads to incontinence. The class of drugs used to relax the bladder are known as anticholinergics.
Strengthening Surrounding Muscles
OAB can also be caused by weakened support tissues around the bladder, especially in menopausal women. Aside from pelvic floor strengthening exercises, taking estrogen can help to strengthen the muscles around the bladder, which will reduce incontinence.
Certain antidepressants are sometimes used for OAB because they can relieve symptoms in two ways: by relaxing the bladder muscle, and by contracting the muscles at the base of the bladder. In turn, the medication reduces your urge to go, while it also reduces your risk of leaks. Tricyclic antidepressants are the most effective class of antidepressant drugs for OAB.
Limit Urine Production
While estrogen can help with muscle strengthening, other hormones can help curb urge incontinence and leaks by controlling urine production. Desmopressin is a synthetic version of a naturally-occurring hormone that is typically produced at night to keep your bladder quiet and comfortable while you sleep. Supplementing with desmopressin can mimic the effect of this hormone, which makes it useful during the day and night.
How Leading OAB Medications Measure Up
There are plenty of OAB medications to choose from, and just like any class of medication, not every drug will be suited to every patient.
It’s crucial to consult with your doctor about your best route forward, considering allergies, known reactions, and any other medications you may be taking. Before you make your decision, compare the efficacy and side effects of the major classes of OAB drugs, and their leading brands.
Oxybutynin, tolterodine, trospium, darifenacin, solifenacin, and fesoterodine.
Research shows that all of the anticholinergics on the market are similarly effective for OAB, though some tend to bring more side effects than others. There are short-acting and long-acting versions of these drugs, and in most cases, the long-acting medication is more effective.
Oxybutynin is one of the drugs that cause problems: more people have quit this drug than any of the others, due to the dry skin and mouth, constipation, and upset stomach that it brought.
In contrast, studies show that solifenacin brought the least amount of side effects (though it did not work as well for nocturia as it did for urge incontinence).
While tolterodine is also less disruptive than oxybutynin, it has been linked with a risk of hallucinations.
Imipramine is the standard antidepressant medication for OAB. Major side effects are rare, but some people may experience milder symptoms, like sleepiness. Since they do tend to make you drowsy, this drug is ideal for those with night-time bladder problems.