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.
Anticholinergics
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.
Tricyclic Antidepressants
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.
How Leading OAB Medications Measure Up
Hormones
Hormones can be more powerful than they first appear, and not always in a good way.
Estrogen has been found to decrease OAB symptoms, but one fairly recent study in the U.K. found that there were no significant differences between those receiving vaginal estrogen therapy and those who received a placebo. However, some women did experience vaginal bleeding, and five participants required a hysterectomy due to complications.
Desmopressin has been shown to cause some mild side effects like headache and diarrhea, but only in a small percentage of patients. Moreover, one study found that combining desmopressin with an anticholinergic was more effective at treating OAB symptoms than using an anticholinergic alone.
Generally, OAB medications are taken daily, sometimes in pill form and sometimes in topical form (skin patch or gel). It’s good to keep in mind the method and timing of the medication when you’re making your choice, but there are other important points to consider, too.
Possible side effects, expense, and the extent of research that has gone into the drug all help to determine which approach will suit you best.
Urinary Antispasmodics
Mirabegron is a unique one as it is the first and only one of its class, which is the beta-3 adrenergic agonist. More importantly, it is one of the most recent and most promising in treating OAB. How it works is it targets the beta-3 receptors and stimulates them to relax and reduce muscle spasms of the bladder and urinary tract. This will increase the bladders capacity to store urine.
Mirabegron, or Myrbetriq, also has no generic brand available yet for purchase. This means that to get this medication, your doctor has to prescribe it, and your pharmacy usually will decide on the overall cost to dispense. However, it is a well-received and promising medication that may be worth looking into if you’ve tried other medications with no luck.
Flavoxate is another urinary antispasmodic. It aims to treat painful urination, bladder pain, incontinence, frequent or urgent urination, and night-time urination. However, it is not able to treat a bladder infection.
Flavoxate is a fast-acting medication that works by reducing muscles spasms of the bladder and muscles spasms of the urinary tract. These can be the occurrence of frequent catheter usage, as well as interstitial cystitis, among other conditions. That being said, flavoxate has been used to treat many other types of conditions like this, so its inclusion of treating OAB has been a more recent development in the past two years.
Trospium belongs under the antispasmodics category, however, it is also known as antimuscarinic/anticholinergic drugs (which in other words, these drugs relax smooth muscles in the body, such as your bladder, by relaxing the nervous system).
Trospium drug works by relaxing the muscles in the bladder, the detrusor muscles, which will improve your ability to control when you urinate. It will help tackle all aspects of OAB, like your frequency, urgency, urge incontinence, and nocturia. Trospium is one of the only drugs that is across the board recommended to be taken an hour before eating, as opposed to with or without food.
The last one in this category we’ll talk about is Belladonna tincture. Belladonna (also known as deadly nightshade) is a natural plant. The plant is toxic if ingested. There are a few ways Belladonna can be used in OAB medicine. Combined with phenobarbital, an antiseizure medication, it can be used to treat symptoms of OAB by decreasing muscle activity, gastrointestinal tract spasms, as well as act as a mild sedation.
This scientific discovery allows for it to treat many things in the body including colitis, spastic bladder, diverticulitis, infant colic, renal and biliary colic, peptic ulcers, and IBS (irritable bowel syndrome). It comes in a liquid/syrup form, Belladonna Tincture, as well as in a suppository (B&O Supprettes Rectal) for those suffering from severe muscle spasm pain in the tubes that connect the kidneys to the bladder.
Alpha Blockers
This medication is specifically for men, however, it is under the list of treatments for OAB because it treats the symptoms of an enlarged prostate, along with passing kidney stones, as well as urinary retention.
In BPH (benign prostatic hyperplasia) Tamsulosin does not affect the size of the prostate, but it does help relax the muscles in the prostate and in the bladder neck. Symptoms of BPH are similar or the same as OAB, such as urgency, and frequent urination during the day and night, however, men who have BPH also might experience weak stream and a difficulty in starting a stream.
Tamsulosin will help relax the bladder muscles and allow for easier urination.
New OAB Medications on the Market
The latest medication that has been introduced to the market is Propiverine. Although it’s been around since 1993, drugs take years of studying and testing before being approved for patients. It is an anticholinergic drug, which as we said earlier, helps relax the smooth muscles in the body. This drug tackles all the symptoms of OAB.
There are doses specifically marketed towards children and their weight, for efficacy, of 5 years and up as well. This is significant, as children aren’t always the target market for overaction bladder medication.
If you haven’t had any success with other anticholinergic drugs, this drug has been compared to others in its class and was more successful at treating OAB symptoms in men and women, so it may be worth asking your doctor about.
When Medications Don’t Work
Lifestyle changes and medication will usually do the trick for most OAB patients, but if you’re one of the unlucky few to experience little relief, don’t lose hope. Some other options might be able to improve your condition.
Botox has been used for wrinkles, twitches, and skin issues for quite a while, but it has also proven effective as an OAB treatment by paralyzing the overactive detrusor muscle. The pros are impressive, and the cons are few: studies show that Botox injections into the bladder are safe, long-lasting, and effective, and the risk of side effects is low. In fact, the majority of patients saw major improvement in their symptoms, and many did not need another injection for over a year.
No medicine or therapy is completely risk-free, so you’ll need to weight the pros and cons before deciding on an OAB intervention. However, the good news is that you have several options to try, which means there’s an excellent chance you can bring your bladder issues under control with a bit of patience and medical guidance.