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Best Medications for Overactive Bladder

Understanding overactive bladder

Having overactive bladder (OAB) can be uncomfortable and even painful. OAB is a set of symptoms that cause incontinence, or a loss of bladder control. Symptoms include:

  • needing to urinate more than normal
  • sudden urges to urinate
  • not being able to control urination
  • needing to urinate more than once overnight
  • urine leakage

These symptoms may interfere with your daily life. There’s no cure for OAB, but the good news is that there are effective ways to manage it. These include behavioral treatments, lifestyle changes, medications, and sometimes surgery.

Drugs cannot cure OAB, but they can help manage your symptoms. However, all drugs come with the risk of side effects. This is why doctors often suggest making lifestyle changes before trying medications.

OAB can happen for several reasons. Sometimes treating the underlying cause of your OAB can help your symptoms. For instance, neurological disorders, such as Parkinson’s disease or multiple sclerosis, can cause your bladder to contract more often than it should. In men, the cause of bladder issues is often an enlarged prostate gland. Bladder stones or cancer may also cause OAB symptoms.

If your doctor can find the cause for your OAB, you can receive targeted treatment for the cause. In turn, you can relieve your OAB symptoms. However, it’s not always possible to pinpoint the exact cause of OAB. In these cases, other medications are available. Here are some of the more common medications used to treat OAB.

Medications for unspecified OAB

If your doctor can’t find a cause for your OAB, don’t worry. Drugs can still help ease your symptoms. Some of these drugs work by relaxing your bladder. They stop involuntary contractions that bring on the urge to urinate. Other drugs help strengthen the tissues around your bladder that may have become weak. The stronger tissue can help improve your bladder control.

Anticholinergic drugs

The largest class of drugs used to treat OAB is anticholinergic drugs. They work by blocking a chemical in your body called acetylcholine. This chemical sends a message to your bladder to contract. By blocking this chemical, these drugs reduce the contractions that cause you to release urine. In studies that compared the drugs, all anticholinergics worked equally as well in treating OAB.

Anticholinergics are sold under different brand names. Some are also available as generic drugs. These medications include:

All of these drugs except for Oxytrol come as either tablets or capsules that you take by mouth. Oxytrol is available as a skin patch.

The most common side effects of anticholinergic drugs include:

  • dry mouth
  • blurry vision
  • constipation

Seniors have the greatest risk of side effects from these drugs. These medications may also cause drowsiness and an increased risk of falls in seniors. Oxybutynin may cause more side effects than the other drugs in this class. However, taking oxybutynin in its extended-release form may reduce some of the side effects.

Beta-3 adrenergic drug

The only drug in this class is mirabegron (Myrbetriq). It works by relaxing the smooth muscle in the walls of your bladder. This effect helps your bladder hold more urine.

This drug is available as a tablet that you take by mouth once per day. It interacts with several other drugs. Make sure you tell your doctor about all medications you’re taking.

The most common side effect of this drug is high blood pressure.

Anti-spasmodic drug

Flavoxate is the only drug in this class. It’s an oral drug that reduces bladder spasms. This is an older drug. Some studies show that it doesn’t work as well as newer drugs to treat symptoms of OAB.

Antidepressants

If other OAB drugs don’t work for you, or if you can’t take other OAB medications, your doctor may give you an antidepressant. These drugs are used to treat depression. But they may help relieve some OAB symptoms. The FDA has not reviewed these drugs for the treatment of OAB, so your doctor may use them off-label.

What is off-label drug use?
Off-label drug use means that a drug that’s been approved by the FDA for one purpose is used for a different purpose that has not been approved. However, a doctor can still use the drug for that purpose. This is because the FDA regulates the testing and approval of drugs, but not how doctors use drugs to treat their patients. So, your doctor can prescribe a drug however they think is best for your care.

An antidepressant that your doctor may prescribe for OAB is desipramine. This oral drug works by relaxing your bladder while also contracting the muscles at the neck of your bladder. These actions may reduce your urge to urinate. They also help control leakage and improve bladder control.

Another antidepressant used to treat OAB is imipramine. It’s an oral medication that works in the same way as desipramine. The main side effect of this drug is sleepiness. This makes it a good choice if you have nighttime incontinence.

Side effects of antidepressants used to treat OAB can include:

  • drowsiness
  • fatigue
  • anxiety
  • decreased sex drive

Hormones

Some women may suffer from OAB due to weak support tissues around their bladder and urethra. If this is the cause of your OAB, your doctor may give you topical estrogen. This is a hormone the body makes naturally. Estrogen works to strengthen the muscles around the bladder, vagina, and urethra. After menopause, women start to make less of it.

Topical estrogens used for OAB include estradiol cream (Estrace) or conjugated estrogen cream (Premarin). All estrogens raise your risk of some cancers, stroke, and heart attack. However, topical estrogen has less risk than the oral forms of the drug do.

OnabotulinumtoxinA (Botox)

Botox, which is well known for smoothing out wrinkles, can also be used for OAB. Like anticholinergic drugs, this drug works by blocking acetylcholine. It also paralyzes the muscle of the bladder. This treatment is new and is still being studied. It may not be covered by all health insurance plans.

Botox comes with risks. It’s a very strong drug that your doctor must inject. They will watch you for side effects after you receive your injection. The risks include paralyzing your bladder. This means you won’t have any control of your bladder. If this happens, you must be able to catheterize yourself. This involves inserting a catheter (thin tube) into your urethra and bladder to drain urine.

Takeaway

OAB can be tricky to manage. But if you have this condition, take heart. With the right treatment, you should be able to return to a more comfortable lifestyle. Your treatment plan may include medications for OAB. Work with your doctor to find the best drug for you.

You asked, we answered

  • What lifestyle changes can help OAB?
  • Your doctor will likely suggest lifestyle changes as a first-line treatment for OAB. Modifications can strengthen your bladder and improve your bladder control. You may try changing what, when, and how much you drink. Noting your urination habits in a journal, setting a bathroom schedule, and keeping a healthy weight can also help. So can double voiding. This means urinating twice in a short period of time. Your doctor may also suggest bladder training and doing Kegel exercises to strengthen your bladder.

    - Healthline Medical Team

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