Best Medications for Overactive Bladder

Having an overactive bladder causes an urgent urge to urinate. It can also trigger involuntary leakage of urine, known as urinary incontinence. Overactive bladders affect over 30 million Americans, with women being more affected than men. Having an overactive bladder is not only uncomfortable, but it can also be painful. There are many causes for an overactive bladder, and the treatment for this condition depends on the underlying cause. Once your doctor finds the reason for your overactive bladder, you will begin to receive targeted treatment to treat the cause. There are many medications available for the treatment of overactive bladder. Here are some of the best medications for overactive bladder.

Introduction to Overactive Bladder

Overactive bladder is a term used to refer to a set of symptoms that affect the urinary system. Overactive bladder typically causes urinary incontinence or an involuntary loss of bladder control leading to urine leakage. The overactive bladder also causes frequent and urgent need to urinate. According to the Urology Care Foundation, overactive bladder affects over 30 million Americans. Women are more likely to have an overactive bladder than men. (1,2,3,4,5)

Some of the symptoms of overactive bladder include:

  • Having sudden urges to urinate.
  • Need to urinate more frequently than normal.
  • Need to urinate more than once or twice during the night.
  • Urine leakage or urinary incontinence.
  • Not being able to control urination.

These symptoms interfere with and disrupt your day-to-day life. It is challenging to manage the symptoms of this condition because an overactive bladder is often unpredictable. This causes people with overactive bladder to restrict their social lives, impacting the quality of their life. The disease is also likely to trigger emotional distress, causing them to stay isolated, with many suffering from depression. (6,7,8)

While there is no cure for overactive bladder, the good news is that there are many ways to manage this condition. These include lifestyle changes, behavioral treatments, medications, and in some cases, surgery.

There are many causes of overactive bladder. (9) In some cases, treatment of the underlying cause of overactive bladder can help alleviate the symptoms. For example, people with neurological disorders like multiple sclerosis or Parkinson’s disease may find that the disease causes their bladder to contract more often than it normally should. (10,11)

It has also been observed that in men, the cause of bladder issues like an overactive bladder usually stems from an enlarged prostate gland. (12) Bladder cancer or bladder stones may also be the underlying cause behind the overactive bladder symptoms.

If the cause for your overactive bladder is determined, your doctor can then begin targeted treatment for the underlying medical condition, which will relieve the symptoms of an overactive bladder. However, it is not always possible to find the exact cause of this condition. In such cases, there are several medications available that can help you manage your symptoms. Let us take a look at some of the best and common medications used in the treatment of overactive bladder.

Medications For Overactive Bladder Caused By Unspecified Reasons

If your doctor is unable to find the exact underlying cause for your overactive bladder, there is no need to worry as there are still medications that will help relieve your symptoms. Some of these medicines function by relaxing the bladder. The drugs work to stop any involuntary contractions that set off the urge to urinate urgently. Some other medicines are available that help strengthen the tissues around the bladder that might have gotten weak and caused the symptoms associated with an overactive bladder. Once the tissue is strengthened, it can help improve the bladder control. (13)

Treating Overactive Bladder with Anticholinergic Drugs

The largest class of drugs used for the treatment of overactive bladder is anticholinergic drugs. These medications work by blocking a chemical known as acetylcholine in the body. Acetylcholine is a chemical that sends a message to the bladder to contract. The medications block the release of this chemical, thus reducing the contractions that cause the bladder to release urine. In studies that carried out a comparison of various medications, all the anticholinergic drugs were found to work equally well in treating overactive bladder. (14,15)

Anticholinergic drugs are sold under many different brand names. Some of them are also available as generic drugs. These drugs include:

  • Darifenacin (brand name: Enablex)
  • Fesoterodine (brand name: Toviaz)
  • Oxybutynin (brand name: Ditropan XL, Oxytrol)
  • Solifenacin (brand name: Vesicare)
  • Tolterodine (brand name: Detrol, Detrol LA)
  • Trospium (brand name: Sanctura)

All these medications, with the exception of Oxytrol, are available as either capsules or tablets that can be taken orally by mouth. Oxytrol comes in the form of a skin patch.

Just like any other medication, there are some side effects of anticholinergic drugs as well. These include:

Older adults are at the highest risk of suffering from the side effects of these medications. (16) These drugs are also known to cause drowsiness, which increases the risk of falls in seniors. The drug oxybutynin is known to also cause more side effects than the other anticholinergic drugs. However, taking oxybutynin in the extended-release form is likely to reduce some of these side effects. Anticholinergics are also known to worsen the symptoms of dementia, which is why these medications should be used with caution in people who have dementia or another form of mental health condition. (17,18)

Treating Overactive Bladder with Beta-3 Adrenergic Drugs

There is only one drug in this class for the treatment of overactive bladder. This is mirabegron (brand name: Myrbetriq). This drug works by relaxing the smooth muscle of the walls of the bladder. This relaxing effect helps the bladder hold more urine and for a longer time. (19)

The drug mirabegron is available in the form of a tablet that has to be taken once a day orally. This medication may interact with many other drugs. This is why it is important to inform your doctor about all the medications you are taking. High blood pressure is the most common side effect of mirabegron.

Treating Overactive Bladder with Antispasmodic Drugs

There is only one drug in the antispasmodic class of drugs that is used for treating overactive bladder. Flavoxate is an oral drug that helps reduce bladder spasms. This is not a new medication. Many studies have found that flavoxate does not work as well as the newer antispasmodic drugs to treat the symptoms of overactive bladder. (20)

Treating Overactive Bladder with Antidepressants

If the other class of drugs for treating overactive bladder do not help your condition, or if for some reason you are not able to take the other overactive bladder medications, your doctor might prescribe an antidepressant for you. Antidepressants are used for the treatment of depression, but they have been shown to help alleviate some symptoms of the overactive bladder as well. The US Food and Drug Administration (FDA), though, has not reviewed and approved the use of antidepressants for the treatment of overactive bladder. This is why many doctors use them off-label for the treatment of overactive bladder. (21)

One of the common antidepressants prescribed by doctors for treating the symptoms of an overactive bladder is desipramine. Desipramine is an oral drug that works by relaxing the bladder and also contracting the muscles located at the neck of the bladder. These actions help reduce the need to urinate and also help control urine leakage while improving overall bladder control.

Another antidepressant that is used to treat overactive bladder is imipramine. (22) Imipramine is another oral medication that functions in the same manner as desipramine. However, one of the main side effects of imipramine is that it causes sleepiness. This is why imipramine is a good choice for those who experience nighttime incontinence due to an overactive bladder.

However, there can be side effects of using antidepressants to treat overactive bladder. These include:

Using Hormones to Treat Overactive Bladder in Women

Some women experience the symptoms of an overactive bladder owing to the weak support tissues around the urethra and bladder. If this is the cause of your overactive bladder, your doctor may prescribe topical estrogen for treating the symptoms. Estrogen is made by the body naturally, and it works to naturally strengthen the muscles around the vagina, bladder, and urethra. However, after menopause, the production of estrogen starts to decline. This can lead to a weakening of the supporting tissues.

Topical estrogens that are typically used in the treatment of overactive bladder include conjugated estrogen cream (brand name: Premarin) or estradiol cream (brand name: Estrace). All topical estrogens, though, increase the risk of certain types of cancers, heart attacks, and stroke. However, topical estrogen has a lower risk of side effects than some of the oral forms of the drug. (23)

Conclusion

An overactive bladder is actually more common than you would think. The condition is very much treatable, but it requires you to seek the help of your doctor. Many people avoid consulting a doctor as they feel the symptoms are just a normal part of getting older, or it’s happening because of something they did. Treatment of an overactive bladder can range from making lifestyle changes to taking medications to relieve the symptoms.

References:

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