When physical therapy and behavior modifications or environmental modifications fail to address urge incontinence or overactive bladder problems, medications may be an appropriate second-line therapy. There are several approved medications for the treatment of overactive bladder(OAB) or urge incontinence(UI). The most commonly used is oxybutynin, either in pill form or as a topical gel (Gelnique®). It is among the original medications approved for OAB/UI, and can be effective. It is also now available over-the-counter as Oxytrol patches. Other medications in the same class as oxybutynin include tolterodine (Detrol®), fesoterodine (Toviaz®), darifenacin (Enablex®), solifenacin (Vesicare®), trospium (Sanctura®), among others. Each of these medications is in a class known as “anticholinergics” (an-tee-kol-in-urge-icks). They work to block the chemical messengers instructing the bladder to contract and empty. Unfortunately, their effects are not limited to the bladder, and for that reason may cause constipation, dry mouth, and pupil dilation (which makes them unacceptable to use in a type of glaucoma known as “narrow-angle”), as well as other side-effects. However, in someone who has no known reasons to avoid those medications, they may be quite helpful in reducing the symptoms of OAB or UI. Certain individuals do better on particular medications, however, none of these medications has specifically been shown to be superior to any of the others. Starting with the smallest dose and working up from there to an appropriate effect is typically how these medications are prescribed. It may take a few weeks before the full effects are seen.
A new class of medications has just been introduced, with only one approved medication available in the US. This is mirabegron (Myrbetriq®), which is, scientifically speaking, a beta-3 receptor agonist. In English this means that it stimulates chemical receptors in the bladder that cause the bladder to relax. Because it is a totally different class of medications, the side effects are generally different. The likelihood of constipation, dry mouth, etc. is reduced. It may be used in narrow angle glaucoma. However, individuals with uncontrolled or poorly controlled high blood pressure are not considered good candidates for this medication, as there is a slight risk of elevated blood pressure or fast heart rate. Because it is new, it is also more expensive than the older medications, making it more difficult to obtain for some individuals. Samples and coupons can be helpful in reducing costs, however, depending upon an individual’s medication coverage or financial situation it may be difficult or impossible to afford. We anxiously await newer medications in this class as well.
For night time urinary frequency, certain individuals may be given a medication called desmopressin, as a tablet or a nasal spray at night to reduce urine production at night. It requires close monitoring because it may cause a dangerous drop in sodium levels in the blood under certain circumstances. However, it may be very helpful for individuals with just night-time frequency for whom other treatments have been unsatisfying or ineffective.
None of these medications are approved to treat stress urinary incontinence (SUI). Please see earlier posts regarding the different types of urinary incontinence and how they are treated.
This is meant to be a basic overview to familiarize you with types of medications and their names. I feel strongly that starting with medications is usually not necessary or advisable, and should be used only as a second-line treatment in most cases. If you have questions or concerns, discuss them with your physician. For more information or a consultation, call 561-701-2841.
Linda Kiley, MD
Dr. Kiley is a Board Certified subspecialist in Female Pelvic Medicine and Reconstructive Surgery, and is also Board Certified in general Obstetrics and Gynecology.