overacTive BLadder

What is the role of medications in treating overactive bladder?

There are several medications recommended for the treatment of overactive bladder. Using these medications in conjunction with behavioral therapies has shown to increase the success rate for the treatment of overactive bladder.

The most common medications (anticholinergics) target to decrease the overactivity of the detrusor muscle. These medications (anticholinergics) should be used under the direction of the physician prescribing them. They may have some common side effects, including dry mouth, constipation, blurry vision, and confusion (in the elderly). Here is a list of the most commonly recommended medications for overactive bladder.

* Oxybutynin (Ditropan) prevents urge incontinence by relaxing the detrusor muscle. This is typically taken two to three times a day (Ditropan XL is extended release, taken once a day). Ditropan patch (Oxytrol) is also available with fewer side effects, but it releases a smaller dose than the oral form. The patch is placed on the skin once to twice weekly and it may cause some local skin irritation.


* Tolterodine (Detrol, Detrol LA) is indicated for the treatment of an overactive bladder with symptoms of urinary frequency, urgency, or urge incontinence. This medication affects the salivary glands less than oxybutynin, thus, it is better tolerated with fewer side effects (dry mouth). Detrol is usually prescribed twice a day, whereas the long-acting type (Detrol LA) is taken only once a day.


* Solifenacin (VESIcare) is a relatively newer medication in this group. It is generally similar to tolterodine, but it has a longer half-life and needs to be taken once a day.


* Darifenacin (Enablex) is also a newer anticholinergic medicine for treating overactive bladder with fewer side effects, such as, confusion. Therefore, it may be more helpful in the elderly with underlying dementia. This medication is also typically taken once a day.


* Fesoterodine fumarate (Toviaz) is indicated for the treatment of overactive bladder with symptoms of urge urinary incontinence, urgency, and frequency. The medication is taken once daily. Common side effects include constipation and dry mouth.

Tricyclic antidepressants (imipramine [Tofranil] or doxepin [Sinequan, Adapin]) are sometimes used in treating overactive bladder, but their exact mechanism for this application is not clear.
Estrogen, either oral or vaginal, may be helpful in conjunction with other treatments for postmenopausal women with urinary incontinence.

Some of the other newer therapies for overactive bladder are still in trial stages and some are occasionally used in special cases. For example, botulinum toxin injection (Botox) into the detrusor muscle of the bladder may be helpful in some patients with urge incontinence who have responded to other more traditional treatments. There are still other medications for overactive bladder in the research stage that may specifically act on the bladder muscles.

Surgery is rarely necessary in treating overactive bladder unless symptoms are debilitating and unresponsive to other treatments. Reconstructive bladder surgery (cystoplasty) is the most common surgical procedure.