Many people take medication to successfully treat overactive bladder (OAB). However, others put off seeing their doctor to get a prescription that might bring relief. Still others start medication but stop it without ever achieving its full benefit. The more you learn about these medications, the better able you will be to make good choices about treating OAB.
First-line medications
The first-choice medications for treating OAB are called antimuscarinics. They are also known as anticholinergics. These medications include:
- Darifenacin (Enablex)
- Festerodine (Toviaz)
- Oxybutynin (Ditropan, Ditropan XL, Oxytrol, Gelnique)
- Solifenacin (Vesicare)
- Tolterodine (Detrol, Detrol LA)
- Trospium (Sanctura, Sanctura XR)
Medications in this group reduce OAB symptoms by relaxing the smooth muscle of the bladder. All of them can be taken orally. In addition, oxybutynin is sold in patch and gel forms.
The most common side effect of antimuscarinics is dry mouth, which affects almost one-third of people who take these drugs. Other possible side effects include constipation, dry eyes, blurred vision, and trouble emptying the bladder.
Other medications
If antimuscarinics do not work well for you, your doctor might prescribe another type of medication. These other medications include:
- Duloxetine: This is an antidepressant that may decrease OAB symptoms by increasing the availability of two important body chemicals—serotonin and noradrenaline—that affect bladder function.
- Desmopressin: This is an antidiuretic—a drug that reduces urine output. It may decrease waking at night to urinate. There’s also limited evidence that it might help daytime OAB.
- Estrogen: In people who experience menopause, tissues of the vagina and urethra are affected by low levels of estrogen following menopause. The tissues become thin and easily irritated. That irritation, in turn, may worsen OAB symptoms. Topical estrogen applied to the vagina helps some people.
- Imipramine: This antidepressant reduces urine production and may decrease nighttime urination. However, it can also cause side effects, such as sleep problems, loss of appetite, and upset stomach. In addition, there is a small risk of more serious side effects, including heart-related problems and increased thoughts of suicide. As a result, imipramine is not usually prescribed for OAB unless other drugs have not worked.
- Mirabegron: This beta-3 agonist relaxes the detrusor muscle fibers within the bladder. Mirabegron is a tablet. It may help you if you cannot tolerate the side effects of antimuscarinics. Mirabegron is not for people who have uncontrolled high blood pressure.
- Vibegron: This beta-3 agonist is an oral tablet that relaxes the bladder muscles. However, some people taking vibegron have experienced an inability to empty the bladder (urinary retention), a condition for which you should seek emergency medical care.
- Botulinum toxin: Botox injections in the bladder are approved by the U.S. Food and Drug Administration (FDA) as a treatment for OAB after first-line medical therapies have failed. The injections stop excessive contraction of the bladder's detrusor muscle. The effect of the injection lasts an average of 6 months.
Medication effectiveness
In a recent study, researchers asked more than 1,300 OAB patients who had stopped taking their medication about their reason for stopping. Nearly half said the medication did not help as much as they expected. In fact, while medication can often reduce urine leaks or extreme urges to urinate, it may not stop them completely. Side effects—such as dry mouth, constipation, and dry eyes—may also occur.
Having realistic expectations of your medication is one key to successfully treating OAB. Combining medication with nondrug treatments—such as scheduled bathroom breaks and pelvic muscle exercises—can also boost the effectiveness of your treatment plan. If a medication still does not improve your symptoms or if it causes bothersome side effects, a different drug might work better for you. Fortunately, there are several types of medications available for treating OAB. Be sure to discuss your options with your doctor before stopping any medication.