When to Try a Different OAB Medication
Overactive bladder (OAB) is a syndrome. That means it’s defined by a cluster of symptoms—we’re not sure yet about the actual cause. The hallmark symptom of OAB is urinary urgency, which is defined by the International Continence Society as “a sudden compelling desire to pass urine, which is difficult to defer.” Patients also may experience the two other common symptoms of OAB: frequent urination (using the bathroom more than seven or eight times a day) and nocturia (when your need to urinate wakes you up one or more times a night). Some patients also experience urinary incontinence, or “leaking” when they don’t get to the bathroom in time.
OAB can have a very negative impact on your quality of life—it can affect mental health, sexual function, marital satisfaction, and your confidence level in general. Fortunately, there are several treatment paths to try—and if one doesn’t work, another may do the trick. I’ll always start patients on lifestyle modifications—these are non-invasive and non-medicinal strategies that can make a difference. They include controlling fluid intake, avoiding irritants like caffeine and alcohol, retraining the bladder by scheduling urination, and practicing kegels, or pelvic floor exercises.
While many patients find success with these behavioral interventions, some need further treatment. That’s where medications come in—in fact, studies have shown that the combination of behavioral interventions with medication is far more effective than treatment with just one or the other alone.
There are many pharmacological options available to treat OAB. These medications function pretty similarly—most of them block a receptor in the bladder in order to relax it, so it can store more urine without causing the urge to urinate. Some of these drugs also control spasms in the bladder and urinary tract. Your doctor may prescribe the tried and true class of medications for OAB, called anticholinergics, or a new class of medications, called beta-3 adrenergic agonists. These medications can make a big difference in your life, but you may need to try a few things before you settle on the one that works best. I like to tell my patients that these medications are like a pair of jeans. Some therapies work better for you than others, just like some jeans are more flattering than others. If one medication isn’t the right one, I think it’s worthwhile to try at least two others before we turn to more invasive treatments.
Signs It’s Time to Try a Different Medication
1. You can’t stand the side effects.
Of course, as with any medication, there are several side effects to be aware of. OAB medications may cause dry eyes, dry mouth, constipation, and drowsiness. Some drugs also prevent patients from fully emptying their bladders. One drug in particular, oxybutynin (Ditropan), has been associated with some memory loss, so I’ll try to give older patients a different one. For example, trospium (Sanctura) and darifenacin (Enablex) are thought to cause fewer cognitive side effects (like memory loss), so I’ll choose one of those for patients who are concerned about those issues.
If you’re experiencing any side effects to the point where you don’t want to use your medication anymore, talk to your doctor. He or she may lower your dosage or switch you to an extended-release version of your medication, which may reduce side effects. You could also try a patch or gel form for fewer side effects. However, if those tweaks don’t work, ask to try something new: each OAB drug affects your body differently, so it’s important to try other options instead of giving up on medication altogether.
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