Understanding overactive bladder
Having overactive bladder (OAB) can be uncomfortable and even painful. OAB is a set of symptoms that cause incontinence, or a loss of bladder control. Symptoms include:
- needing to urinate more than normal
- having sudden urges to urinate
- not being able to control urination
- needing to urinate more than once overnight
- urine leakage
These symptoms may interfere with your daily life. There’s no cure for OAB, but the good news is that there are effective ways to manage it. These include behavioral treatments, lifestyle changes, medications, and sometimes surgery.
OAB can happen for several reasons. Sometimes treating the underlying cause of your OAB can help your symptoms. For instance, neurological disorders, such as Parkinson’s disease or multiple sclerosis, can cause your bladder to contract more often than it should. In men, the cause of bladder issues is often an enlarged prostate gland. Bladder stones or cancer may also cause OAB symptoms.
If your doctor can find the cause for your OAB, you can receive targeted treatment for the cause. In turn, you can relieve your OAB symptoms. However, it’s not always possible to pinpoint the exact cause of OAB. In these cases, other medications are available. Here are some of the more common medications used to treat OAB.
If your doctor can’t find a cause for your OAB, don’t worry. Drugs can still help ease your symptoms. Some of these drugs work by relaxing your bladder. They stop involuntary contractions that bring on the urge to urinate. Other drugs help strengthen the tissues around your bladder that may have become weak. The stronger tissue can help improve your bladder control.
The largest class of drugs used to treat OAB is anticholinergic drugs. They work by blocking a chemical in your body called acetylcholine. This chemical sends a message to your bladder to contract. By blocking this chemical, these drugs reduce the contractions that cause you to release urine. In studies that compared the drugs, all anticholinergics worked equally as well in treating OAB.
Anticholinergics are sold under different brand names. Some are also available as generic drugs. These medications include:
- oxybutynin (Ditropan XL, Oxytrol)
- tolterodine (Detrol, Detrol LA)
- trospium (Sanctura)
- darifenacin (Enablex)
- solifenacin (Vesicare)
- fesoterodine (Toviaz)
All of these drugs except for Oxytrol come as either tablets or capsules that you take by mouth. Oxytrol is available as a skin patch.
The most common side effects of anticholinergic drugs include:
- dry mouth
- blurry vision
- constipation
Seniors have the greatest risk of side effects from these drugs. These medications may also cause drowsiness and an increased risk of falls in seniors. Oxybutynin may cause more side effects than the other drugs in this class. However, taking oxybutynin in its extended-release form may reduce some of the side effects. Anticholinergics may also worsen dementia symptoms and should be used with caution in people with this disease.
The only drug in this class is mirabegron (Myrbetriq). It works by relaxing the smooth muscle in the walls of your bladder. This effect helps your bladder hold more urine.
This drug is available as a tablet that you take by mouth once per day. It interacts with several other drugs. Make sure you tell your doctor about all medications you’re taking.
The most common side effect of this drug is high blood pressure.
Antispasmodic drugs for OAB | Antispasmodic drugs
Flavoxate is the only drug in this class. It’s an oral drug that reduces bladder spasms. This is an older drug. Some studies show that it doesn’t work as well as newer drugs to treat symptoms of OAB.
If other OAB drugs don’t work for you, or if you can’t take other OAB medications, your doctor may give you an antidepressant. These drugs are used to treat depression, but they may help relieve some OAB symptoms. The FDA has not reviewed these drugs for the treatment of OAB, so your doctor may use them off-label.
An antidepressant that your doctor may prescribe for OAB is desipramine. This oral drug works by relaxing your bladder while also contracting the muscles at the neck of your bladder. These actions may reduce your urge to urinate. They also help control leakage and improve bladder control.
Another antidepressant used to treat OAB is imipramine. It’s an oral medication that works in the same way as desipramine. The main side effect of this drug is sleepiness. This makes it a good choice if you have nighttime incontinence.
Side effects of antidepressants used to treat OAB can include:
- drowsiness
- fatigue
- anxiety
- decreased sex drive
Some women may suffer from OAB due to weak support tissues around their bladder and urethra. If this is the cause of your OAB, your doctor may give you topical estrogen. This is a hormone the body makes naturally. Estrogen works to strengthen the muscles around the bladder, vagina, and urethra. After menopause, women start to make less of it.
Topical estrogens used for OAB include estradiol cream (Estrace) or conjugated estrogen cream (Premarin). All estrogens raise your risk of some cancers, stroke, and heart attack. However, topical estrogen has less risk than the oral forms of the drug do.
Botox, which is well known for smoothing out wrinkles, can also be used for OAB. Like anticholinergic drugs, this drug works by blocking acetylcholine. It also paralyzes the muscle of the bladder. This treatment is new and is still being studied. It may not be covered by all health insurance plans.
Botox comes with risks. It’s a very strong drug that your doctor must inject. They will watch you for side effects after you receive your injection. The risks include paralyzing your bladder. This would leave you without any control over your bladder. If this happens, you must be able to catheterize yourself. This involves inserting a catheter (thin tube) into your urethra and bladder to drain urine.
OAB can be tricky to manage. But if you have this condition, take heart. With the right treatment, you should be able to return to a more comfortable lifestyle. Your treatment plan may include medications for OAB. Work with your doctor to find the best drug for you.
Medically Reviewed by Jabeen Begum, MD on September 28, 2021
Overactive bladder can have a major impact on just about every aspect of your life. It can force you to avoid vacations, dinners out, and other social situations. You can even miss out on valuable time with family and friends because you're afraid your overactive bladder -- also called OAB -- will trigger at the wrong time and embarrass you. Fortunately, there are ways to combat the problem. Overactive bladder treatment has many approaches, from medication, to behavioral changes, to a combination of both. Visiting your doctor for a thorough evaluation and following their instructions carefully can help you get the OAB treatment you need to get back into your old routine. Bladder training and pelvic floor exercises are just two natural treatments for overactive bladder. Research suggests that these nondrug remedies can be very effective for many women, and they have almost no side effects. But before starting any OAB treatment, it’s important to understand bladder function and what things may cause overactive bladder.
Another way to strengthen pelvic floor muscles is electrical stimulation, which sends a small electrical pulse to the area via electrodes placed in the vagina or rectum. Until you get your overactive bladder under control, wearing absorbent pads can help hide any leakage. Other lifestyle tips for preventing incontinence include: In people with overactive bladder, muscles in the bladder wall contract at the wrong time. A group of drugs called anticholinergics combat this problem by blocking the nerve signals related to bladder muscle contractions. Research suggests that these drugs also might increase bladder capacity and decrease the urge to go. Anticholinergic drugs include: Oxytrol for women is the only drug available over the counter. Overall, these drugs work about the same in treating overactive bladder, and generally people tolerate all of them well. The main side effect is dry mouth, but anticholinergics also can cause constipation, blurred vision, and increased heartbeat.
Anticholinergics aren't right for everyone. Some people with glaucoma, urinary retention, or gastrointestinal disease should avoid using anticholinergic drugs. The drugs mirabegron (Myrbetriq) and vibegron (Gemtesa) called beta-3 adrenergic agonists. These medications work by activating a protein receptor in bladder muscles that relaxes them and helps the bladder fill and store urine. Another type of drug for overactive bladder is the tricyclic antidepressant imipramine hydrochloride (Tofranil), which also relaxes bladder muscles. Botox (Onabotulinumtoxin A), more commonly known for removing wrinkles, can be injected into the bladder muscle, causing it to relax. This can increase capacity in the bladder and lessen contractions. You’ll get the shots in your doctor’s office. About 6% of people who get Botox may temporarily be unable to pee. You must be able and willing to have a catheter put in if this happens. Botox is only recommended for people who can't control symptoms with behavioral therapies or oral medications. Studies have found that the lack of estrogen that occurs after menopause can affect urination, and some women are treated for OAB with estrogen. However, there isn’t strong evidence to show that estrogen is an effective treatment for OAB. Sometimes overactive bladder treatment for men includes a type of blood pressure medication called alpha-blockers, but again, the research on these drugs isn’t conclusive. Doctors also treat men with drugs that relax a muscle at the bladder neck and prostate to help with emptying. They include: Capsaicin, which is the active ingredient in chili peppers, may target the nerves of the bladder. A related substance, resiniferatoxin, has also had favorable findings in preliminary research of patients with spinal cord injury. In rare cases when all OAB treatment fails and overactive bladder is severe, doctors may recommend one of several types of surgery. Augmentation cystoplasty. A procedure called bladder augmentation uses part of the bowel to increase bladder capacity. Or, urinary diversion, an alternate route for bladder drainage for severe, complicated OAB patients.
Sacral nerve stimulation. Another procedure implants a small device, similar to a pacemaker, under the skin. The device is connected to a wire, which sends small electrical pulses to nerves around the pelvic floor that control the bladder and muscles surrounding it. This helps build bladder control. It’s often called a bladder pacemaker. The main limitation with this treatment is that it keeps you from having a spinal MRI. Percutaneous tibial nerve stimulation. The doctor places a needle on nerves near your ankle that affect bladder control. You’ll have one session a week for 12 weeks and then maintenance treatments as needed. This procedure is done in the office. An overactive bladder doesn’t have to get in the way of your daily life. With a little time, patience, and the right treatment, you can regain control -- and peace of mind. Whatever treatment for overactive bladder you and your doctor decide upon, it's important that you stick with it. If you do, chances are your condition will improve in time.