What Is the Best Medication for Overactive Bladder?

Megan Nunn, PharmD
·9 min read
2

Treatment options for OAB symptoms like frequent urination, urgency, and incontinence

Medically reviewed by Mary Choy, PharmD

Overactive bladder (OAB) is a group of symptoms that are not usually life-threatening but can significantly decrease productivity and quality of life.

The condition is characterized by the sudden need to urinate (called urgency).

People with OAB often (but not always) have the following symptoms as well:

To be diagnosed with OAB, urinary tract infections (UTIs) and other diseases must be ruled out.

OAB occurs in about 16% of the population and, more commonly, in people over age 40.

OAB can contribute to issues such as the following:

  • Trouble sleeping

  • Anxiety

  • Depression

  • Reduced physical activity

  • Reduced sexual activity

  • Fractures

  • Injuries

Here's what you need to know about treatment options to help control symptoms of OAB.



Lifestyle Modifications

The American Urological Association recommends lifestyle modifications and behavioral therapies before starting medications for OAB. These can also happen in conjunction with medications.

Strategies with proven effectiveness include the following:



Overview of OAB Medications

Several types of medications may be prescribed for OAB management. The two most common classes include the following:

  • Anticholinergics, which reduce bladder contractions

  • Beta-3 adrenergic agonists, which relax the bladder muscles and increase the bladder's capacity to hold urine

Other medications that are taken for OAB less commonly include:

  • Antidepressants, which regulate chemical messengers and can increase bladder capacity

  • Hormones, which can build strength in the pelvic floor and reduce incontinence

  • Botox, which relaxes the bladder muscle

Here's a closer look at the medicines in these classes.

Anticholinergic Medications

Anticholinergic medications help alleviate OAB symptoms by blocking nerve signals that trigger bladder contractions.

These medicines can reduce symptoms of OAB by up to 70%. However, their side effects often cause people to discontinue treatment. Keep in mind that some research shows that despite improving symptoms of OAB, anticholinergic medicines don't typically impact overall quality of life.

As a class, anticholinergic medicines are known for causing some serious side effects, such as the following:

These side effects are more common in older adults. Taking more than one medicine with anticholinergic action, such as some antidepressants, antipsychotics, and allergy medicines, can intensify them. For this reason, older people should only take medicines in this class when the benefits outweigh the risks.

Most anticholinergic medications for OAB are taken by mouth once or twice a day. Some of the oral prescription medications available include:

  • Ditropan (oxybutynin) 5 to 15 milligrams (mg) by mouth daily

  • VESIcare (solifenacin) 5 to 10 mg by mouth daily

  • Enablex (darifenacin) 7.5 to 15 mg by mouth daily

  • Detrol (tolterodine) 2 mg by mouth twice a day

  • Sanctura (trospium) 20 mg by mouth twice a day

  • Toviaz (fesoterodine) 4 to 8 mg by mouth daily

Oxytrol is an oxybutynin patch applied to the skin on the abdomen, hip, or buttocks every three or four days. It has a much lower incidence of dry mouth and constipation than the medicines taken by mouth, though it may cause a skin reaction.

For mild anticholinergic side effects, consider strategies like increasing your fiber intake or adding MiraLAX for constipation. For dry eyes, you can use lubricating eye drops.

If you are experiencing severe side effects from your medicine, discuss other options with your healthcare provider. Your doctor may lower your dose, switch to another medicine, or try alternative treatments. Because of the high incidence of this class of medication's side effects, many healthcare providers are turning away from it in favor of other treatments.

<p>Willie B. Thomas / Getty Images</p> Older black female standing in kitchen sorting her medication.

Willie B. Thomas / Getty Images

Older black female standing in kitchen sorting her medication.

Beta-3 Adrenergic Agonists

Beta-3 adrenergic agonists work to relax bladder muscles and increase bladder capacity, offering an alternative treatment option for OAB.

They are as effective as anticholinergic medications in treating the symptoms of OAB but with fewer side effects.

There are two drugs currently available in this class:

  • Myrbetriq (mirabegron), with 25 to 50 mg dosages by mouth daily. Myrbetriq can increase blood pressure, so it's not recommended for people with severe high blood pressure (hypertension). It's also not recommended for people with severe liver or kidney disease. Myrbetriq may interact with other medicines, such as tricyclic antidepressants and some medicines for irregular heart rate.

  • Gemtesa (vibegron), which is dosed at 75 mg by mouth daily. Gemtesa is relatively safe and has a low incidence of side effects.

Antidepressants

Some antidepressants may reduce OAB symptoms in people who also have depression, though the U.S. Food and Drug Administration (FDA) for this use.

Antidepressants that have been studied for OAB include:

Remember that significant side effects are also associated with these medicines.

Cymbalta can cause drowsiness, high blood pressure, and a fast heart rate. Tofranil is associated with mania, heart abnormalities, and sun sensitivity.

Both medicines carry a black-box warning due to an increased risk of suicidal ideation in children, adolescents, and young adults.

Hormones

Estrogen is a hormonal option for controlling OAB symptoms in females after menopause.

Some prescription products include:

  • Premarin cream, applied twice a week to the vagina

  • Vagifem, estradiol tablets inserted into the vagina

Estrogen increases the strength and flexibility of pelvic floor muscles to help control incontinence— but keep in mind that current guidelines do not recommend it.

Precautions to note if you're considering an estrogen product: estrogen can increase the risk of stroke or blood clots and may also increase the risk of endometrial cancer.

As always, discuss the pros and cons of hormone therapy with your healthcare provider before starting treatment.

Botox

Botox (botulinum toxin A) can be injected into the bladder wall to relax or paralyze the detrusor muscle. It is FDA-approved for OAB.

The ideal dose of Botox for OAB is 100 units. Higher doses work better but can often cause urinary retention or the inability to urinate. Other side effects include UTIs, pain when urinating, and muscle weakness. Up to 45% of people who get Botox injections for OAB reported difficulties urinating after the procedure.

A few important things to remember: Botox injections wear off over time and must be repeated every six to nine months. And if you decide to go this route, you may have to use a catheter to release extra urine if it builds up.

Alternative Treatment Approaches

Other alternative treatments are generally recommended only after other therapies have failed.

These more invasive strategies include:

  • Short-term posterior tibial nerve stimulation, wherein a needle is used to stimulate a nerve in the lower leg. It can be performed in the hospital setting or using an implantable device. It's not a good choice for people with defibrillators, pacemakers, bleeding problems, or those who are pregnant or may become pregnant.

  • Sacral neuromodulation, which uses an implanted device to deliver continuous electrical stimulation to the bladder and pelvic floor. This device is not recommended for females who are pregnant or plan to be or for people who need magnetic resonance imaging (MRI).

Natural Treatments

Some people prefer natural remedies for OAB—but note that natural does not always mean safe. These treatments aren't generally studied like prescription medications, so we know less about their benefits and risks.

Natural treatments for OAB include the following:

Overall, there's not much evidence that these treatments are effective. More research is necessary before they can be routinely recommended.



Explainer

In the United States, the Food and Drug Administration (FDA) does not regulate supplements like prescription drugs. This means some supplement products may not contain what the label says.

When choosing a supplement, look for third-party tested products and consult a healthcare provider, registered dietitian nutritionist (RDN or RD), or pharmacist.



Overactive Bladder Causes

Though the exact cause of OAB is unknown, there are several theories. Some involve dysfunction of body parts like the detrusor (bladder muscle) or the urethra.

Other theories focus on imbalances in the autonomic nervous system, which regulates involuntary bodily functions like breathing and heart rate.

Older age is recognized as a risk factor for developing OAB. In the United States, over one in four males and almost half of females over age 40 have symptoms of OAB.

Other possible risk factors for OAB include the following:

When to Speak to Your Healthcare Provider

If you are experiencing symptoms of OAB, seeking guidance from healthcare providers like urologists or primary care physicians is key. These providers can diagnose and recommend therapies or medications that help.

Before starting or discontinuing any OAB medication, take the time to discuss potential risks, benefits, and alternatives to optimize your therapy. Pharmacists are great resources for treatment recommendations, screening for drug interactions, and helping you keep up with your medications.

Summary

When it comes to OAB, there are lots of treatment options available.

Before adding medications, the latest recommendations call for lifestyle modifications and behavioral interventions.

The medications most commonly taken for OAB are prescription anticholinergics or beta-3 adrenergic agonists. Anticholinergics, in particular, are associated with some significant side effects, including dry mouth, constipation, and cognitive impairment.

If these medicines don't help or side effects make them a poor choice for you, alternative medications include antidepressants, estrogen, and Botox. Procedures like posterior tibial nerve stimulation or sacral neuromodulation are options as well. There are notable precautions to keep in mind for whichever option you choose.

Your healthcare provider or pharmacist can help you decide which intervention or medication may be best for you. If you experience side effects or feel your treatment isn't working, ask your healthcare provider which alternatives can help.

Read the original article on Verywell Health.