MEDICATIONS FOR OVERACTIVE BLADDER (OAB)

The most common treatment for OAB symptoms is medication. We’ve been using various ones for more than 50 years. The basic principal is to find a medicine that can control bladder contractions so that your urinating pattern normalizes without resulting in unpleasant side effects.

WHAT MEDICINES ARE AVAILABLE AND HOW TO THEY WORK?

The oldest, and most commonly used medicines, are called anti-cholinergics or anti-muscarinics. Their mechanism of action is to bind the neurotransmitter Acetylcholine so that it doesn’t stimulate the bladder muscle inappropriately.

All of these medicines work on the muscarinic receptors in the bladder. Muscarinic receptors are found in many areas of our bodies. They are classified with numbers. They control:

M1 – Salivation, brain function (can lead to confusion)
M2 – Heart contractility
M3 – Bladder contractility and eye function (can lead to blurry vision)
M4 – Lung tissue
M5 – Not well understood at this time
M6 and beyond – not yet discovered

Over the years, pharmacology companies have focused a lot of effort on creating anti-muscarinic medications that specifically target certain “M” receptors. They have been able to do that. Despite that, there is a fair amount of cross over from different receptors so that even a pure M3 receptor, which should target that bladder, can cause side effects like constipation, a dry mouth, blurry vision and confusion.

DOES THIS MEAN I SHOULDN’T TAKE AN ANTI-MUSCARINIC MEDICATION?

NO. It means that, as with all medical decisions, the potential benefits of a treatment should be weighed against the potential benefits. Overall, about 10% to 20% of patients who take OAB anti-cholinergic medicines achieve a significant benefit without bothersome side effects.

MY INSURANCE PLAN DENIES A NEWER TYPE OF ANTI-MUSCARINIC MEDICINE. SHOULD I TAKE AN OLDER VERSION?

In some cases, older, generic versions of anti-muscarinics can help you. However, they often have more side effects and produce less control of your bladder. In certain situations, we can produce a “prior authorization form,” for a small fee, to try to get your insurance plan to cover a more effective medicine with less side effects.

WHAT OTHER MEDICATIONS ARE AVAILABLE?

The newest class of medications for OAB are called beta 3 adrenergic agonists. They target smooth muscle cells in the bladder and can significantly reduce frequent or urgent bladder contractions.

HAT ARE THE ADVANTAGES OF THESE MEDICINES COMPARED TO ANTI-MUSCARINIC MEDICINES?

In some patients, beta 3 adrenergic agonists are significantly better because they can reduce inappropriate bladder contractions more significantly. In addition, while some patients cannot take anti-muscarinics because of a history of glaucoma, or they experience bothersome side effects, this newer class of medicine can often be taken safely and without side effects.

WHAT ARE THE SIDE EFFECTS?

The principal one is an elevation of blood pressure. We see this in about 7% of patients. That’s why we always caution you to check your blood pressure for the first week or two to ensure that there’s no blood pressure elevation.

HOW DO I KNOW IF MEDICINE IS THE RIGHT ANSWER FOR MY OAB SYMPTOMS? WHICH ONE SHOULD I TAKE?

If you have an OAB problem that we diagnose at Pacific Coast Urology Medical Center, medication is often the first level of treatment because it’s the lease invasive therapy. Based upon your medical history, we’ll help you decide which medicine is right for you. But, remember, only 10% – 20% of patients do well with medication on a long term basis. That’s why we offer a wide range of additional treatments including:

Acupuncture – FDA approved in the United States that stimulates the posterior tibial nerve behind your ankle bone (the Chinese call this the kidney – bladder pathway)
Sacral neuromodulation -Interstim®, the tiny battery that can end OAB symptoms overnight

BOTOX® – injected directly into your bladder muscle to stop frequent urges to urinate

To learn more about your OAB (overactive bladder) and learn more about what treatment is right for you, Call us to schedule a consultation in one of our 3 conveniently located offices: 888.735.4336 or Email us via our Contact Us form.