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Medications for Controlling an Overactive Bladder

Posted Aug 24 2008 1:49pm
ANNOUNCER: Overactive bladder is a common problem, affecting perhaps 16 percent of the population. People with overactive bladder experience a sudden, urgent need to urinate. They need to urinate frequently, often at night, and sometimes, they leak urine before they are able to make it to a bathroom. Lifestyle changes can play an important role in treatment, but medication can, too.

RAY RACKLEY, MD: The overactive bladder condition is typically characterized by overactive muscle contractions of the bladder. Therefore, for years, we've used medications to inhibit the overactive muscle. Since the muscle's driven by a nerve supplying acetylcholine, we have drug therapies that block this neurotransmitter, called anticholinergic medication.

ANNOUNCER: The available drugs in this class are generic oxybutynin, and the brand-name products Ditropan XL, Detrol, Oxytrol, Sanctura, Enablex, and Vesicare.

RAY RACKLEY, MD: The anticholinergic class of medication's effect on the bladder is witnessed by the patient in the following way. They notice that they're able to increase the amount of volume of urine that they actually can hold before they have an accident or the sense of urgency. They actually reduce the frequency of urination and they've shown to reduce the actual frequency of leakage events. So the patient would notice, "I go less often, I have less urgency and, because of the less urgency and frequency, I even have less leakage of urine."

ANNOUNCER: Many patients experience side effects with these drugs.

JOSEPH G. OUSLANDER, MD: By far, the most common and bothersome side effect is dryness of the mouth. They can also cause constipation and, for people who have problems with heartburn or esophageal reflux disease, they can exacerbate those symptoms. They can cause dryness of the eyes. And some patients, may have side effects that relate to the central nervous system, headaches, dizziness, problems with memory.

ANNOUNCER: Side effects sometimes cause people to quit taking the medicine, even if it is effective. Health care providers say that can often be avoided.

DIANE NEWMAN, RNC, MSN: If the drug is effective and it really has helped them with their overactive bladder symptoms and they're having a problem with side effects, I ask them if maybe we can help them manage their side effects. One of the things I suggest is maybe changing the time of day they take the medication. We may see it impact dry mouth or possibly dry eyes.

Another thing that, with constipation, if they find that the drug is causing, maybe, them to be more constipated, I put them on a bowel regimen that may include increased fiber or maybe some type of laxative.

ANNOUNCER: The side effects of anticholinergics result from the effects of the drug on acetylcholine receptors called muscarinic receptors, not only on the bladder, but in other parts of the body as well.

RAY RACKLEY, MD: The side effects of the antimuscarinic class of medication is attributed to the fact that we're blocking the receptor that exists on many other organ sites. Therefore, if we block the bladder receptor, we're at risk for blocking receptors in the brain, in the salivary gland, in the colon, on the heart and many other organ systems.

ANNOUNCER: Recently, more selective drugs have been approved.

JOSEPH G. OUSLANDER, MD: Some of the newer drugs that are available for treatment of overactive bladder don't interact with all the types of muscarinic receptors you have in your body, so there are some theoretic advantages to blocking certain types of muscarinic receptors in your body, but not others.

This is especially important in older patients, who are even more susceptible to side effects, in whom you might be able to use lower dosages of drugs that are more selective.

ANNOUNCER: Another technique to reduce side effects is to alter dose, timing of the doses, and the method of delivering the drug.

DIANE NEWMAN, RNC, MSN: The drug delivery, which means how you take the drug, can affect the side effect profile. Most of these drugs are taken in pill format. That means they go through the stomach and the bowel. That may cause more side effects.

A novel way to give a drug is by a skin patch. That way, you don't have to go through the bowel and the stomach and you may have less overall side effects. However, remember, with the skin patch, it may irritate the skin. So you may be trading off what we call central side effects that are through the body with skin side effects and you have to decide what's best for the patient, as far as delivering that drug.

ANNOUNCER: Other types of drugs can be helpful, too. Creams containing estrogen can help relieve irritation and prevent urinary tract infections. Antidepressants can relax the bladder. And a drug called DDAVP can shift urine output from nighttime to daytime, to help people get through the night.

Some trial and error is to be expected in the treatment of OAB. But experts say most patients can expect a good outcome.

DIANE NEWMAN, RNC, MSN: But what we have to realize is we're not sure which drug fits which patient, and we're learning as we go along. But what's important for the patient to understand is we have a solution for the problem overactive bladder. And it's probably going to include some type of drug -- it may be one of the newer drugs -- and some behavioral treatments. Combined, this is probably going to be the most successful outcome for that patient.

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