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Medications and Overactive Bladder

‘Is there a pill for that?’ - the age-old question; and when it comes to Overactive Bladder (OAB), the answer is yes. However, as with any medication, it is important to understand the pros and cons.

Behavioral therapy is the first-line treatment for OAB symptoms recommended by the National Institute of Clinical Excellence (NICE) guidelines1, however medications are still commonly prescribed by healthcare professionals. Most of these medications work by decreasing bladder muscle activity, which is often (yes, you’ve guessed it!) excessively active in OAB, due to a brain-bladder signalling error.  Although medications can be effective in treating OAB, they can also have negative side-effects, be costly, and some medications need to be taken multiple times a day2.  

Let’s have a look at some of the different types of medication currently prescribed for treating OAB:

Anticholinergic (antimuscarinic) agents:  

Anticholinergics are the most commonly prescribed medication for OAB treatment. They work by blocking the chemical messenger acetylcholine. This chemical messenger gets sent from the bladder to the brain to let us know when our bladder is full and that we need a bathroom break. With OAB, the brain-bladder signalling does not work properly and our bladder can send multiple false acetylcholine signals to the brain. These false signals cause our brain to think that we need to pass urine, even when the bladder is not full.  

Anticholinergic medication helps to block these false signals, which can enable us to hold more urine in our bladder before the brain is told “you gotta go pee, now!”.  This medication can help reduce involuntary bladder activity and the resulting symptoms of urgency, frequency and/or incontinence.  Although research has shown anticholinergics can be effective in treating OAB, they can unfortunately result in side-effects that further worsen quality of life. Reported side effects of anticholinergic medications include blurred vision, dry eyes and mouth, and constipation3.  

Mirabegron (β3-AR agonist):  

Mirabegron works by stimulating receptors (i.e. Beta3 agonists) in the bladder muscle, which allows the bladder to relax. When bladder muscles are relaxed, this can reduce feelings of urgency and make it possible to hold more urine before feeling like you need to “go”. This type of medication can be effective in the treatment of OAB when used alone or in combination with other medications. Although there are some reported side-effects, including dry mouth and constipation, they are typically not as severe as those experienced with anticholinergics4.  

Onabotulinumtoxin type A (Botox):  

You may have heard of “Botox” for reducing facial wrinkles, but did you know it can be injected into the bladder muscle too? Similar to anticholinergic medication, Botox works by blocking the chemical messenger acetylcholine, helping the bladder muscle relax.  Botox is not considered as a first-line treatment for OAB, but is considered as an option by medical professionals if other treatments are not successful. As with the fine lines on our face, the effects of Onabotulinumtoxin eventually wear off. This means that the bladder muscle activity will revert back to the same level experience before Botox treatment and additional injections may be required throughout each year.  

There are fewer side-effects associated with Botox treatment, however urinary tract infections (UTIs) and voiding dysfunction (i.e. some urine remains in the bladder after using the toilet) have been reported, which can result in people abandoning this line of treatment5.  

In Summary

There are a variety of medications that have been shown to effectively treat OAB, however research has found that many women stop taking medication due to negative side-effects, cost and not working as expected5.  It is for these reasons, amongst others, that behavioral therapy is the first-line recommended treatment for OAB symptoms. Always speak with your healthcare provider to understand the best treatment option for you and your quality of life.

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1. 2019 - Urinary incontinence and pelvic organ prolapse in .pdf. Accessed November 4, 2022. https://www.nice.org.uk/guidance/ng123/resources/urinary-incontinence-and-pelvic-organ-prolapse-in-women-management-pdf-66141657205189

2. Jayarajan J, Radomski SB. Pharmacotherapy of overactive bladder in adults: a review of efficacy, tolerability, and quality of life. Res Rep Urol. 2013;6:1-16. doi:10.2147/RRU.S40034  

3. Alhasso AA, McKinlay J, Patrick K, Stewart L. Anticholinergic drugs versus non‐drug active therapies for overactive bladder syndrome in adults. Cochrane Database of Systematic Reviews. 2006;(4). doi:10.1002/14651858.CD003193.pub3  

4. Kelleher C, Hakimi Z, Zur R, et al. Efficacy and Tolerability of Mirabegron Compared with Antimuscarinic Monotherapy or Combination Therapies for Overactive Bladder: A Systematic Review and Network Meta-analysis. European Urology. 2018;74(3):324-333. doi:10.1016/j.eururo.2018.03.020  

5. Liao CH, Kuo HC. Practical Aspects of Botulinum Toxin-A Treatment in Patients With Overactive Bladder Syndrome. Int Neurourol J. 2015;19(4):213-219. doi:10.5213/inj.2015.19.4.213  

6. Benner JS, Nichol MB, Rovner ES, et al. Patient-reported reasons for discontinuing overactive bladder medication. BJU International. 2010;105(9):1276-1282. doi:10.1111/j.1464-410X.2009.09036.x

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