If the muscles (detrusor) in the bladder contract too much, this results in an overactive bladder. Anticholinergic (antimuscarinics) medication helps by slowing down these contractions. There are some side effects associated with this type of medication, which may include: dry mouth, dry eyes, blurred vision, constipation and nausea. People can react differently to medication and what suits one person may not suit another. It is therefore important to discuss all options and to be followed up by your GP, consultant or continence advisor to check on any side effects in case you need to change to another medication.
Some of the Anticholinergic medication available is:
| Generic Name | Brand Name |
| Fesoterodine Fumarate | Toviaz |
| Oxybutynin | CystrinDitropanLyrinel XL (modified release)Kentera (skin patch) |
Transdermal oxybutynin (skin patch) can reduce side effects as it is not absorbed by the liver. Some side effects include a lack of saliva and products are available to help a dry mouth.
| Propiverine Hydrochloride | Detrunorm |
| Solifenacin Succinate | Vesicare |
| Tolterodine | Detrusitol XL (modified release)Detrusitol |
| Trospium Chloride | Regurin |
Desmopressin
Desmopressin is a synthetic replacement for Vasopressin, the hormone which reduces the production of urine. This can help with night time frequency and nocturnal enuresis.
Botox
Botox is now being used in some hospitals as a treatment for OAB. Botox, (Botulinum A-toxin), is injected into the wall of the bladder to control the contractions. Whilst some patients have reported an immediate improvement in their symptoms it does not work for everyone and has to be repeated as the effect wears off. One side effect may be urine retention therefore a patient is taught intermittent self-catheterisation (ISC). It is advisable to fully discuss all the options and possible side effects with your consultant.
Neuromdulation – Urgent® PC – PTNS percutaneous tibial nerve stimulation
Electrical stimulation of the nerves that control the bladder can improve symptoms of urgency, frequency and urge incontinence, as well as bladder emptying problems. This treatment is usually offered to patients who cannot tolerate or do not benefit from medications. Neuromodulation can be delivered non-surgically through a series of low-risk outpatient treatments – PTNS, percutaneous tibial nerve stimulation.
Sacral Nerve Stimulation (SNS)/Sacral Neuromodulation – Interstim®
Sacral nerve stimulation may be used to treat the symptoms of OAB in patients who have failed, or cannot tolerate, drug treatment. This implantable medical device uses mild electrical stimulation of the sacral nerve, that influences the behaviour of the bladder, sphincter and pelvic floor muscles. In properly selected patients this treatment can be successful in reducing or eliminating symptoms. The effects may reduce over time.
Betmiga (Mirabegron) Mirabegron is a once-daily beta-3 adrenoceptor agonist for the symptomatic treatment of urgency, frequency and/or urgency incontinence which is now available for the treatment of OAB. Antimuscarinic agents such as Oxybutynin, Vesicare and Toviaz are the current treatment standard but doctors will now be able to offer patients an alternative new treatment that works in a different way. Mirabegron has a completely different mechanism of action to antimuscarinics. It works by stimulating the beta-3 receptors in the muscle of the bladder causing relaxation of the bladder muscle and improving storage capacity of the bladder without impeding bladder voiding. Potential Side Effects In the three 12 week, Phase III studies, the most common adverse reactions reported for Mirabegron 50mg were tachycardia (a faster than normal heart rate) (1.2%) and urinary tract infections (2.9%). More serious adverse reactions include artrial fibrillation. For further information we suggest you contact your GP and if possible, take a bladder diary with you to show him/her the measurements and frequency of voiding.
The COB Foundation has fact sheets available for members on all of the medication listed. Please contact us for more information.