Navigating bladder medications for an overactive bladder and/ or stress incontinence can feel like a minefield, can't it? Vesicare, Toviaz, solifenacin, trospium, oxybutynin…. it feels very confusing. This article should give you a heads up on the questions to ask your GP and some information on the possible side effects too so you can make an informed decision. We also explore what they cost the NHS too and why there may be certain medications that are recommended more often than others.
What is an overactive bladder?
Overactive bladder (OAB) is the urge to pass urine and is usually associated with passing urine throughout the day and waking up at night to pee. It seems strange to describe overactive bladder as ‘wet’ or ‘dry’ but there is a difference. ‘Wet’ is where people experience leaks/ incontinence. ‘Dry’ is where you do not get leaks but you still get the urge to pee and pee more frequently (so you feel like you need to pee but don’t).
The first tip in helping with overactive bladder is lifestyle changes which include avoiding bladder irritants and undergoing bladder retraining. You can learn more about these in the ‘Jude Bladder Care Handbook’.
Overactive bladder medications: cost vs effectiveness
Doctors often prescribe according to the NICE guidelines which take into account both cost to the NHS and effectiveness. Here we break down what you need to know.
NICE recommends the most cost-effective medication should be used for most patients and this is called-oxybutynin immediate release. If the first medicine is not effective or tolerated, then the second line solifenacin is prescribed. Then third line medications can be offered if the first two are not effective or side effects are not tolerated. You can see on this chart what the recommended medications are and their potential cost to the NHS. ‘First line’ just means it’s the first medication that is likely to be recommended when you talk to your GP.
Other medications can include Propiverine (Detrunorm), Darifenacin (Emselex) and Fesoterodine (Toviaz), Tolterodine (Detrol) and these have similar side effects to Oxybutynin.
What are the main side effects of these drugs?
All of the medications apart from mirabegron are anticholinergic.
What does this mean?
We have two systems in the body: ‘rest and digest’ and ‘fight and flight’. The cholinergic system in the body is the rest and digest system which helps to relax the eyes, keep the heart rate down, helps digest food and helps pass urine. In an overactive bladder your body is passing too much urine so by tackling the cholinergic system we can slow down that process , help the bladder relax and stop you from passing urine as frequently. In effect it is telling your bladder to ‘chill out’.
There are some potential side effects too which can include dry mouth, blurred vision, constipation, drowsiness, memory problems and others.
When thinking about medication it’s important to remember that not everyone experiences side effects (and it can be easy to panic if you read the potential side effects). The reality is that some people will only experience the benefits with minimal side effects.
Immediate release vs modified release medications
Immediate release medications tend to have fewer side effects compared to modified or sustained release versions.
Risk of memory issues and anticholinergic medications
Some observational studies show that there is a possible link between increased memory issues (trouble remembering, learning new things and difficulty concentrating) and anticholinergic medications. Although more research is needed, for the time being these medications should be used with caution in those over 65 and in those who already have memory issues. If you are ever in doubt about any medication, it is best to speak to your doctor directly as they can advise you the best.
What is Mirabegron?
Mirabegron works in a different way to other overactive bladder medications. It works to directly relax muscles by acting on the M3 receptors in the bladder. By relaxing this muscle it increases bladder capacity and reduces the urge to constantly need to pee.
It has not been linked to memory issues and has fewer side effects. But in some people it can still cause side effects which include: headache, constipation, dizziness and nausea.
What about stress incontinence?
Stress incontinence is leaking when you cough, sneeze, laugh or when you are heavy lifting. It occurs due to strain on the pelvic floor muscles. It is difficult to plan for as it can occur at any time and can put a bit of barrier up in terms of exercise because you may feel worried about the potential consequences.
Again, firstly lifestyle changes such as pelvic floor exercises, stopping smoking etc are recommended. Then patients are generally recommended procedures such as botox or surgical procedures. Botox is a particularly interesting treatment and one that it is worth considering and researching potentially.
What is Duloxetine?
However if patients do not wish to undergo surgery or procedures then there is one medication available for stress incontinence. This is called duloxetine. NHS guidelines state it should only be used if a woman prefers medications to surgical treatment or if a woman is not suitable for surgery.
This medication works to increase two hormones: sertraline and noradrenaline. Sertraline is also known as the happy hormone and this medication is also used as an antidepressant for this reason.
Side effects of duloxetine include anxiety, constipation, dizziness, dry mouth, weight changes, muscle pains.
Every person is unique. Only your doctor knows your personal medical history and they’re therefore more able to recommend medications for you. It’s definitely worth doing some research beforehand so you can have an informed discussion when you talk to them.
We do not recommend researching medication too heavily on Google. The sources of advice are often not very accurate and can be scare-mongering at times. Think about the kind of bladder weakness you have, what the key challenges are in managing it, tackle some of these with changes in diet and pelvic floor exercises and if this doesn’t work then book to see your GP to discuss the next steps.