Bladder Health

Overactive bladder: the antimuscarinic tablets

An overactive bladder means a sudden urge to pass urine that is hard to put off, often with extra trips by day and sometimes leaks. The three antimuscarinics here work by calming the bladder muscle so it squeezes less often. Oxybutynin is the oldest, sold as Oxybutynin and Ditropan in 2.5mg and 5mg tablets. Tolterodine comes as Detrol (also sold as plain tolterodine) in 1mg and 2mg, and Solifenacin as Vesicare (also sold as plain solifenacin) in 5mg and 10mg. Dry mouth, constipation and blurred vision are the usual complaints with this group, and oxybutynin tends to bring them on more than solifenacin does.

Mirabegron, a different mechanism

Myrbetriq (mirabegron, 50mg) takes a different route. Instead of blocking the nerve signal, it relaxes the bladder muscle so the bladder can hold more before the urge appears. The tablet is swallowed whole, and because mirabegron can raise blood pressure in some people, it makes sense to keep an eye on your readings if you check them at home. It is the one people look at when dry mouth or constipation is the sticking point with the other three.

Spasms, bladder pain and nights out of bed

Some bladder trouble is less about urgency and more about discomfort. Flavoxate is listed as Urispas (also sold as Flavoxate Hcl), 200mg tablets for bladder spasm and frequent urination. Pyridium and Phenazopyridine are 200mg tablets that numb the lining of the urinary tract and take the sting out of burning urine. They colour urine orange-red, which can stain underwear and soft contact lenses, and they ease symptoms without treating an infection.

Elmiron is a different kind of medicine altogether: pentosan polysulfate, 100mg capsules, listed for interstitial cystitis (long-term bladder pain with urgency and no infection behind it). Long courses call for regular eye checks, since rare changes to the retina have been reported.

If it is the nights that wear you down, Nocdurna is desmopressin, a 0.2mg tablet that makes the kidneys produce less urine so waking to pass it becomes less frequent. Fluids are cut back in the evening while taking it, because too much water can leave the body short of sodium.

Choosing within the group

Browse by symptom first: urge and leaks point to the antimuscarinics or mirabegron, burning and spasm to flavoxate or phenazopyridine, pain to Elmiron and night-time waking to Nocdurna. Detrol is also sold as plain Tolterodine and Vesicare as plain Solifenacin: the ingredient and strengths are the same and only the name differs. Prostate enlargement in men sits in Men's Health.