Chapter 8: What can be done? Treatments for urinary incontinence and pelvic floor prolapse:

Medical treatment for overactive bladder symptoms

The bladder is a muscle regulated by the nervous system. How does regulation take place? How is the information delivered from the nerve ending to the bladder muscle? 

Regulation is carried out through a series of events that ultimately lead to the release of a substance called a neurotransmitter from the end of the nerve. Neurotransmitters are molecules produced by the nerve cells that serve as mediators of information between nerve endings and cells. The neurotransmitter travels to the muscle fibers and connects with a tiny projection on the muscle cell called a receptor (for its ability to receive information). This interaction between the neurotransmitter and the receptor is the final event that leads to bladder muscle contraction. Most medications designed to treat overactive bladder symptoms work on this junction. They are designed to block the interaction between the neurotransmitters and the receptor on the muscle cells of the bladder so that contraction does not take place. The most active neurotransmitter affecting the bladder is acetylcholine (a kind of choline). Since these medications counteracts acetylcholine they are referred to as anti-cholinergic medications.

The most commonly prescribed medications in this group include oxybutininin (Ditropan) and Tolterodine (Detrol). Both have a long acting formula that can be taken only once a day (Detrol LA and Ditropan XL). They are both very efficacious in reducing and even eliminating the symptoms of overactive bladder. Side effects include dry mouth, constipation, blurred vision, and irregular heart rhythm. Some patients may experience severe dry mouth to a degree where they decide to stop taking the medication. One of my patients described the medication as “making me dry at the wrong end”. If you have an eye condition called glaucoma, you will have to notify your doctor since it may result in a worsening of your condition.