Overactive Bladder

Nov 12, 2019

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Last week was take your kids to work day. My son Eric, of course wanted nothing to do with the pharmacy. We did have a couple other wonderful Grade 9 students, Seth and Dylan, spend part of the day with us. And who wouldn't want to come to the pharmacy and mix up a pain killing cream in the lab, draw up flu shots or make a bubble pack? Eric went to the accounting firm MNP with Doris. By all accounts the day went well, Eric enjoyed himself and the people of MNP were patient and generous with their time. Apparently, I witnessed all the drama of the day the morning before he left for work. Eric was failing at pants.

If you find yourself pulling pants on and off multiple times per day, it could be a sign of overactive bladder. Overactive bladder is a condition that causes a sudden urge to urinate. The urge to urinate may be very strong and hard to control. The urge to urinate may lead to the involuntary loss of urine which is called urge incontinence. Often the patient will urinate 8 or more times in 24 hours and at least twice during the night. Not surprisingly, overactive bladder can cause embarrassment and for people to isolate themselves and limit their social and work life.

Overactive bladder is more common as we age. It can happen in men and women. Often overactive bladder in males is associated with an enlarged prostate. Enlarged prostate is treated differently, so for the rest of this article we are going to assume the patient with an overactive bladder is an older female.

A few weeks ago, Dr. Katie Pernarowski gave a talk about overactive bladder to the Dauphin doctors and us pharmacists were allowed to sit in. Dr. Pernarowski reviewed non-drug treatments like timing when you drink fluids and going to the bathroom on a schedule, so your bladder doesn't get too full. Surprisingly, Dr. Pernarowski didn't say a limit to the amount of fluid a patient consumes. She still recommended 6-8 glasses of water per day. She explained that if you don't drink enough, the urine gets concentrated. Concentrated urine can be irritating and make overactive bladder symptoms worse. She described Kegels which are exercises a patient can do on their own to tighten the pelvic floor. I got a chuckle out of Dr. Pernarowski's description of telling patients to squeeze the muscles you would use to hold in a fart. For those of you at home, try it right now. Pretend to hold in a fart. You are doing Kegels! Kegel and other pelvic floor exercises are so effective that Dr. Pernarowski and other docs refer their interested patients to special physiotherapists who specialize in pelvic floor rehab to learn Kegels and other exercises.

As a pharmacist, I was at Dr. Pernarowski's talk for the drugs. We have an old standby medication to treat overactive bladder. It is called oxybutynin and it works well. It reduces symptoms of overactive bladder in many patients. And it is cheap. Because it is an older medication, there are generic versions of oxybutynin and it is the cheapest option to treat overactive bladder. Can you feel the but coming? Yes, there is a big but. Oxybutynin has a lot of side effects. Blurred vision, constipation, dizziness and sleepiness are quite common. And dry mouth happens in most patients.

There are newer and better options. A popular one is called tolterodine or Detrol. It is in the same family as oxybutynin. We call these drugs antimuscarinics. This means tolterodine works well, but, it still has side effects like constipation, dizziness, fatigue and dry mouth. However, these side effects happen far less often than with oxybutynin. A medication for overactive bladder from a completely different drug family is mirabegron or Myrbetriq. It stimulates beta-3 receptors in the bladder which causes relaxation and increases bladder capacity. Its side effects include constipation, headache and high blood pressure.

Arguably the safest of the current batch of overactive bladder medications is fesoterodine or Toviaz. It is an antimuscarinic but it seems to only cause constipation, dry eyes, urinary retention and dry mouth. It doesn't seem to cause the dizziness and sleepiness of the other antimuscarinics. We think this is because less fesoterodine crosses the blood-brain barrier than other antimuscarinics.

As overactive bladder is more common in older people, side effects like dizziness, sedation and changing how the patient is thinking become more and more important. Older people are already more likely to fall and break a bone, so we don't want their bladder medication to make a fall more likely. Older people are already more likely to have issues with dementia and other cognitive deficits. Again, we don't want their bladder pill to make these thinking issues worse. For overactive bladder the higher costs of the newer fesoterodine seems to be worth it to get less of the most serious side effects.

Eric is growing like a weed. And all he wears are shorts and track pants. So, the weekend before going to MNP, Doris thought she'd buy him some inexpensive black dress pants that would fit so Eric wouldn't embarrass her at work. Eric went into the Walmart change room with the pants, came out and said, "Yeah, yeah they fit." The morning of job shadowing, Doris told Eric to put his dress pants on. He came out of his room holding the pants up with one hand. The waistline of the pants that he had just tried on 4 days earlier was at least 6 inches too long. Without a belt there was no way these pants were going to stay up. At that point I left to go meet the appropriately dressed Seth and Dylan at the pharmacy. Doris worked some magic and Eric and the pants left for MNP together. I'm glad he learned a little about the world of accounting. Maybe Eric needs to job shadow a tailor next?

As always if you have any questions or concerns about these or other products, ask your pharmacist.

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.


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