Feature: What's New in Bladder Control Medications

By Barbara C. Bourassa

Like any field of medicine, researchers who study bladder weakness are working hard on the next generation of drugs for controlling bladder leakage. To find out what's going on, and what research holds the most promise, we talked to Sandip Vasavada, MD, a specialist in urinary incontinence at the Cleveland Clinic.

Patients seeking medication for bladder weakness issues essentially had one class of medicine available for the past 30 years, says Dr. Vasavada. This type of drug, known as anticholinergics, worked by blocking nerve receptors that told the bladder muscles to contract, or spasm, he explains. As it related to the bladder, this type of medication decreased the number of muscle spasms in the bladder, the frequent urge to urinate, or uncontrolled urination caused by these spasms. Unfortunately, when patients took the older, earlier form of this medicine, it also blocked the same type of receptors in the tear ducts, the salivary glands, and the bowels, meaning patients often had side effects such as dry eyes, dry mouth, or constipation.

About eight years ago, however, the newer generation of this type of medicine was introduced. "This is the same class of medicine, but it has a slightly different, more selective binding process," Dr. Vasavada explains. The newer medicines are more bladder specific, meaning they only affect the nerve receptors in the bladder, and not the receptors in the eyes, mouth, or bowels. For the consumer this means fewer side effects.

In addition, a number of different brand names of this type of medicine have become available in the past few years, which means consumers have more choices. "There's not a huge clinical difference in the drugs, meaning they all basically work the same way, but it does mean the consumer has more choices, and some work better for some people than others," he says.

And what does the future hold? Certainly, many people have been helped by the current crop of bladder control medications, and there's no question those drugs will continue being available.

At the same time, however, researchers are also exploring new possibilities for treating bladder weakness, such as Botox. Botox is effective for treating facial wrinkles because it "freezes" the muscles around the eyes or between the eyebrows. Along the same lines, some urologists are using Botox injections to relax and/or temporarily paralyze the muscles around the bladder or sphincter.

Dr. Vasavada believes Botox holds a lot of promise, but he notes that federal approval for use with bladder weakness is probably at least two or three years away. (For more information on Botox and bladder weakness, click here.)

Another promising area of research involves chili pepper extract. "When tested in clinical research trials, this has been shown to decrease bladder spasms," says Dr. Vasavada. "You know how hot peppers turn your mouth numb? It basically does the same thing to the bladder." Although Dr. Vasavada notes that any medication or treatment based on this or other types of extracts are at least four or five years away, this area of research shows a lot of promise.

Another area of research that shows promise is called neuromodulation, says Dr. Vasavada. This involves implanting tiny nerve devices near the bladder in order to control or influence nerve responses. Although this field is not new, the latest research revolves around developing "minimally invasive" neuromodulation devices to help with bladder leakage. Consumers can expect those devices to become available within two to three years, he says.

Editor's note: All medications have side effects, and not all drugs are appropriate for individual bladder weakness issues, so consult your doctor or medical professional for more information.