If you suffer from overactive bladder you now have two new options: Botox injections (yes, the wrinkle-shrinking drug), and an over-the-counter version of the Oxytrol patch, which used to require a prescription. The Food and Drug Administration approved both recently. But our medical advisors recommend caution before trying either medication.
"The decision to move Oxytrol patch from prescription to OTC status may have been premature," says Marvin M. Lipman, M.D., Consumer Reports' Chief Medical Adviser. "The symptoms of overactive bladder, which include incontinence and a frequent need to urinate, overlap with those of bladder infections, other forms of incontinence, and even bladder cancer. Those conditions might go untreated if you mistakenly think your symptoms are due to overactive bladder. So see your physician, initially, for proper diagnosis."
In addition, Oxytrol (oxybutynin) is only moderately effective for relieving overactive bladder symptoms--like all drugs in its class--and it can cause dry mouth and constipation. The patch form, which will be available OTC probably starting next fall, can cause skin reactions at the site of application in about a quarter of patients--in 11 percent of people the reactions are so severe, they stop using the patch.
Botox has downsides, too. While clinical trials showed that Botox injections reduce incontinence and the need to urinate, the injections can also cause painful urination, incomplete emptying of the bladder (which could require the insertion of a catheter), and urinary tract infections. The risk of infections is so high, in fact, that the FDA says you should take an antibiotic along with the shot. Moreover, Botox is only approved for use in people who can't take or haven't gotten relief from other overactive bladder medications, and it can be expensive. A single treatment can cost more than $800.
For all those reasons, first check with a doctor to see if your overactive bladder symptoms stem from another condition, such as an infection, or a medication, such as a high blood pressure drug. If those are ruled out, try lifestyle changes, such as cutting back on caffeinated and alcoholic beverages and drinking less before bedtime, along with bladder-training Kegel exercises to strengthen the pelvic muscles that help control urination.
If those measures don't help, then it might be time to consider a medication. Our Best Buy Drug recommendations include tolterodine (Detrol or generic) or the extended-release version (Detrol LA). Those have lower rates of side effects than other medications in their class, including Oxytrol tablet, but you still have to watch out for dry mouth, constipation, blurred vision, and dizziness.
If those drugs don't work or you can't take them, you could consider Botox. But make sure you understand the risks and benefits of the shots. For details, read our Botox precautions. And see our advice on off-label prescribing.
