If you take medication for overactive bladder or urge incontinence, there’s a good chance you’ve experienced dry mouth. It’s not a minor annoyance—for some people, it becomes so uncomfortable that they stop taking their medication entirely, which then brings back the bladder symptoms they were trying to control. This puts you in an unenviable position: choose between a dry, uncomfortable mouth or an unpredictable bladder.

I’ve heard from many people who feel stuck in this dilemma. The good news is that dry mouth from these medications can usually be managed well enough to make treatment bearable. The key is understanding why it happens and having realistic strategies beyond just “drink more water.”

Why bladder medications cause dry mouth

Most medications prescribed for overactive bladder belong to a class called antimuscarinics (also known as anticholinergics). These include oxybutynin, tolterodine, solifenacin, darifenacin, fesoterodine, and trospium. They work by blocking acetylcholine receptors in the bladder muscle, which reduces the involuntary contractions that cause urgency and frequency 1.

The problem is that acetylcholine receptors aren’t just in your bladder—they’re throughout your body, including your salivary glands. When the medication blocks these receptors in the salivary glands, saliva production drops. Your mouth becomes dry, sometimes severely so.

The extent of dry mouth varies considerably between different medications. Immediate-release oxybutynin tends to cause the worst dry mouth because it produces high peak blood levels. Extended-release formulations and newer selective antimuscarinics generally cause less dry mouth, though none eliminate it completely 2. If you’re struggling with dry mouth, asking your doctor about switching to a different formulation or medication is a reasonable first step.

Newer alternatives: beta-3 agonists

Mirabegron (Betmiga/Myrbetriq) works through an entirely different mechanism—it relaxes the bladder muscle by stimulating beta-3 receptors rather than blocking acetylcholine. Because it doesn’t affect the salivary glands in the same way, dry mouth is much less common 3. If anticholinergic side effects are making your life difficult, this class of medication is worth discussing with your prescriber.

That said, mirabegron isn’t perfect. It can raise blood pressure slightly and isn’t suitable for everyone, particularly those with uncontrolled hypertension. Some people also find it less effective than antimuscarinics for their symptoms. There’s no universally best option—it depends on your individual response and what side effects you find tolerable.

What dry mouth actually does to your mouth

Saliva does far more than keep your mouth moist. It contains enzymes that begin digesting food, antibacterial compounds that protect against infection, and minerals that help remineralise tooth enamel. When saliva production drops, several problems can develop:

Dental decay accelerates. Without adequate saliva to neutralise acids and wash away food particles, tooth decay becomes much more likely. Some people who’ve never had dental problems suddenly develop multiple cavities after starting anticholinergic medications. This is one of the less-discussed consequences of chronic dry mouth.

Speaking and swallowing become difficult. Saliva lubricates the mouth for speech and helps form food into a bolus for swallowing. Without enough, you may find yourself clearing your throat constantly or struggling to eat dry foods like bread or crackers.

Taste perception changes. Saliva helps dissolve food compounds so they can reach taste receptors. Reduced saliva often means food tastes different or bland, which can affect appetite and nutrition, particularly in older adults who may already have reduced taste sensitivity.

Oral infections become more common. Saliva contains immunoglobulin A and other antimicrobial compounds. Chronic dry mouth increases the risk of oral thrush (candidiasis), angular cheilitis (cracked corners of the mouth), and bacterial infections.

Bad breath worsens. Saliva normally washes away bacteria and food debris. When the mouth is dry, bacteria proliferate and produce volatile sulphur compounds that cause halitosis.

Practical management strategies

Saliva substitutes and stimulants

Sipping water provides temporary moisture but doesn’t truly replicate what saliva does. Water is thin and evaporates quickly; saliva is a complex mucoid fluid that coats and protects oral tissues. Saliva substitutes, available as gels, sprays, and mouth rinses, contain compounds like carboxymethylcellulose or mucin that better mimic saliva’s properties.

Several products exist specifically for dry mouth sufferers. Biotène produces a range including mouthwash, gel, and spray. Other options include Glandosane spray, BioXtra products, and various pharmacy own-brand alternatives. The NHS sometimes prescribes these on repeat prescription for people with chronic dry mouth from medication.

My take on these products: they work reasonably well for temporary relief, but you’ll likely need to reapply frequently. The gels tend to last longer than sprays but feel thicker in the mouth, which some people dislike. It’s worth trying a few to find what suits you. None are perfect, but most people find at least one that makes things more bearable.

Sugar-free chewing gum and lozenges

Chewing stimulates saliva production through mechanical action. Sugar-free gum (xylitol-based is ideal) can boost natural saliva flow if you still have functional salivary glands—which most people on anticholinergics do, since the medication reduces rather than eliminates function.

Xylitol has the added benefit of inhibiting the bacteria responsible for tooth decay. Products like Biotène lozenges combine xylitol with lubricating compounds. I’d recommend keeping some in your pocket or bag for situations where your mouth becomes particularly dry.

Medication timing adjustments

If your medication offers some flexibility in timing, consider when dry mouth bothers you most. Some people find taking their dose in the evening means the peak effect (and worst dry mouth) occurs during sleep when it’s less noticeable. Others find the opposite—that nighttime dry mouth disrupts their sleep more than daytime symptoms bother them. Discuss timing options with your prescriber.

Environmental modifications

Air conditioning and central heating dry out indoor air, which worsens dry mouth symptoms. A humidifier in your bedroom can help, particularly during winter months when heating runs constantly. Sleeping with your mouth open (common in people who snore or have nasal congestion) dramatically worsens overnight dryness—if this applies to you, addressing nasal obstruction may help.

Dietary adjustments

Certain foods and drinks make dry mouth worse:

Caffeine has a mild diuretic effect and can irritate the bladder, potentially worsening your underlying overactive bladder symptoms while doing nothing positive for dry mouth. This doesn’t mean you must eliminate caffeine entirely, but moderating intake makes sense.
Alcohol dehydrates and directly irritates oral tissues. Alcohol-based mouthwashes should also be avoided—they may feel refreshing momentarily but worsen dryness afterwards.
Salty and spicy foods draw moisture from tissues and can cause discomfort in an already dry mouth.
High-sugar foods are particularly problematic because reduced saliva means less natural protection against the acids produced when mouth bacteria metabolise sugar. If you’re going to eat something sweet, rinse with water afterwards.

Foods that may help include those with high water content (watermelon, cucumber, soups) and those that stimulate saliva production (citrus fruits, though these may irritate if your mouth is very dry). Sucking ice chips provides temporary relief without the calories of sugary drinks.

Oral hygiene becomes critical

With reduced natural protection, maintaining good oral hygiene isn’t optional—it’s essential to prevent the dental problems chronic dry mouth causes. I can’t overstate this: people who develop chronic dry mouth and don’t adjust their dental care often face serious dental consequences within a year or two.

Brush twice daily with fluoride toothpaste. Consider a higher-fluoride prescription toothpaste if your dentist recommends it—these are available on prescription in the UK for people at high risk of decay.

Floss daily. Food debris left between teeth contributes to both decay and gum disease, and without adequate saliva to help wash it away naturally, mechanical removal becomes more important.

See your dentist regularly. Mention that you’re taking medication causing dry mouth. Your dentist may recommend more frequent check-ups (every three to four months rather than every six) and may apply fluoride varnish to help protect your teeth.

Avoid alcohol-based mouthwashes. Paradoxically, many commercial mouthwashes contain alcohol and will worsen dry mouth. Look for alcohol-free formulations or those designed specifically for dry mouth.

When to reconsider your medication

Some people tolerate the dry mouth reasonably well with the strategies above. Others find it intolerable despite their best efforts. If you’re in the second group, don’t simply stop your medication—talk to your doctor about alternatives.

Options include:

Switching to a different antimuscarinic. Different drugs in this class cause different degrees of dry mouth in different people. Extended-release oxybutynin causes less dry mouth than immediate-release. Darifenacin and solifenacin tend to be more bladder-selective and may cause less dry mouth for some people.
Trying mirabegron. As mentioned, this works through a different mechanism and rarely causes significant dry mouth.
Dose reduction. A lower dose might still control your bladder symptoms while causing less dry mouth. This isn’t always possible, but it’s worth exploring.
Combination approaches. Sometimes a lower dose of medication combined with pelvic floor exercises or bladder training achieves good symptom control with fewer side effects than higher medication doses alone.
Non-medication treatments. Botox injections, percutaneous tibial nerve stimulation, and sacral neuromodulation are options for people who can’t tolerate or don’t respond to medication.

The bigger picture

Dry mouth from bladder medication is a real problem, not something to dismiss or push through indefinitely. At the same time, it’s usually manageable enough to allow continued treatment if the medication is helping your bladder symptoms significantly.

The worst outcome is silently suffering with intolerable side effects until you give up on treatment altogether. Your doctor can’t help adjust your medication if they don’t know how much the side effects are affecting you. Be specific about what you’re experiencing—don’t just say “it’s fine” if it isn’t.

Living with overactive bladder or urge incontinence is challenging enough without medication side effects making things worse. With the right combination of medication adjustment, practical management strategies, and attention to dental health, most people can find a balance that keeps both their bladder and their mouth reasonably comfortable.

References

Andersson KE. Antimuscarinics for treatment of overactive bladder. Lancet Neurol. 2004 Jan;3(1):46-53. https://pubmed.ncbi.nlm.nih.gov/23142402/
Chapple CR, et al. Comparison of once-daily antimuscarinic drugs for overactive bladder: a systematic review. BJU Int. 2008 Aug;102(3):303-14. https://pubmed.ncbi.nlm.nih.gov/18076934/
NHS. Mirabegron - Side effects. https://www.nhs.uk/medicines/mirabegron/