If you’ve been diagnosed with a bladder condition, there’s a good chance your doctor has mentioned medication as part of your treatment plan. The range of drugs available can feel overwhelming at first, and the technical names don’t help much. This guide walks through the main categories of bladder medications, what they actually do, and what you might expect when taking them.

I should be clear upfront: this isn’t medical advice, and you should always work with your GP or urologist to find what works for your specific situation. What suits one person may not suit another, and finding the right medication often involves some trial and adjustment.

Anticholinergics and Antimuscarinics

These are probably the most commonly prescribed medications for overactive bladder. The bladder muscle (called the detrusor) contracts to push urine out, but in OAB, these contractions happen too often or at the wrong times. Anticholinergic medications work by blocking acetylcholine, a chemical messenger that tells the bladder muscle to contract 1.

The result? Fewer unwanted contractions, less urgency, and hopefully fewer trips to the toilet.

Commonly Prescribed Anticholinergics

Oxybutynin is one of the oldest and most studied options. It’s available as tablets or a transdermal patch. The patch version (Kentera) bypasses the liver, which can reduce some side effects like dry mouth 2. Generic oxybutynin is also available under brand names Cystrin and Ditropan, with Lyrinel XL being an extended-release formulation.

Tolterodine (brand names Detrusitol and Detrusitol XL) works similarly to oxybutynin but may cause fewer side effects in some people. The extended-release version tends to be better tolerated than immediate-release tablets.

Solifenacin (Vesicare) is a newer antimuscarinic that’s more selective for bladder receptors, which theoretically means fewer side effects elsewhere in the body. Clinical trials suggest it’s effective for reducing urgency and frequency 3.

Darifenacin and Fesoterodine (Toviaz) are other options your doctor might consider.

Trospium chloride (Regurin) has an interesting property: it doesn’t cross the blood-brain barrier as easily as some other anticholinergics, which may mean fewer cognitive side effects. This can be particularly relevant for older patients 4.

Side Effects to Watch For

Here’s the honest truth about anticholinergics: they’re effective, but the side effects can be bothersome enough that many people stop taking them. The NHS reports that up to 80% of patients discontinue antimuscarinic therapy within the first year, often due to side effects 5.

Common side effects include:

Dry mouth (very common, and for some people, quite severe)
Constipation
Dry eyes
Blurred vision
Drowsiness
Difficulty with mental focus, particularly in older adults

If you’re experiencing side effects, don’t just stop taking your medication. Talk to your doctor about alternatives or dosage adjustments. The transdermal patch, for instance, often causes less dry mouth than tablets.

Mirabegron (Betmiga)

Mirabegron represents a different approach entirely. Rather than blocking contractions, it works by stimulating beta-3 receptors in the bladder muscle, which promotes relaxation and improves the bladder’s storage capacity 6. The nice thing about this mechanism is that it achieves similar results without the anticholinergic side effects like dry mouth.

Mirabegron is taken once daily at 50mg and has been available since 2013. For people who couldn’t tolerate anticholinergics, it’s been a genuine alternative.

That said, mirabegron has its own considerations. The main ones to be aware of are:

Increased heart rate (tachycardia) in about 1-2% of patients
Urinary tract infections
Raised blood pressure
It’s not recommended if you have severe uncontrolled hypertension

Your doctor will likely want to check your blood pressure before starting mirabegron and may monitor it periodically.

Some patients are now prescribed a combination of mirabegron with a low-dose antimuscarinic when either alone isn’t providing adequate relief.

Desmopressin

If your main problem is nocturia (waking multiple times at night to urinate), desmopressin might be an option. This is a synthetic version of vasopressin (also called antidiuretic hormone), which naturally reduces urine production 7.

By taking desmopressin before bed, you reduce how much urine your kidneys produce overnight, meaning fewer disruptions to your sleep.

There’s an important caveat here: desmopressin can cause a condition called hyponatraemia (low sodium levels in the blood), which can be serious, particularly in older adults. Your doctor will likely want to monitor your sodium levels, especially when starting the medication or adjusting the dose. You’ll also need to restrict fluid intake in the evening when taking desmopressin.

Desmopressin is available as tablets, a nasal spray, and an orally dissolving tablet (Noqdirna/Noctiva).

Alpha-Blockers

These medications are primarily used for men with benign prostatic hyperplasia (BPH), where an enlarged prostate restricts urine flow. Alpha-blockers relax the smooth muscle in the prostate and bladder neck, making it easier to urinate 8.

Common alpha-blockers include:

Tamsulosin (Flomax) - the most commonly prescribed, and relatively selective for the urinary tract
Alfuzosin (Xatral)
Doxazosin (Cardura)
Terazosin
Prazosin

Alpha-blockers can lower blood pressure (that’s actually their original use), so dizziness when standing up quickly is a common side effect. Tamsulosin is more selective and causes less blood pressure drop than some older alpha-blockers.

Other potential side effects include:

Nasal congestion
Headaches
Retrograde ejaculation (where semen goes into the bladder instead of out during orgasm)

If you’re scheduled for cataract surgery, make sure your ophthalmologist knows you’re taking alpha-blockers. They can cause a condition called intraoperative floppy iris syndrome that complicates the procedure.

Tricyclic Antidepressants

Medications like amitriptyline, nortriptyline, and imipramine weren’t designed for bladder problems, but they can help with certain bladder conditions. They have mild anticholinergic effects that reduce bladder contractions, plus they can help with pain perception 9.

Tricyclics are sometimes prescribed for:

Interstitial cystitis / painful bladder syndrome
Urge incontinence when other medications haven’t worked
Nighttime bedwetting (enuresis)

The doses used for bladder conditions are typically much lower than those used for depression. Amitriptyline at 10-25mg at bedtime is common. The sedating effect can actually be helpful if you’re being woken by bladder symptoms.

Side effects overlap with anticholinergics (dry mouth, constipation) plus drowsiness and weight gain. These medications aren’t suitable for everyone, particularly those with certain heart conditions.

5-Alpha Reductase Inhibitors

For men with significantly enlarged prostates, 5-alpha reductase inhibitors like finasteride (Proscar) and dutasteride (Avodart) can actually shrink the prostate over time by blocking the conversion of testosterone to dihydrotestosterone (DHT) 10.

These aren’t quick fixes. It can take six months to see the full benefit. They’re often used in combination with alpha-blockers for men with larger prostates and bothersome lower urinary tract symptoms.

Side effects relate to the hormonal mechanism and can include reduced libido, erectile dysfunction, and breast tenderness. There’s been ongoing discussion about a possible link to depression, though the evidence remains mixed.

Botulinum Toxin (Botox)

You might know Botox from cosmetic uses, but it’s also licensed for treating overactive bladder that hasn’t responded to other medications. When injected directly into the bladder wall during a cystoscopy procedure, it blocks the nerve signals that cause unwanted contractions 11.

The results can be impressive: significant reductions in urgency, frequency, and incontinence episodes. The effects typically last six to nine months, after which the procedure needs repeating.

The main downside? About 6% of patients develop urinary retention and need to use a catheter temporarily until the Botox wears off. For this reason, you’ll need to be comfortable with the idea of self-catheterisation before starting treatment.

Botox isn’t a first-line treatment. It’s generally reserved for people who’ve tried at least two other medications without success.

What to Discuss with Your Doctor

Finding the right medication often involves some experimentation. Here are questions worth asking:

What are the most likely side effects with this particular medication?
How long until I should expect to see improvement?
Are there alternatives if this doesn’t work or causes problems?
Will this medication interact with anything else I’m taking?
Should I have any monitoring tests (blood pressure, sodium levels, etc.)?

Keep a bladder diary before and after starting medication. It’s the best way to objectively assess whether things are improving, and it gives your doctor useful information for adjusting your treatment.

Beyond Medication

Medication works best as part of a broader approach. Lifestyle changes like reducing caffeine and alcohol, bladder retraining exercises, and pelvic floor physiotherapy can all contribute to better bladder control. For some people, these non-drug approaches are enough on their own.

If your symptoms aren’t improving with medication, there are also more advanced options like nerve stimulation therapies (sacral neuromodulation or tibial nerve stimulation) that your specialist can discuss with you.

The important thing is to keep communicating with your healthcare team. Bladder conditions are common, treatments are improving, and there’s no need to simply put up with symptoms that affect your quality of life.

References

Andersson KE. Antimuscarinics for treatment of overactive bladder. Lancet Neurol. 2004;3(1):46-53.
Dmochowski RR, et al. Efficacy and safety of transdermal oxybutynin in patients with urge and mixed urinary incontinence. J Urol. 2003;170(6 Pt 1):2372-2378.
Chapple CR, et al. A pooled analysis of three phase III studies to investigate the efficacy, tolerability and safety of darifenacin, a muscarinic M3 selective receptor antagonist, in the treatment of overactive bladder. BJU Int. 2005;95(7):993-1001.
Staskin D, Kay G. Trospium chloride has no effect on memory testing and is assay undetectable in the central nervous system of older patients with overactive bladder. Int J Clin Pract. 2007;61(1):13-17.
NHS. Urinary incontinence - Treatment. Available at: https://www.nhs.uk/conditions/urinary-incontinence/treatment/
Chapple CR, et al. Randomized double-blind, active-controlled phase 3 study to assess 12-month safety and efficacy of mirabegron, a β3-adrenoceptor agonist, in overactive bladder. Eur Urol. 2013;63(2):296-305.
Weatherall M. The risk of hyponatremia in older adults using desmopressin for nocturia: a systematic review and meta-analysis. Neurourol Urodyn. 2004;23(4):302-305.
Roehrborn CG, Schwinn DA. Alpha1-adrenergic receptors and their inhibitors in lower urinary tract symptoms and benign prostatic hyperplasia. J Urol. 2004;171(3):1029-1035.
Hanno PM, et al. AUA guideline for the diagnosis and treatment of interstitial cystitis/bladder pain syndrome. J Urol. 2011;185(6):2162-2170.
McConnell JD, et al. The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med. 2003;349(25):2387-2398.
Schurch B, et al. Botulinum neurotoxin type a is a safe and effective treatment for neurogenic urinary incontinence: results of a single treatment, randomized, placebo controlled 6-month study. J Urol. 2005;174(1):196-200.