Oral Medications for Bladder Conditions

When dealing with chronic bladder conditions like interstitial cystitis, painful bladder syndrome, or overactive bladder, oral medications are often part of the treatment strategy. They are not magic solutions—I want to be clear about that upfront—but for many people they offer meaningful symptom relief when combined with other approaches.

This guide covers the main categories of oral medications used for bladder conditions, with a focus on pain management, medications that target bladder function, and the few drugs designed specifically for interstitial cystitis. If you are looking for information about medications instilled directly into the bladder, see our separate guide to intravesical medications.

Pain Relief Options

Analgesics and Painkillers

Chronic bladder pain responds to the same painkillers used for other types of pain, though with some caveats.

Paracetamol is the gentlest option and works for mild to moderate pain. It does not have anti-inflammatory effects, which limits its usefulness when inflammation is driving symptoms, but it is well-tolerated and safe for most people at recommended doses.

Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, naproxen, and aspirin address both pain and inflammation. They can help when bladder symptoms flare, though long-term use carries risks including stomach ulcers, kidney problems, and cardiovascular issues 1. Some people with IC find NSAIDs helpful; others notice no benefit. If you need to use them regularly, speak with your GP about monitoring.

Stronger painkillers including codeine, tramadol, and other opioids may be prescribed for severe chronic pain. These should be used cautiously and typically as part of a broader pain management plan supervised by a specialist. Long-term opioid use brings serious risks including dependence, tolerance (needing higher doses for the same effect), and constipation that can worsen bladder symptoms.

Topical Pain Relief

For localised pain around the urethra or vulva, anaesthetic creams and gels containing lidocaine or similar agents can numb the area temporarily. These are applied externally before activities that trigger pain (including urination or sexual intercourse). They do not treat the underlying condition but can make daily life more manageable for some patients.

Anticonvulsants for Chronic Pain

This might seem like an odd category, but anticonvulsant medications—drugs originally developed for epilepsy—have proven useful for chronic pain conditions including bladder pain.

Gabapentin (Neurontin) and pregabalin (Lyrica) alter nerve signalling in ways that reduce chronic pain perception 2. They work best for neuropathic pain (pain caused by nerve damage or dysfunction), and some researchers believe that IC and painful bladder syndrome involve nerve sensitisation that these drugs can help calm.

Typical side effects include drowsiness, dizziness, and weight gain. These drugs need to be started at low doses and increased gradually. Stopping them also requires gradual tapering rather than abrupt discontinuation.

My honest assessment: some people with chronic bladder pain find gabapentinoids genuinely helpful; others get side effects without much benefit. They are worth trying when other approaches have not worked, but temper your expectations.

Tricyclic Antidepressants

Amitriptyline is one of the most commonly prescribed medications for interstitial cystitis and chronic bladder pain. It is a tricyclic antidepressant, but at the low doses used for pain (10-50mg, versus 150mg+ for depression), it works primarily by blocking pain signal transmission in the spinal cord and brain rather than by altering mood 3.

Amitriptyline also has mild anticholinergic effects, which means it can reduce bladder spasms and urgency. An additional benefit: the sedating effect helps some patients sleep through the night rather than waking repeatedly to urinate (nocturia).

The catch is that sedation, dry mouth, constipation, and weight gain are common. Most doctors start with 10mg at bedtime and increase gradually based on response and tolerability. The sedative effect often improves over a few weeks as your body adjusts.

Nortriptyline and imipramine are alternative tricyclics that may suit people who cannot tolerate amitriptyline. They work similarly but have slightly different side effect profiles.

Worth noting: these medications take several weeks to reach full effect. Do not give up after a few days—give them at least four to six weeks before concluding they are not helping.

Anticholinergic and Antimuscarinic Medications

If your main symptoms are urgency, frequency, and bladder spasms rather than pain, anticholinergic medications (also called antimuscarinics) may help. These drugs block the chemical messenger acetylcholine from triggering unwanted bladder muscle contractions 4.

This class includes:

• Oxybutynin (Cystrin, Ditropan, Lyrinel XL)
• Tolterodine (Detrusitol)
• Solifenacin (Vesicare)
• Fesoterodine (Toviaz)
• Trospium (Regurin)
• Darifenacin (Emselex)

These medications can increase bladder capacity and reduce how often you need to urinate. They are the first-line drug treatment for overactive bladder.

The problem is that acetylcholine operates throughout the body, not just in the bladder. Blocking it causes dry mouth, constipation, blurred vision, and—particularly concerning for older adults—cognitive effects including confusion and memory problems 5. Extended-release formulations and skin patches tend to cause fewer side effects than immediate-release tablets.

If anticholinergic side effects are intolerable, mirabegron (Betmiga) offers an alternative. This beta-3 agonist relaxes the bladder through a different mechanism and does not cause dry mouth or cognitive effects, though it can raise blood pressure and is not suitable for everyone.

For detailed information on these medications, see our guide to medication for overactive bladder.

Antihistamines for IC and PBS

Hydroxyzine

Hydroxyzine (Atarax, Vistaril) is an antihistamine that has shown promise for some patients with interstitial cystitis. The rationale is that mast cells (immune cells that release histamine and other inflammatory substances) may play a role in IC, and blocking histamine could reduce bladder inflammation 6.

In practice, hydroxyzine helps some IC patients but not others. Studies have shown mixed results—some trials found significant symptom improvement, while others found no benefit compared to placebo. I would describe the evidence as “suggestive but not conclusive.”

Hydroxyzine also has sedating properties, which can help with sleep. The starting dose is usually 25mg at bedtime, increasing if tolerated. Drowsiness is the main side effect, though this often improves with continued use.

My take: hydroxyzine is worth trying for IC, particularly if poor sleep compounds your symptoms. It is generally well-tolerated and inexpensive. But do not expect dramatic results—if it helps, the benefit is usually modest.

Cimetidine

Cimetidine (Tagamet) is an H2-receptor antihistamine more commonly known for treating stomach ulcers and acid reflux. However, some IC patients report symptom improvement when taking it 7.

The mechanism is not entirely clear. Cimetidine blocks H2 histamine receptors, which are present in the bladder, so it may work by reducing histamine-mediated inflammation. Whatever the mechanism, some patients find it helpful, and it has a good safety profile.

A word of caution: cimetidine interacts with many other medications by affecting liver enzymes. If you take other drugs regularly, check with your pharmacist before adding cimetidine.

Elmiron (Pentosan Polysulfate Sodium)

Pentosan polysulfate sodium, sold as Elmiron, is the only oral medication specifically approved for interstitial cystitis. It was developed based on the theory that IC involves damage to the bladder’s protective GAG (glycosaminoglycan) layer. Elmiron is excreted in urine and is thought to coat the bladder wall, helping to restore this protective barrier 8.

When Elmiron works, it works by allowing damaged bladder tissue to heal while reducing the penetration of irritating urinary substances into the bladder wall.

Reality check: Elmiron is genuinely helpful for a subset of IC patients, but it is not a miracle drug. Clinical trials showed that roughly 30-40% of patients had meaningful symptom improvement compared to about 20% taking placebo. That is a modest benefit, and many patients see no improvement at all.

Elmiron also requires patience. It typically takes three to six months of continuous use before any benefit becomes apparent. Many patients abandon it before giving it a fair trial.

Elmiron and Eye Toxicity

In recent years, a serious concern has emerged about Elmiron and eye problems. Reports starting around 2018 described a distinctive maculopathy (damage to the central part of the retina) in long-term Elmiron users 9. This can cause symptoms including difficulty reading, slow adjustment to low or dim light, and blurred vision.

The risk appears to increase with cumulative dose—meaning years of use are more concerning than months. Current guidance suggests baseline eye examinations before starting Elmiron and periodic monitoring during treatment, with particular vigilance for anyone who has been taking the drug for more than a few years.

This does not mean Elmiron should never be used. For patients with significant IC symptoms who are not responding to other treatments, the potential benefits may outweigh the risks, particularly for shorter-term use. But patients deserve to know about this risk so they can make informed decisions and watch for early warning signs.

Availability in the UK

Elmiron is not routinely available on NHS prescription in the UK. It can be obtained on a “named-patient” basis, which means your consultant must apply specifically for your case. This adds bureaucratic hurdles, but it is possible if your specialist believes it could help you.

Medications for Specific Symptoms

Preventing Recurrent UTIs

For patients with recurrent urinary tract infections, preventive medications may be appropriate. These are covered in more detail in our medication guide for bacterial cystitis, but briefly:

• Low-dose prophylactic antibiotics taken daily or after triggers (like sexual intercourse) can reduce infection frequency
• Methenamine hippurate (Hiprex) is an alternative that works by producing formaldehyde in acidic urine, killing bacteria without contributing to antibiotic resistance 10
• Topical oestrogen helps postmenopausal women by restoring vaginal flora that protect against infections

Managing Nocturia

If waking at night to urinate is your main complaint, desmopressin may help by reducing urine production overnight. See our medication for OAB guide for details. Desmopressin is also used for nocturnal enuresis in adults and children.

Practical Considerations

Finding the Right Medication

Managing chronic bladder conditions often involves trial and error. What works brilliantly for one person may do nothing for another. If the first medication you try does not help, do not conclude that nothing will work—there are other options to try.

I recommend keeping a symptom diary when starting a new medication. Note your symptoms (pain level, urinary frequency, urgency episodes, sleep quality) before starting treatment and track changes over several weeks. This gives you objective data to discuss with your doctor rather than relying on general impressions.

Combining Medications with Other Treatments

Oral medications work best as part of a broader management strategy. This includes:

• Dietary modifications—identifying and avoiding foods that trigger your symptoms
• Bladder training techniques
• Lifestyle changes including stress management, sleep hygiene, and pelvic floor exercises
• Intravesical medications for patients who need more targeted treatment

Do not expect pills alone to solve everything. They are one tool among several.

Side Effects and When to Seek Help

All medications have potential side effects. Mild effects like dry mouth or drowsiness often improve as your body adjusts. More serious effects—severe constipation, confusion, chest pain, difficulty urinating, visual changes—warrant contacting your doctor promptly.

If you are taking multiple medications, be particularly vigilant about interactions and cumulative side effects. Bring a complete medication list (including supplements and over-the-counter drugs) to every medical appointment.

Working with Your Healthcare Team

If standard treatments are not controlling your symptoms, ask your GP for referral to a urologist or urogynaecologist with expertise in chronic bladder conditions. Specialist centres have access to treatments and clinical trials not available through general practice.

The COB Foundation provides fact sheets on individual medications. Contact us for more information or support in managing your bladder condition.

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References

1. Bhala N, et al. Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials. Lancet. 2013;382(9894):769-779. PubMed

2. Finnerup NB, et al. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol. 2015;14(2):162-173. PubMed

3. van Ophoven A, et al. A prospective, randomized, placebo controlled, double-blind study of amitriptyline for the treatment of interstitial cystitis. J Urol. 2004;172(2):533-536. PubMed

4. NHS. Urinary incontinence - Treatment. NHS website. 2024. NHS

5. Gray SL, et al. Cumulative use of strong anticholinergics and incident dementia: a prospective cohort study. JAMA Intern Med. 2015;175(3):401-407. PubMed

6. Theoharides TC. Hydroxyzine in the treatment of interstitial cystitis. Urol Clin North Am. 1994;21(1):113-119. PubMed

7. Thilagarajah R, et al. Oral cimetidine gives effective symptom relief in painful bladder disease: a prospective, randomized, double-blind placebo-controlled trial. BJU Int. 2001;87(3):207-212. PubMed

8. Parsons CL, et al. A quantitatively controlled method to study prospectively interstitial cystitis and demonstrate the efficacy of pentosanpolysulfate. J Urol. 1993;150(3):845-848. PubMed

9. Pearce WA, et al. Pigmentary maculopathy associated with chronic exposure to pentosan polysulfate sodium. Ophthalmology. 2018;125(11):1793-1802. PubMed

10. Harding C, et al. Alternative to prophylactic antibiotics for the treatment of recurrent urinary tract infections in women: multicentre, open label, randomised, non-inferiority trial. BMJ. 2022;376:e068229. PubMed