Researchers are looking into new drugs that may have longer lasting benefits and fewer side effects. Here are some examples:
* Selective anticholinergics. One of the limitations of current anticholinergic drugs is that they affect multiple parts of the body in addition to the bladder. Their effect on the salivary glands, for example, can produce dry mouth, and their effect on the central nervous system, can cause dizziness. Darifenacin (Enablex), solifenacin (Vesicare) and trospium (Sanctura) are three more recently approved anticholinergics that target the bladder specifically in order to treat overactive bladder, without affecting other organs and systems.
* Capsaicin. Some studies have shown that instilling an extract of capsaicin, the spicy component of hot chili peppers, numbs a hypersensitive bladder. The extract is placed in the bladder through a thin tube (catheter) inserted through the urethra. At first, it stimulates the sensory nerves of the bladder, but after a while, it produces a long-term resistance to sensory activation, which may last for two to seven months. Capsaicin has been used successfully as a treatment for overactive bladder associated with nerve disorders, such as multiple sclerosis or spinal cord injuries. Temporary side effects include discomfort and a burning sensation in the pubic area when the capsaicin is instilled. Instilling the local anesthetic lidocaine before the capsaicin can help alleviate this problem. You also might experience a temporary worsening of your symptoms before they get better. However, at this time, capsaicin isn't readily available — due in part to the severe bladder pain it can cause — and is rarely used outside of clinical studies.
* Resiniferatoxin. Resiniferatoxin, an extract from a cactus-like plant, has effects similar to those of capsaicin, but a thousand times more potent. Remarkably, though, burning sensations do not occur when resiniferatoxin is infused in the bladder. Studies of resiniferatoxin have found that it doesn't produce the temporary worsening of bladder symptoms seen with capsaicin, and its beneficial effects may last up to three months. Resiniferatoxin is still under investigation and available only to those in clinical studies at this time.
Botulinum toxin type A. Injections of botulinum toxin type A (Botox) into the bladder muscle may benefit people who have an overactive bladder. Botox blocks the actions of acetylcholine and paralyzes the bladder muscle.
Preliminary studies have found that Botox significantly improves symptoms of incontinence and causes few side effects. Benefits can last up to nine months. Scientists speculate that in cases of severely overactive bladder unrelated to a neurological condition, Botox may be helpful for people who haven't responded to other medications.
See your doctor
When talking to your doctor, carefully review all other medications you're taking, including over-the-counter drugs or herbal remedies. Some medications increase bladder control problems. Others may interact with incontinence medications in a way that increases symptoms. Your doctor can help you decide if you need medicine to treat your bladder control problem, and if so, which one may be best for you.28