Medications for neurogenic bladder & detrusor overactivity
A neurogenic bladder occurs when there is damage to the nerves which carry messages from the brain to the bladder via the spinal cord, resulting in difficulties storing and releasing urine. Detrusor overactivity is where damage to the nerves that supply the detrusor muscle in the bladder result in increased or involuntary bladder contractions. Neurogenic bladder/detrusor overactivity affects millions of people and may be connected to another condition such as spina bifida or multiple sclerosis or be a result of nerve damage caused by stroke or spinal cord injury.
The primary symptom of neurogenic bladder/detrusor overactivity is the inability to control urination and the aim of treatment is to prevent kidney and detrusor damage, as well as reducing episodes of incontinence. Treatment will vary depending on an individual’s situation and options may include medications, lifestyle changes, catheterisation, and medical procedures.
Oral Medications – Anticholinergic (antimuscarinic) medications
Anticholinergic drugs reduce involuntary detrusor activity and bladder contractability by blocking messages to the muscle receptors. These drugs are not selective and can have adverse side effects such as dry mouth, constipation, urinary retention, blurred vision, and dizziness.
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Cost* |
Side Effects |
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Oxybutynin/Ditropan
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Available on the PBS Approx. $8
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Available in both tablet and patch form. This is the most widely used medication for overactive bladder, and one of the cheapest. The tablets have high rates of discontinuation, largely due to the dry mouth side effect. Patches have fewer side effects however they can cause skin irritation.
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Tolterodine/Detrusitol |
Private Script Approx. $55-$60 |
Tolterodine has similar efficacy to Oxybutynin with a lower incidence of dry mouth. |
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Solifenacin/Vesicare |
Private Script Approx. $70-$75 |
Incidence of dry mouth side effect is reportedly lower again with this medication. |
* As of August 2022
Oral Medications – Other
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Name/Brand
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Cost |
Side Effects |
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Mirabegron/Betmiga |
Private Script Approx. $65 |
Mirabegron is not an anticholinergic medication and does not cause dry mouth or constipation. Mirabegron is more effective when used in conjunction with anticholinergic medication, however this reintroduces side effects. |
Botulinum toxin - Botox ®
Botox is injected into the bladder to reduce unwanted contractions. This treatment is usually repeated every three to nine months and can produce very effective and long-lasting improvements in some people. Botox is listed on the PBS for treatment of neurogenic detrusor overactivity for people with MS, spinal cord injury and spina bifida. Botox requires a day procedure in hospital and can be done under local or general anaesthetic. The procedure can be done privately or through the public health system (subject to wait times).
Herbal extracts – Urox
Urox is made from concentrated herbal extracts which work to strengthen and tone the muscles of the bladder, sphincter, and pelvic floor as well as support health connective tissue in the surrounding area.
Further Information on medications is available as Consumer Medicines Information (CMI) available from the Therapeutic Goods Administration website (www.tga.gov.au)