From the Guidelines
Antimuscarinic medications or beta-3 agonists are the recommended medications to assist with micturition (urination) in patients with overactive bladder, as they have been shown to improve urinary urgency, frequency, and/or urgency urinary incontinence. According to the most recent guideline on the diagnosis and treatment of idiopathic overactive bladder 1, these medications have demonstrated improvement in urgency urinary episodes, voiding episodes, and UUI as compared to placebo. The guideline strongly recommends offering these medications to patients with OAB to improve symptoms.
Some examples of antimuscarinic medications include oxybutynin, tolterodine, and solifenacin, which work by reducing bladder muscle contractions. Beta-3 agonists, such as mirabegron (Myrbetriq), relax the bladder to increase storage capacity. While combination therapy with solifenacin and mirabegron has been shown to be effective in reducing incontinence episodes and micturitions per 24 hours 1, the most recent guideline recommends antimuscarinic medications or beta-3 agonists as the primary treatment options.
Key points to consider when selecting medications for urination problems include:
- The underlying cause of the urination problem (e.g. overactive bladder, urinary retention, enlarged prostate)
- The specific symptoms being targeted (e.g. urgency, frequency, incontinence)
- The potential side effects and interactions of the medications
- The need for individualized treatment and discussion with a healthcare provider.
From the FDA Drug Label
The co-primary efficacy endpoints in all 3 trials were (1) change from baseline to end of treatment (Week 12) in mean number of incontinence episodes per 24 hours and (2) change from baseline to end of treatment (Week 12) in mean number of micturitions per 24 hours, based on a 3-day micturition diary An important secondary endpoint was the change from baseline to end of treatment (Week 12) in mean volume voided per micturition. Mirabegron 25 mg was effective in treating the symptoms of OAB within 8 weeks and mirabegron 50 mg was effective in treating the symptoms of OAB within 4 weeks.
- Medications that can assist with micturition (urination):
- Mirabegron (PO) The medication mirabegron can assist with micturition by reducing the number of incontinence episodes and micturitions per 24 hours, and increasing the volume voided per micturition 2
From the Research
Medications for Micturition
The following medications can assist with micturition (urination):
- 5-alpha reductase inhibitors (5-ARIs) such as finasteride and dutasteride, which reduce the serum and intraprostatic concentration of dihydrotestosterone (DHT), causing an involution of prostate tissue and improving lower urinary tract symptoms (LUTS) and urinary flow rates 3
- Alpha-blockers, which can quickly and effectively decrease LUTS and symptomatic disease progression 4
- Phosphodiesterase type 5 inhibitors (PDE5-Is) such as tadalafil, which can be used as an alternative to alpha-blockers and can reduce LUTS and sexual side effects during 5-ARI treatment 4
- Muscarinic receptor antagonists, which can be used to treat bladder storage symptoms and a small prostate 4
- Combination therapy with 5-ARI plus alpha-blocker, which can reduce LUTS and disease progression more effectively than drug monotherapy 4, 5
Medications to Avoid
Certain medications can cause urinary retention, including:
- Anticholinergics, which can cause failure of bladder contraction 6
- Anaesthetics and analgesics, which can cause urinary retention due to failure of bladder contraction 6, 7
- Opioids, which can cause urinary retention due to their effects on the micturition pathway 7
- Alpha-adrenoceptor agonists, benzodiazepines, NSAIDs, detrusor relaxants, and calcium channel antagonists, which can also cause urinary retention 7