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Thread: What is the strongest, most effective bladder med I can be prescribed?

  1. #1

    What is the strongest, most effective bladder med I can be prescribed?

    Since my injury I've been on a number of different bladder meds and I still haven't found any that really work all that well. The first one I was on was ditropan and that worked wonders for a while til my 1st UTI. Then I was on didronel,( I highly doubt I spelled that right), then it was vesicare, which didn't work at all. Then I saw a neuro-urologist which put me on 60 mg sanctura xr which worked well for a long time but now I can't seem to hold more than 10 oz of urine in my bladder without it giving out. It used to be I could fill up a 20 bottle plus some but now its just not working. I go to a regular urologist now and I let them know my dilemma, and she suggested that I keep a 2 day diary of what I drank and what I cath for so it can help her make an assessment of what to put me on. Its been 2 weeks since I've been there but before I left I told her about carecure and she told me if I could get any suggestions, it would help. I cath every 4 hrs and I can't hold much at all. Any suggestions?

  2. #2
    Ditropan (oxybutinin) is the most commonly used anticholenergic medication. I assume you are trying to increase capacity, decrease pressure, and reduce leaking. Other medications have other effects. Others commonly used are the extended release form of Ditropan (Ditropan XL), Detrol, extended release Detrol (Detrol LA), Vesicare, Sanctura, and Enablex. In addition, meds like imipramine are often added for their anticholenergic side effects. What does of the meds you took above were you on?

    Didronel is a a medication for heterotopic ossification (HO), so does not help with your bladder at all.

    You should not try to hold more than about 425 cc. (about 14 oz.) of urine in your bladder at one time, and should be drinking about 2.5 quarts daily, while cathing 5-6X daily.

    I assume you have had urodynamics to determine your bladder pressures and the effects of these medications on your bladder? If not, that should be done.

    The next step if none of these meds, or combinations of meds, nor regulating your fluids or cath times resolve your leaking, then you may want to pursue bladder Botox injections. If this is not an option, or does not work for you, then a surgical procedure like a bladder "clamshell" augmentation (by an experienced urologic surgeon) may need to be considered.

    I would also recommend that your urologist spend some time reviewing this document:
    http://www.pva.org/site/News2?news_i...rticle&id=7121


    (KLD)

  3. #3
    Ok, the ditropan I was on was about 2 years ago, and those were 10 mg pills 1x daily. Then the next thing was 15 mg vesicare. (I think) That didn't even work, I would've been better off taking caffeine pills! I did have urodynamics and the outcome was my bladder was normal. I can't understand why these meds work for a while and then just stop. I get dehydrated easy so at times I do drink more water that others, but never more than 4 bottles during the day and 2 bottles during the night. Is there one med better than another?

  4. #4
    Senior Member mr_coffee's Avatar
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    Han,

    I actually have the same experience. They use to work when I was newly injured but not anymore. I'm going to get a urodyanmics test to see whats up!
    Injured:10-16-04
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  5. #5
    If your bladder is normal, why are you taking anything? Most people with SCI have a neurogenic (not normal) bladder. Do you have a reflex bladder? Coordinated or uncoordinated sphincter? Maximum bladder pressure (PdetMax)?

    How many cc. or oz. in those "bottles" of water? I recommend no more than 2.5 quarts, with half prior to noon, the rest by 6PM and nothing after that until the AM if possible.

  6. #6
    Im confused now because I definately asked out of curiousity what was wrong with my bladder and she told me clear as day," your bladders perfectly normal." So I don,t know if its shrinking or what. On monday I'll call and request another appointment and post as soon as I go. Thank you for your help.
    Last edited by Han Solo; 11-15-2009 at 12:31 PM.

  7. #7
    Good. You need a complete explaination of the results of your urodynamics and other tests in order to make the proper decisions about your bladder management. Insist that you get this when you see your urologist.

    (KLD)

  8. #8
    Senior Member
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    I have this same problem. I start "leaking" at 300ml. If I cath an hour after going to bed, then half the time it will be under 50ml and the rest it will be over 200, and it will have no bearing at all on middle of the night leaking.

    It is very frustrating, and I have the same experience with the different medications as well. Sanctura XR does the "best" for a while, then seems to completely stop working. I'll stop taking it for a week, and then it starts working again.

    It's just another one of those SCI things where I've given up, no-one seems to have any helpful ideas.

    If you find anything, please post back.

    -- JB
    Don't anthropomorphise computers. They hate that.

  9. #9
    It is unlikely that these meds stop working, but instead that your bladder is changing neurologically. This is important reason for getting urodynamics repeated periodically as without this test this cannot be accurately determined.

    (KLD)

  10. #10
    Senior Member nevada's Avatar
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    I have been taking two Toviaz daily now for almost three months and I have not leaked a drop and have reduced my cathing from an average of 7 times a day to 4 and I am really happy with these results

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