I’ve had pee problems for as long as I’ve had multiple sclerosis. Many folks with MS have these issues, including urinary urgency, frequency, or both, bladders that don’t empty completely, or streams that don’t start when you need to go.
There are medications to treat these problems. The best known is probably Ditropan (oxybutynin), which has been around for quite a while. I’ve been taking the generic oxybutynin once a day for a long time, I don’t think it works for me anymore. In fact, I think it’s been failing me for years.
So, during my last checkup with my neurologist, I asked if there was something better I could use. “Sure,” she said. “There’s Myrbetriq.”
Myrbetriq (mirabegron) works by helping to relax the detrusor muscle that surrounds the bladder. In MS, this muscle can spasm so the bladder can feel like it’s full when it isn’t. Relaxing the muscle allows the bladder to fill more completely, which lessens the urge to urinate frequently.
How are they different?
Ditropan is an anticholinergic that inhibits the transmission of some nerve impulses in the brain and spinal cord, which reduces smooth muscle spasms such as those in the bladder. To do this, it crosses the blood-brain barrier.
According to Gavin Giovannoni, a London-based neurologist and professor who writes for The MS Blog, anticholinergics can exacerbate cognitive problems in people with MS. Giovannoni says there’s also a risk that the bladder will be relaxed too much, which can prevent it from fully emptying.
Giovannoni said he prefers to prescribe Myrbetriq (called Betmiga in the U.K.) rather than Ditropan,because, rather than crossing from the blood into the central nervous system, it targets a beta-3 adrenergic receptor directly on the detrusor muscle, which causes the bladder to relax.
Making the switch to Myrbetriq
Trying Myrbetriq sounded like a no-brainer, but my neurologist added a “but” to her recommendation: “It’s pretty expensive,” she said.
My copay for oxybutynin was about $0.23 a pill. The copay for Myrbetriq would be over $1 a dose and possibly higher. But I decided to bite the bullet (swallow the pill?) and give it a try.
So far, so good. I’ve only been using Myrbetriq for a couple of days, but my frequency and urgency seem to be somewhat improved. Things still aren’t normal, but I feel I’m controlling my bladder a bit better. My urgency seems to have lessened, and I think I’m doing a better job of fully emptying my bladder. We’ll see.
(A version of this blog first appeared as my column on the MS News Today website.)
(Featured image by Gerd Altmann from Pixabay.)
