Two new drugs for the overactive MS bladder.

Many people with MS have bladder problem--and far too many simply accept them or try to treat themselves by quietly cutting down on fluids. Now 2 new drugs--Ditropan XL and Detrol--tame urge incontinence (not enough time between sensing the need and letting go) and urinary frequency (voiding more than 8 times in 24 hours).

Ditropan XL (oxybutynin chloride), approved in December 1998, delivers one of the most commonly prescribed drugs for calming the bladder via a new one-a-day tablet. This controlled-release tablet keeps a consistent level of medication in the body throughout the day, which increases the drug's effectiveness. The major side effect in the clinical trials was dry mouth.

Detrol (tolterodine tartrate tablets), approved in March 1998, calms overactive bladders by reducing bladder muscle contractions. It also decreases the number of trips to the toilet by increasing the volume voided each time. In clinical trials, dry mouth was also the most common side effect.

The drugs use two different pathways to address the same problems--urgency, frequency, and incontinence or loss of bladder control. Both are safe and work well. Before prescribing anything, a physician will first check for a urinary tract infection, since infections can produce the same symptoms. "Urinary retention" should also be ruled out because, ironically, the inability to completely empty the bladder, which is another MS problem, can also produce urgency, frequency, and incontinence. Retention needs different therapy.

With the addition of these 2 drugs, there is now a big medicine chest for overactivity, which, like other MS bladder problems, can and should be managed, according to the Society's Medical Advisory Board. Avoiding fluids is actually dangerous because being dehydrated can set serious kidney complications in motion.