BobOct14Q. I’m 24, in my second year as a T4 para and manage my bladder with intermittent catheterization. I started leaking and having accidents while I was still in rehab, though I was careful not to let my bladder get too full. A urodynamic workup showed I was having bladder spasms, so I was put on 10mg Ditropan XL every day, which keeps me dry. A follow-up urodynamic eval confirmed the medication is keeping my bladder quiet. My problem is the medication gives me dry mouth, and seems to make me drowsy.  

I know it is important to keep my bladder quiet, but I’m tired of the side effects. I’ve heard there are other options that will quiet my bladder but help me ditch the dry mouth and fatigue. What are the ones that produce the fewest side effects?

— Darryl

A. Darryl, less than two decades ago the only medication option to manage bladder spasms caused by neurogenic bladder was Ditropan, which often produces side effects, including severe dry mouth. This changed in early 2000s, when the pharmaceutical industry saw the financial potential in creating medications for millions of nondisabled adults over 40 who experience bladder spasms. The term “overactive bladder” was coined and medications to control bladder spasms has became big business — a bonus for th