Q. I’m in my seventh year as a T4 para. About a year after I was injured I started having bladder accidents. I had a urodynamics test and was told I have a spastic bladder and was prescribed Ditropan. The Ditropan kept me dry, but made me feel like I was wheeling around in a fog and gave me severe dry-mouth. The side effects were so bad that I stopped taking it and started cathing more often. With the extra cathing I was staying dry and figured I had the problem under control.
 
In December I had a urology check-up, which showed my bladder spasms have caused ridges (scarring) on the walls of my bladder. I’m back on the Ditropan, but the side effects are really bugging me. Is there anything out there that will quiet my bladder but not make me feel like I’m spitting sand and lost in a haze?
— Phil

A. Phil, your letter points out a dilemma many wheelers face — a spastic bladder can cause permanent bladder and kidney damage without any noticeable symptoms. Left unchecked, this can lead to kidney failure. Yet, for many wheelers the side effects of oxybutynin chloride (Ditropan’s generic name) can be difficult to live with. And as you found out in your urology check-up, cathing enough to stay dry doesn’t mean you have solved the problem.

In January of this year the FDA approved a topical gel form of oxybutynin choloride. Peer reviewed studies show this topical gel to be as effective as the pill form, but with few side effects. In May, Watson Pharmaceuticals came out with the first and only commercially available version of this gel, called Gelnique.

To understand how the gel works, it is helpful to take a look at how oxybutynin choloride works and what causes the side effects. Oxybutynin chloride is a muscle relaxant that specifically targets smooth muscle tissue; bladder muscle is smooth muscle, hence the drug’s effectiveness in reducing bladder spasms. When the oral (pill) version passes through the system, the stomach and liver turns some of it into N-desethyloxybutynin (N-DEO). Researchers think that N-DEO is the culprit that causes most of the adverse side effects. By applying the drug to the skin in gel form, it bypasses the stomach and liver, they don’t produce N-DEO and you have a delivery system that leaves most of the side effects behind but still relaxes the bladder muscle.

Gelnique comes in individual packets about the size of an alcohol skin prep. Each application lasts for 24 hours. The user rubs the gel onto an area of skin on the stomach, shoulder, or thigh. The gel dries quickly, is colorless, odor