Learn about medications used to treat bladder control problems, including how they work to treat urinary incontinence and possible side effects.By Mayo Clinic Staff
You've given up coffee and soda. You've followed your doctor's suggestions for bladder retraining. But bladder control remains a problem. What else can you do? Ask your doctor about medication options.
Effective medications are available for people with overactive bladder and urge incontinence — a bladder control problem marked by sudden, intense urinary urges and urine leakage. Fewer medication options exist for stress incontinence — urine leakage prompted by a physical movement or activity, such as coughing, sneezing or heavy lifting.
Here's an overview some medications commonly prescribed to treat urinary incontinence along with their possible side effects.
How they work
Anticholinergic drugs block the action of a chemical messenger — acetylcholine — that sends signals to your brain that trigger abnormal bladder contractions associated with overactive bladder. These bladder contractions can make you feel the need to urinate even when your bladder isn't full.
Anticholinergic medications include:
- Oxybutynin (Ditropan XL, Oxytrol)
- Tolterodine (Detrol)
- Darifenacin (Enablex)
- Solifenacin (Vesicare)
- Trospium (Sanctura)
- Fesoterodine (Toviaz)
Some of these medications are available in an extended-release form, meaning you take them once a day. These may have fewer side effects than the immediate-release versions, which are usually taken multiple times a day.
Still, the immediate-release form may be helpful if you experience incontinence only at certain times, such as at night, or if you want to take a medication for only a short time, such as when you travel. These medications are usually given as a pill or tablet that you take by mouth. Oxybutynin is also available as a cream or skin patch that delivers a continuous amount of medication.
The most common side effects of anticholinergics are dry mouth and constipation. To counteract dry mouth, you might suck on a piece of candy or chew gum to produce more saliva. Other less common side effects include heartburn, blurry vision, rapid heartbeat (tachycardia), flushed skin, urinary retention and cognitive side effects, such as impaired memory and confusion.
The most common side effect of the oxybutynin skin patch is skin irritation. Your doctor may recommend that you rotate the location of your patch.
How it works
Mirabegron is a medication approved to treat certain types of urinary incontinence. It relaxes the bladder muscle and can increase the amount of urine your bladder can hold. It may also increase the amount you are able to urinate at one time, helping to empty your bladder more completely.
Some side effects of mirabegron include increased blood pressure, common cold symptoms (nasopharyngitis), urinary tract infection and headache. Constipation also may occur. Before taking mirabegron, talk with your doctor if you have kidney or liver disease. Mirabegron may also interact with other medications, so make sure your doctor knows which medications you're taking before you begin taking mirabegron.
How it works
Injections of Botox into the bladder muscle may benefit people who have an overactive bladder. Botox blocks the actions of acetylcholine and paralyzes the bladder muscle. Botox may be helpful for people who haven't responded to other medications. Benefits can last several months. Your doctor may recommend repeat injections once or twice a year.
Studies have found that Botox significantly improves symptoms of incontinence and causes few side effects. Some research indicates it may increase urinary tract infections, but the data aren't conclusive.
The FDA warns that adverse reactions including respiratory arrest and death may occur after the use of Botox for both approved and unapproved uses.
How it works
After menopause, a woman's body produces less estrogen. This drop in estrogen may contribute to deterioration of the supportive tissues around the bladder and urethra, weakening the tissues and potentially aggravating stress incontinence.
Applying low-dose, topical estrogen in the form of a vaginal cream, an estrogen-containing ring or a patch may help rejuvenate deteriorating tissues in the vagina and urinary tract and relieve some incontinence symptoms.
There's not a lot of scientific evidence to support using topical estrogen to treat urinary incontinence, but some women report that it's helpful for their urinary symptoms. Estrogen may not be recommended if you have a history of breast or uterine cancer or both. Talk with your doctor about the potential risks of using estrogen in your situation.
Combination hormone replacement therapy (estrogen plus progestin) isn't the same as topical estrogen and is no longer used to treat urinary incontinence. Oral estrogen replacement also is not the same as topical estrogen, and it may actually worsen incontinence symptoms.
When used correctly, topical estrogen therapy typically doesn't cause side effects. However, to treat incontinence, topical estrogen is usually paired with another medication or therapy — which may cause side effects.
How it works
Imipramine is a tricyclic antidepressant. It makes the bladder muscle relax, while causing the smooth muscles at the bladder neck to contract. It may be used to treat mixed incontinence — a combination of urge and stress incontinence.
Imipramine may cause drowsiness, so it's often taken at night. Because of this, imipramine may be useful for nighttime incontinence, as well. It may also be helpful for children who bed-wet at night (nocturnal enuresis). Imipramine is usually not a good fit for older adults.
Serious side effects from imipramine are rare but can include cardiovascular problems, such as irregular heartbeat and dizziness or fainting from reduced blood pressure when you stand up quickly. Children and older adults may be especially susceptible to these side effects.
Other side effects, including dry mouth, blurry vision and constipation, are similar to those of anticholinergics. Tricyclic antidepressants interact with many different medications, so make sure your doctor knows which medications you're taking before you begin taking imipramine.
How it works
Duloxetine is a serotonin and norepinephrine reuptake inhibitor that is approved to treat depression and anxiety. It can help the urethral sphincter relax, so it can improve urinary incontinence in some women. It may be especially helpful for women who have urinary incontinence and depression.
In research studies, many women stopped taking duloxetine because of its side effects. These can include nausea, dry mouth, dizziness, constipation, insomnia and fatigue. Women who have chronic liver disease should not take duloxetine. Be sure your doctor knows your full medical history before you begin using this drug.
When talking to your doctor, carefully review all the medications you're taking, including over-the-counter drugs or herbal remedies. Some medications increase bladder control problems. Others may interact with incontinence medications in a way that increases symptoms.
Your doctor can help you decide if you need medicine to treat your bladder control problem and, if so, which one may be best for you.
Sept. 13, 2014
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