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.
See your doctor
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
See more In-depth
- Urinary incontinence in women. National Kidney and Urologic Diseases Information Clearinghouse. http://kidney.niddk.nih.gov/kudiseases/pubs/uiwomen. Accessed May 14, 2014.
- Non-surgical treatments for female stress urinary incontinence. National Association for Continence. http://www.nafc.org/bladder-bowel-health/types-of-incontinence/stress-incontinence/non-surgical-treatment-for-female-stress-urinary-incontinence/. Accessed May 11, 2014.
- What every woman should know. National Association for Continence. http://www.nafc.org/bladder-bowel-health/what-is-incontinence/what-every-woman-should-know/. Accessed May 11, 2014.
- Medications. National Association for Continence. http://www.nafc.org/bladder-bowel-health/types-of-incontinence/urge-incontinence/medications/. Accessed May 11, 2014.
- DuBeau CE. Treatment and prevention of urinary incontinence in women. http://www.uptodate.com/home. Accessed May 11, 2014.
- Mahajan ST. Use of botulinum toxin for treatment of non-neurogenic lower urinary tract conditions. http://www.uptodate.com/home. Accessed May 11, 2014.
- Cipullo LMA, et al. Pharmacological approach to overactive bladder and urge urinary incontinence in women: An overview. European Journal of Obstetrics and Gynecology and Reproductive Biology. 2014;175:27.
- Cody JD, et al. Oestrogen therapy for urinary incontinence in post-menopausal women. Cochrane Database of Systematic Reviews. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001405.pub3/full. Accessed May 11, 2014.
- Hersh L, et al. Clinical management of urinary incontinence in women. American Family Physician. 2013;87:634.
- Shamilyan T, et al. Benefits and harms of pharmacologic treatment for urinary incontinence in women: A systematic review. Annals of Internal Medicine. 2012;156:861.
- Visco AG, et al. Anticholinergic therapy vs. onabotulinumtoxinA for urgency urinary incontinence. New England Journal of Medicine. 2012;367:1803.
- Ferri FF. Ferri's Clinical Advisor 2014: 5 Books in 1. Philadephia, Pa.: Mosby Elsevier; 2014. https://www.clinicalkey.com. Accessed May 11, 2014.
- Information for healthcare professionals: OnabotulinumtoxinA (marketed as Botox/Botox Cosmetic), AbobotulinumtoxinA (marketed as Dysport) and RimabotulinumtoxinB (marketed as Myobloc). Food and Drug Administration. http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/DrugSafetyInformationforHeathcareProfessionals/ucm174949.htm. Accessed June 9, 2014.
- Wein AJ, et al. Campbell-Walsh Urology. 10th ed. Philadelphia, Pa.: Saunders Elsevier; 2012. http://www.clinicalkey.com. Accessed June 10, 2014.
- Castle EP (expert opinion). Mayo Clinic, Scottsdale/Phoenix, Ariz., May 20, 2014.
- Myrbetriq (prescribing information). Northbrook, Ill.: Astellas Pharma US, Inc.; 2012. http://www.us.astellas.com/docs/Myrbetriq_WPI.pdf. Accessed July 30, 2014.
- Sanford M. Mirabegron: A review of its use in patients with overactive bladder syndrome. Drugs. 2013;73:1213.