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.
Topical estrogen might not be recommended if you have a history of breast cancer, uterine cancer or both. Talk with your doctor about the potential risks.
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 might worsen incontinence symptoms.
When used correctly, topical estrogen therapy typically doesn't cause side effects.
How it works
Imipramine (Tofranil) 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 can 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 various medications, so make sure your doctor knows the other medications you're taking.
How it works
Duloxetine (Cymbalta) 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 might be especially helpful for women who have urinary incontinence and depression.
Side effects of duloxetine 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 make bladder control problems worse. Others can 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 might be best for you.
July 15, 2017
See more In-depth
- Bladder control problems in women (urinary incontinence). National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/urologic-diseases/bladder-control-problems-women. Accessed May 9, 2017.
- Lukacz E. Treatment of urinary incontinence in women. https://www.uptodate.com/home. Accessed May 9, 2017.
- Medical student curriculum: Urinary incontinence. American Urological Association. http://www.auanet.org/education/educational-programs/medical-student-education/medical-student-curriculum/urinary-incontinence. Accessed May 9, 2017.
- Female stress urinary incontinence. National Association for Continence. https://www.nafc.org/womens-stress-urinary-incontinence/?rq=Female%20stress%20urinary%20incontinence. Accessed May 9, 2017.
- Hersh L, et al. Clinical management of urinary incontinence in women. American Family Physician. 2013;87:634.
- DeMaagd GA, et al. Management of urinary incontinence. Pharmacy & Therapeutics. 2012;37:345.
- Highlights of prescribing information: Botox. U.S. Food & Drug Administration. https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/103000s5232lbl.pdf. Accessed May 16, 2017.
- Imipramine hydrochloride. U.S. Food & Drug Administration. https://google2.fda.gov/search?q=Imipramine+side+effects&client=FDAgov&site=FDAgov&lr=&proxystylesheet=FDAgov&requiredfields=-archive%3AYes&output=xml_no_dtd&getfields=*. Accessed May 16, 2017.