Bladder control: Medications for urinary problems
When other options for bladder control don’t work, medication may help. Learn what medications are available and their possible side effects.
Bladder control problems sometimes continue even after making lifestyle changes and trying bladder training. When other options don’t work, it may be time to talk to your health care provider about medications.
Medications are available for people who often have sudden, intense urges to urinate, also called overactive bladder. They’re also available to people who have urine leaks that can happen along with overactive bladder. This is called urge incontinence.
There are fewer drug options for people who have urine leaks during activity. This is called stress incontinence. Stress incontinence can cause leaks when coughing, sneezing or lifting heavy objects.
Here’s a look at drugs commonly used to treat bladder control problems and their possible side effects. Medications combined with behavioral treatment might be more effective than medication alone.
How they work
Anticholinergic drugs block the action of the chemical messenger acetylcholine. Acetylcholine sends signals to your brain that trigger bladder contractions associated with an overactive bladder. These bladder contractions can cause a need to urinate even when the bladder isn’t full.
Anticholinergic medications include:
- Oxybutynin (Ditropan XL, Oxytrol, Gelnique)
- Tolterodine (Detrol, Detrol LA)
- Solifenacin (Vesicare, Vesicare LS)
- Fesoterodine (Toviaz)
These prescription drugs are usually given as a pill or tablet taken by mouth. Oxybutynin is also available as a prescription gel or skin patch that delivers a continuous amount of medication.
In addition, oxybutynin is available as a skin patch without a prescription (Oxytrol for Women).
It can take several weeks before symptoms begin to improve on an anticholinergic medication. It might take 12 weeks to see the full effect of the drug.
The most common side effects of anticholinergics are dry mouth and constipation. An extended-release form taken once a day might cause fewer side effects.
For dry mouth, try sucking hard candy or chewing gum to produce more saliva. Other less common side effects include heartburn, blurry vision, rapid heartbeat, flushed skin and trouble urinating. Cognitive side effects may also occur. They include trouble with memory and confusion.
The oxybutynin skin patch might cause skin irritation. Your health care provider may suggest 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 how much urine the bladder can hold. It might also increase the amount you’re able to urinate at one time. This may help you to empty the bladder more completely. Mirabegron is available as a tablet or granules.
Some common side effects of mirabegron include nausea, diarrhea, constipation, dizziness and headache. It can increase blood pressure. Your blood pressure should be monitored while on this drug.
Mirabegron can interact with other medications. Give your health care provider a full list of your medications before you begin taking this medication.
Onabotulinumtoxin type A (Botox)
How it works
Injections of Botox into the bladder muscle might benefit people who have an overactive bladder or urge incontinence. Botox blocks the actions of acetylcholine and paralyzes the bladder muscle.
Botox might be helpful for people who haven’t responded to other medications. Benefits can last several months. Your health care provider might recommend repeating the injections once or twice a year.
Studies have found that Botox significantly improves symptoms of incontinence and causes few side effects. Some research shows it may increase urinary tract infections, but the data are limited.
The Food and Drug Administration (FDA) warns that adverse reactions may occur after the use of Botox for both approved and unapproved use. They can include stopping breathing and death.
How it works
After menopause, the body produces less estrogen. This drop in estrogen may contribute to weakening of the supportive tissues around the bladder and the tube that allows urine to pass from the body. This can contribute to stress incontinence.
Applying low-dose, topical estrogen may help. The medication comes in the form of a vaginal cream, ring or patch. The estrogen may help restore the tissues in the vagina and urinary tract to relieve some symptoms.
Topical estrogen might not be safe for people with a history of breast cancer, uterine cancer or both. Talk with your health care provider about the potential risks.
Combination hormone therapy isn’t the same as topical estrogen and is no longer used to treat urinary incontinence. Oral estrogen therapy is pills that you take by mouth. It also is not the same as topical estrogen. Oral estrogen therapy might make incontinence symptoms worse.
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, which is 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. It may also be helpful for children who bed-wet at night. Imipramine isn’t usually a good fit for older adults.
Serious side effects from imipramine are rare but can include heart and blood vessel problems. They may include an irregular heartbeat and dizziness or fainting from low blood pressure when you stand up quickly. Children and older adults may be especially at risk of these side effects.
Other side effects may include dry mouth, blurry vision and constipation. Tricyclic antidepressants interact with various medications. Make sure your health care provider knows all the medications you’re taking.
How it works
Duloxetine (Cymbalta, Drizalma Sprinkle) is a serotonin and norepinephrine reuptake inhibitor that is approved to treat depression and anxiety. It can help relax the muscles that control urination and improve bladder leaks in some people. It might be especially helpful for people who have urinary incontinence and depression.
Side effects of duloxetine can include nausea, dry mouth, dizziness, constipation, insomnia and fatigue. People with chronic liver disease shouldn’t take duloxetine. Be sure your health care provider knows your full medical history before you begin using this drug.
See your health care provider
When talking to your health care provider, carefully review all the medications you’re taking. Include nonprescription drugs and any herbal remedies. Some medications make bladder control problems worse. Others can interact with bladder control drugs in a way that increases symptoms.
Your health care provider can help you decide if you need medicine to treat bladder leaks. Discuss which one might be best for you.
From Mayo Clinic to your inbox
Sign up for free, and stay up to date on research advancements, health tips and current health topics, like COVID-19, plus expertise on managing health.
To provide you with the most relevant and helpful information, and understand which
information is beneficial, we may combine your email and website usage information with
other information we have about you. If you are a Mayo Clinic patient, this could
include protected health information. If we combine this information with your protected
health information, we will treat all of that information as protected health
information and will only use or disclose that information as set forth in our notice of
privacy practices. You may opt-out of email communications at any time by clicking on
the unsubscribe link in the e-mail.
Thank you for subscribing
Our Housecall e-newsletter will keep you up-to-date on the latest health information.
Sorry something went wrong with your subscription
Please, try again in a couple of minutes
July 15, 2022
- Bladder control problems (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 April 8, 2022.
- Lukacz ES. Urgency urinary incontinence/overactive bladder (OAB) in females: Treatment. https://www.uptodate.com/contents/search. Accessed April 8, 2022.
- Highlights of prescribing information: Botox. U.S. Food and Drug Administration. https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&ApplNo=103000. Accessed April 18, 2022.
- Stress urinary incontinence in women. National Association for Continence. https://www.nafc.org/female-stress-incontinence. Accessed April 8, 2022.
- Pearlman A, et al. Evaluation and treatment of urinary incontinence in the aging male. Postgraduate Medicine. 2020; doi:10.1080/00325481.2020.1831790.
- Trowbridge ER, et al. Evaluation and treatment of urinary incontinence in women. Gastroenterology Clinics of North America. 2022; doi:10.1016/j.gtc.2021.10.010.
- Ferri FF. Incontinence, urinary. In: Ferri’s Clinical Advisor 2022. Elsevier; 2022. https://www.clinicalkey.com. Accessed April 12, 2022.
- Oxybutynin transdermal. Facts & Comparisons eAnswers. https://fco.factsandcomparisons.com. Accessed April 12, 2022.
- Mirabegron oral. Facts & Comparisons eAnswers. https://fco.factsandcomparisons.com. Accessed April 18, 2022.
- Sussman RD, et al. Guideline of guidelines: Urinary incontinence in women. BJU International. 2020; doi:10.1111/bju.14927.
- Imipramine. IBM Micromedex. https://www.micromedexsolutions.com. Accessed April 19, 2022.
- He Q, et al. Treatment for refractory overactive bladder: A systematic review and meta-analysis of sacral neuromodulation and onabotulinumtoxinA. International Urogynecology Journal. 2021; doi:10.1007/s00192-020-04427-w.
- Shim S, et al. Updates on therapeutic alternatives for genitourinary syndrome of menopause: Hormonal and non-hormonal managements. Journal of Menopausal Medicine. 2021; doi:10.6118/jmm.20034.
- Duloxetine (prescribing information). Ajanta Pharma USA Inc.; 2021. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=1e6d2c80-fbc8-444e-bdd3-6a91fe1b95bd. Accessed April 25, 2022.