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)
• Darifenacin
• Solifenacin (Vesicare, Vesicare LS)
• Trospium
• 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.

Side effects

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.

Side effects

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.

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.

Side effects

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.

Side effects

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.

Side effects

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

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.

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.

Sept. 20, 2023

Original article: https://www.mayoclinic.org/diseases-conditions/urinary-incontinence/in-depth/bladder-control-problems/art-20044220