Sometimes behavioral changes and pelvic strengthening just aren’t enough to fix your leaking.  If this sounds like you, it is time to try other treatments.  For urgency urinary incontinence (AKA overactive bladder), this can mean trying a medication.  There are 8 FDA approved medications for urgency urinary incontinence but none for stress urinary incontinence.  These medications fall into two classifications of medications: anti-cholinergics and beta-3 agonists.  So, do medications help an overactive bladder?

Anticholinergic medications for overactive bladder

The anticholinergic family has been around the longest and there are some generic medications in this class.  There are many studies on these medications but most of them are industry sponsored.  Industry -sponsored studies aren’t bad but they are more susceptible to bias.  This is because the companies really want their products to work.  There aren’t many head-to-head comparisons between the medications.  Generally, the evidence for these medications is strong, although short term.  Studies show that these medications reduce leaking by 50-80%.  There is also a 12-30% reduction in urinary frequency.

The names of the medications are darifenacin (enablex), fesoterodine (toviaz), oxybutynin (ditropan), solifenacin (vesicare), tolterodine (detrol), and trospium (sanctura).  All medications have a generic name and a brand name.  The names in parentheses are the brand names.  One medication is not clearly better than another.  We frequently pick the medication based on your other medical problems, your general health, and your insurance formulary.

Lots of women stop using these medications because of side effects.  The most common side effects include dry eyes, dry mouth and constipation.  There is an increased risk of dementia when using these medications.  This risk makes them difficult to prescribe.  Higher doses of the medication, older age, and longer treatment times increase the risk of dementia.

Beta-3 agonist medications for overactive bladder

Beta-3 agonists are also used to treat urinary incontinence.  There are two medications in this family: mirabegron (myrbetriq) and vibegron (gemtesa).  Mirabegron works as well as anticholinergics but has a different side effect profile.  It can cause increased blood pressure but does not increase the risk of dementia.  Vibegron does not cause high blood pressure or dementia but can cause headaches.  This family of medications is much newer.  This means that there are no generics and they are frequently very expensive (a generic name doesn’t mean there is a cheap generic version).  The companies have coupons and discount programs which can help with the cost.

Are medications a good idea?

I think it is always best to fix overactive bladder symtoms with lifestyle changes, pelvic floor strengthening, urge supression and timed voiding.  That is, when it works.  It doesn’t work for everyone and then other treatments are needed.  Medications have helped millions of women with their leakage.  I worry about anticholinergics over long periods of time but they can be helpful for younger women or for a short period of time.  Beta-3 agonists can be super expensive but I have also seen them cure leakage.  And insurances frequently will make you try a medication before moving on to another line of treatment (see other treatment options here).  It is worth trying them to evaluate how well they work for you.

Lucacz ES et al. Urinary incontinence in women: a review. JAMA (2017);318(16):1592-1604.