Table of ContentsView AllTable of ContentsAnticholinergicsBotoxBeta-3 Adrenergic AgonistsEstrogenTofranil (Imipramine)Cymbalta (Duloxetine)Over-the-Counter and Alternative Options
Table of ContentsView All
View All
Table of Contents
Anticholinergics
Botox
Beta-3 Adrenergic Agonists
Estrogen
Tofranil (Imipramine)
Cymbalta (Duloxetine)
Over-the-Counter and Alternative Options
Bladder control problems, or urinary incontinence, can cause an uncontrolled urgency to urinate, increased visits to the bathroom, and accidental leakage. Different medical conditions, aging, and lifestyle habits can all contribute to these symptoms.
When nondrug strategies fail to help, medications are available to address symptoms and improve quality of life.
Anticholinergic medicationsare the mainstay ofurinary incontinencemanagement. Other prescription treatment options include Botox (onabotulinumtoxinA), beta-3 adrenergic agonists, estrogen, muscarinic receptor antagonists, and certain types of antidepressants. In some cases, over-the-counter (OTC) medications can help.
For bladder control, these medications block the muscarinic M3 receptors on the smooth muscles of the bladder to prevent contractions that would unintentionally release urine.
Medications belonging to this family of drugs include:
Side Effects
Side effects of anticholinergic medications can include:
Botox injections in the bladder are sometimes given after traditional anticholinergic medications have failed because people have shown better compliance with Botox over anticholinergics.
You may be a candidate for Botox if traditional oral medications have not helped your symptoms.
The most common side effects of Botox injection include repeated UTIs while Botox remains in the bladder. A possible temporary side effect is also trouble completely emptying the bladder for the first few weeks after the injection. If this is the case, you may receive a catheter to completely void the bladder until the body is accustomed to the medication.
Beta-3 adrenergic agonists are an alternative class of medications to anticholinergics that generally cause fewer adverse effects.
As a result, the bladder muscles are relaxed when filling up with urine, which allows the bladder to contain its urine instead of sending the brain signals of urinary urgency. When this happens, symptoms associated with overactive bladder are reduced.
Medications that fall under the beta-3 adrenergic agonists class of drugs are Myrbetriq (mirabegron) and Gemtesa (vibegron).
Though both medications work well, comparative studies have suggested that vibegron may be more effective in reducing the amount of urine voided during urination (an indicator of a functional bladder).
They have similar tolerability, although mirabegron has a higher risk of nasopharyngitis and cardiovascular-related side effects.
Side effects associated with mirabegron include:
Side effects associated with vibegron include:
Studies have shown that topical application of low-dose estrogen may help postmenopausal women with overactive bladder symptoms.Estrogenimproves the elasticity and strength of the bladder; this allows the bladder to relax more, giving you more control.
It is important to note that estrogen should not be taken if you have not achieved menopause because it will not provide benefits in terms of managing your symptoms.
Some side effects of vaginal estrogen can include:
Tofranil is an antidepressant that can help with symptoms of nighttime bladder control problems in children and teenagers. This is known asenuresis, or an involuntary release of urine during sleep.
Tofranil belongs to a class of medications calledtricyclic antidepressants. Although the mechanism of how imipramine works is unclear, its anticholinergic side effects are presumed to help cause urine retention. Studies have suggested it may work better when combined with oxybutynin.
Side effects can include:
Duloxetine is an antidepressant that belongs to a family of medications known asserotonin-norepinephrine reuptake inhibitors (SNRIs). Studies show that duloxetine helps with urinarystress incontinencedue to its dual action on both serotonin and norepinephrine.
Side effects can include
Cymbalta RecallStarting in October 2024, over 200,000 bottles of duloxetine delayed-release capsules were recalled over concerns about the presence of nitrosamines, which can increase the risk of cancer.If you take duloxetine, check your medication packaging to see if it was part of the affected lots or call your pharmacist to find out. You should also contact your prescriber, as abruptly stopping a medication like duloxetinecan be dangerous.The recalled lots have expiration dates from November 2024 to December 2025. You can check the lot numbers in the FDA enforcement reports released inOctoberandDecember.
Cymbalta Recall
Starting in October 2024, over 200,000 bottles of duloxetine delayed-release capsules were recalled over concerns about the presence of nitrosamines, which can increase the risk of cancer.If you take duloxetine, check your medication packaging to see if it was part of the affected lots or call your pharmacist to find out. You should also contact your prescriber, as abruptly stopping a medication like duloxetinecan be dangerous.The recalled lots have expiration dates from November 2024 to December 2025. You can check the lot numbers in the FDA enforcement reports released inOctoberandDecember.
Starting in October 2024, over 200,000 bottles of duloxetine delayed-release capsules were recalled over concerns about the presence of nitrosamines, which can increase the risk of cancer.If you take duloxetine, check your medication packaging to see if it was part of the affected lots or call your pharmacist to find out. You should also contact your prescriber, as abruptly stopping a medication like duloxetinecan be dangerous.
The recalled lots have expiration dates from November 2024 to December 2025. You can check the lot numbers in the FDA enforcement reports released inOctoberandDecember.
Some over-the-counter options for symptoms are available, depending on the type of urinary problem.
Oxybutynin is the main ingredient in an OTC patch that you apply to the skin to help with overactive bladder symptoms. However, it is only available over the counter for use in women (under the brand name Oxytrol for Women). Oxybutynin for men must be obtained through a prescription.
OTC products containing phenazopyridine, an analgesic for urinary problems, are also available. These are typically taken to manage UTI symptoms, such as urinary pain, burning, urgency, and frequency.Examples include AZO Urinary Pain Relief and AZO Bladder Control.
Though they can relieve symptoms, these products do not treat UTIs. If you are experiencing UTI symptoms, visit a healthcare provider for a proper diagnosis and prescription treatment.
Other nondrug therapies may be effective for types of incontinence not linked to an infection or underlying medical condition. This can include:
A Word from Verywell HealthMany factors may influence which medication is best for bladder control, including other health conditions (e.g., hypertension, menopause, mental health), interactions with other medications, preferred route of administration (e.g., tablet, injection), and others. Before starting a new medication, it is important to work with your provider to identify the root cause of the issue, as there are different types of incontinence and medications for each.—LINDSAY COOK, PHARMD
A Word from Verywell Health
Many factors may influence which medication is best for bladder control, including other health conditions (e.g., hypertension, menopause, mental health), interactions with other medications, preferred route of administration (e.g., tablet, injection), and others. Before starting a new medication, it is important to work with your provider to identify the root cause of the issue, as there are different types of incontinence and medications for each.—LINDSAY COOK, PHARMD
Many factors may influence which medication is best for bladder control, including other health conditions (e.g., hypertension, menopause, mental health), interactions with other medications, preferred route of administration (e.g., tablet, injection), and others. Before starting a new medication, it is important to work with your provider to identify the root cause of the issue, as there are different types of incontinence and medications for each.
—LINDSAY COOK, PHARMD
Summary
The author would like to recognize and thank Shreya Kumar for contributing to this article.
23 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Stoniute A, Madhuvrata P, Still M, et al.Oral anticholinergic drugs versus placebo or no treatment for managing overactive bladder syndrome in adults.Cochrane Database Syst Rev. 2023;5(5):CD003781. doi:10.1002/14651858.CD003781.pub3DailyMed.Label: Oxytrol- oxybutynin patch.DailyMed.Label: Oxybutynin chloride tablet.DailyMed.Label: Darifenacin tablet, extended release.DailyMed.Label: VESIcare LS- solifenacin succinate suspension.DailyMed.Label: VESIcare-solifenacin succinate tablet, film coated.DailyMed.Label: Trospium chloride tablet, film coated.Jambusaria LH, Dmochowski RR.Intradetrusor onabotulinumtoxinA for overactive bladder.Expert Opin Biol Ther. 2014;14(5):721-727. doi:10.1517/14712598.2014.897322DailyMed.Label: Botox- onabotulinumtoxina injection, powder, lyophilized, for solution.Eldred-Evans D, Sahai A.Medium- to long-term outcomes of botulinum toxin A for idiopathic overactive bladder.Ther Adv Urol. 2017;9(1):3-10. doi:10.1177/1756287216672180Garcio Ferreira Sartori L, Monteiro Nunes B, Farah D, et al.Mirabegron and anticholinergics in the treatment of overactive bladder syndrome: a meta-analysis.Rev Bras Ginecol Obstet. 2023;45(6):337-346. doi:10.1055/s-0043-1770093He W, Zhang Y, Huang G, et al.Efficacy and safety of vibegron compared with mirabegron for overactive bladder: a systematic review and network meta-analysis.Low Urin Tract Symptoms. 2023;15(3):80-88. doi:10.1111/luts.12475DailyMed.Myrbetriq- mirabegron tablet, film coated, extended release.DailyMed.Gemtesa- vibegron tablet, film coatedBaruch Y, Torella M, De Bastiani S, et al.Pre- versus post-menopausal onset of overactive bladder and the response to vaginal estrogen therapy: a prospective study.Medicina. 2023;59(2):245. doi:10.3390/medicina59020245DailyMed.Estrace- estradiol cream.Caldwell PHY, Sureshkumar P, Wong WCF.Tricyclic and related drugs for nocturnal enuresis in children.Cochrane Database Syst Rev. 2016;2016(1):CD002117. doi:10.1002/14651858.CD002117DailyMed.Label: Imipramine pamoate capsule.Lorzadeh N, Jahanshahi M.The effect of duloxetine on stress urinary incontinence.Health Sci Rep. 2024;7(5):e2091. doi: 10.1002/hsr2.2091Fink KG, Huber J, Würnschimmel E, Schmeller NT.The use of duloxetine in the treatment of male stress urinary incontinence.Wien Med Wochenschr. 2008;158(3-4):116-118. doi:10.1007/s10354-007-0494-7DailyMed.Label: Duloxetine capsule, delayed release.Food and Drug Administration.What to Know and Do About Possible Nitrosamines in Your Medication.DailyMed.Label: Oxytrol for Women- oxybutynin patch.
23 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Stoniute A, Madhuvrata P, Still M, et al.Oral anticholinergic drugs versus placebo or no treatment for managing overactive bladder syndrome in adults.Cochrane Database Syst Rev. 2023;5(5):CD003781. doi:10.1002/14651858.CD003781.pub3DailyMed.Label: Oxytrol- oxybutynin patch.DailyMed.Label: Oxybutynin chloride tablet.DailyMed.Label: Darifenacin tablet, extended release.DailyMed.Label: VESIcare LS- solifenacin succinate suspension.DailyMed.Label: VESIcare-solifenacin succinate tablet, film coated.DailyMed.Label: Trospium chloride tablet, film coated.Jambusaria LH, Dmochowski RR.Intradetrusor onabotulinumtoxinA for overactive bladder.Expert Opin Biol Ther. 2014;14(5):721-727. doi:10.1517/14712598.2014.897322DailyMed.Label: Botox- onabotulinumtoxina injection, powder, lyophilized, for solution.Eldred-Evans D, Sahai A.Medium- to long-term outcomes of botulinum toxin A for idiopathic overactive bladder.Ther Adv Urol. 2017;9(1):3-10. doi:10.1177/1756287216672180Garcio Ferreira Sartori L, Monteiro Nunes B, Farah D, et al.Mirabegron and anticholinergics in the treatment of overactive bladder syndrome: a meta-analysis.Rev Bras Ginecol Obstet. 2023;45(6):337-346. doi:10.1055/s-0043-1770093He W, Zhang Y, Huang G, et al.Efficacy and safety of vibegron compared with mirabegron for overactive bladder: a systematic review and network meta-analysis.Low Urin Tract Symptoms. 2023;15(3):80-88. doi:10.1111/luts.12475DailyMed.Myrbetriq- mirabegron tablet, film coated, extended release.DailyMed.Gemtesa- vibegron tablet, film coatedBaruch Y, Torella M, De Bastiani S, et al.Pre- versus post-menopausal onset of overactive bladder and the response to vaginal estrogen therapy: a prospective study.Medicina. 2023;59(2):245. doi:10.3390/medicina59020245DailyMed.Estrace- estradiol cream.Caldwell PHY, Sureshkumar P, Wong WCF.Tricyclic and related drugs for nocturnal enuresis in children.Cochrane Database Syst Rev. 2016;2016(1):CD002117. doi:10.1002/14651858.CD002117DailyMed.Label: Imipramine pamoate capsule.Lorzadeh N, Jahanshahi M.The effect of duloxetine on stress urinary incontinence.Health Sci Rep. 2024;7(5):e2091. doi: 10.1002/hsr2.2091Fink KG, Huber J, Würnschimmel E, Schmeller NT.The use of duloxetine in the treatment of male stress urinary incontinence.Wien Med Wochenschr. 2008;158(3-4):116-118. doi:10.1007/s10354-007-0494-7DailyMed.Label: Duloxetine capsule, delayed release.Food and Drug Administration.What to Know and Do About Possible Nitrosamines in Your Medication.DailyMed.Label: Oxytrol for Women- oxybutynin patch.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Stoniute A, Madhuvrata P, Still M, et al.Oral anticholinergic drugs versus placebo or no treatment for managing overactive bladder syndrome in adults.Cochrane Database Syst Rev. 2023;5(5):CD003781. doi:10.1002/14651858.CD003781.pub3DailyMed.Label: Oxytrol- oxybutynin patch.DailyMed.Label: Oxybutynin chloride tablet.DailyMed.Label: Darifenacin tablet, extended release.DailyMed.Label: VESIcare LS- solifenacin succinate suspension.DailyMed.Label: VESIcare-solifenacin succinate tablet, film coated.DailyMed.Label: Trospium chloride tablet, film coated.Jambusaria LH, Dmochowski RR.Intradetrusor onabotulinumtoxinA for overactive bladder.Expert Opin Biol Ther. 2014;14(5):721-727. doi:10.1517/14712598.2014.897322DailyMed.Label: Botox- onabotulinumtoxina injection, powder, lyophilized, for solution.Eldred-Evans D, Sahai A.Medium- to long-term outcomes of botulinum toxin A for idiopathic overactive bladder.Ther Adv Urol. 2017;9(1):3-10. doi:10.1177/1756287216672180Garcio Ferreira Sartori L, Monteiro Nunes B, Farah D, et al.Mirabegron and anticholinergics in the treatment of overactive bladder syndrome: a meta-analysis.Rev Bras Ginecol Obstet. 2023;45(6):337-346. doi:10.1055/s-0043-1770093He W, Zhang Y, Huang G, et al.Efficacy and safety of vibegron compared with mirabegron for overactive bladder: a systematic review and network meta-analysis.Low Urin Tract Symptoms. 2023;15(3):80-88. doi:10.1111/luts.12475DailyMed.Myrbetriq- mirabegron tablet, film coated, extended release.DailyMed.Gemtesa- vibegron tablet, film coatedBaruch Y, Torella M, De Bastiani S, et al.Pre- versus post-menopausal onset of overactive bladder and the response to vaginal estrogen therapy: a prospective study.Medicina. 2023;59(2):245. doi:10.3390/medicina59020245DailyMed.Estrace- estradiol cream.Caldwell PHY, Sureshkumar P, Wong WCF.Tricyclic and related drugs for nocturnal enuresis in children.Cochrane Database Syst Rev. 2016;2016(1):CD002117. doi:10.1002/14651858.CD002117DailyMed.Label: Imipramine pamoate capsule.Lorzadeh N, Jahanshahi M.The effect of duloxetine on stress urinary incontinence.Health Sci Rep. 2024;7(5):e2091. doi: 10.1002/hsr2.2091Fink KG, Huber J, Würnschimmel E, Schmeller NT.The use of duloxetine in the treatment of male stress urinary incontinence.Wien Med Wochenschr. 2008;158(3-4):116-118. doi:10.1007/s10354-007-0494-7DailyMed.Label: Duloxetine capsule, delayed release.Food and Drug Administration.What to Know and Do About Possible Nitrosamines in Your Medication.DailyMed.Label: Oxytrol for Women- oxybutynin patch.
Stoniute A, Madhuvrata P, Still M, et al.Oral anticholinergic drugs versus placebo or no treatment for managing overactive bladder syndrome in adults.Cochrane Database Syst Rev. 2023;5(5):CD003781. doi:10.1002/14651858.CD003781.pub3
DailyMed.Label: Oxytrol- oxybutynin patch.
DailyMed.Label: Oxybutynin chloride tablet.
DailyMed.Label: Darifenacin tablet, extended release.
DailyMed.Label: VESIcare LS- solifenacin succinate suspension.
DailyMed.Label: VESIcare-solifenacin succinate tablet, film coated.
DailyMed.Label: Trospium chloride tablet, film coated.
Jambusaria LH, Dmochowski RR.Intradetrusor onabotulinumtoxinA for overactive bladder.Expert Opin Biol Ther. 2014;14(5):721-727. doi:10.1517/14712598.2014.897322
DailyMed.Label: Botox- onabotulinumtoxina injection, powder, lyophilized, for solution.
Eldred-Evans D, Sahai A.Medium- to long-term outcomes of botulinum toxin A for idiopathic overactive bladder.Ther Adv Urol. 2017;9(1):3-10. doi:10.1177/1756287216672180
Garcio Ferreira Sartori L, Monteiro Nunes B, Farah D, et al.Mirabegron and anticholinergics in the treatment of overactive bladder syndrome: a meta-analysis.Rev Bras Ginecol Obstet. 2023;45(6):337-346. doi:10.1055/s-0043-1770093
He W, Zhang Y, Huang G, et al.Efficacy and safety of vibegron compared with mirabegron for overactive bladder: a systematic review and network meta-analysis.Low Urin Tract Symptoms. 2023;15(3):80-88. doi:10.1111/luts.12475
DailyMed.Myrbetriq- mirabegron tablet, film coated, extended release.
DailyMed.Gemtesa- vibegron tablet, film coated
Baruch Y, Torella M, De Bastiani S, et al.Pre- versus post-menopausal onset of overactive bladder and the response to vaginal estrogen therapy: a prospective study.Medicina. 2023;59(2):245. doi:10.3390/medicina59020245
DailyMed.Estrace- estradiol cream.
Caldwell PHY, Sureshkumar P, Wong WCF.Tricyclic and related drugs for nocturnal enuresis in children.Cochrane Database Syst Rev. 2016;2016(1):CD002117. doi:10.1002/14651858.CD002117
DailyMed.Label: Imipramine pamoate capsule.
Lorzadeh N, Jahanshahi M.The effect of duloxetine on stress urinary incontinence.Health Sci Rep. 2024;7(5):e2091. doi: 10.1002/hsr2.2091
Fink KG, Huber J, Würnschimmel E, Schmeller NT.The use of duloxetine in the treatment of male stress urinary incontinence.Wien Med Wochenschr. 2008;158(3-4):116-118. doi:10.1007/s10354-007-0494-7
DailyMed.Label: Duloxetine capsule, delayed release.
Food and Drug Administration.What to Know and Do About Possible Nitrosamines in Your Medication.
DailyMed.Label: Oxytrol for Women- oxybutynin patch.
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