From the Guidelines
For urge urinary incontinence, antimuscarinic medications or beta-3 agonists should be offered as the first-line treatment to improve urinary urgency, frequency, and/or urgency urinary incontinence, as recommended by the most recent and highest quality study 1. The medications used to treat urge urinary incontinence include:
- Anticholinergics, such as oxybutynin (2.5-5mg twice daily), tolterodine (2-4mg daily), solifenacin (5-10mg daily), and trospium (20mg twice daily)
- Beta-3 agonists, such as mirabegron (25-50mg daily), which are effective alternatives with fewer side effects like dry mouth Some key points to consider when using these medications include:
- Starting with the lowest effective dose to minimize side effects, which can include dry mouth, constipation, and blurred vision for anticholinergics
- Implementing lifestyle modifications simultaneously, including scheduled voiding, limiting fluid intake before bedtime, avoiding bladder irritants like caffeine and alcohol, and performing pelvic floor exercises
- Considering over-the-counter options, such as Oxytrol patches (3.9mg/day applied twice weekly) and bladder control supplements containing pumpkin seed extract or soy isoflavones, although these have limited scientific evidence
- Being aware that herbal supplements, such as gosha-jinki-gan and corn silk, have not been well-established as effective treatments for urge urinary incontinence The most recent and highest quality study 1 provides strong evidence for the use of antimuscarinic medications and beta-3 agonists in the treatment of urge urinary incontinence, and should be prioritized in clinical decision-making.
From the FDA Drug Label
Mirabegron extended-release tablets are indicated for the treatment of OAB in adult patients with symptoms of urge urinary incontinence, urgency, and urinary frequency. The medication used to treat urge urinary incontinence is mirabegron.
- Mirabegron is a prescription medicine that can be used to treat adults with symptoms due to a condition called overactive bladder (OAB), including:
From the Research
Medications for Urge Urinary Incontinence
- Anticholinergic medications are used to treat urge urinary incontinence, but they are not recommended for older adults due to adverse effects 3
- Mirabegron is a beta-3-adrenoreceptor agonist that is licensed for the symptomatic treatment of urgency, increased micturition frequency, and/or urgency incontinence in adult patients with overactive bladder syndrome 4
- OnabotulinumtoxinA is another medication option for treating urge incontinence 3
Efficacy and Safety of Medications
- Mirabegron has been shown to be poorly effective in treating urge urinary incontinence, with a meta-analysis suggesting that it prevents one episode of urinary incontinence every 2 days 5
- Low-dose oxybutynin (2.5 mg three times daily) has been shown to be effective in treating urge incontinence with few side effects, with a positive responder rate of 95% after 6 weeks 6
- Combination therapy with behavioral training and drug therapy may reduce incontinence frequency during active treatment, but it does not improve the ability to discontinue drug therapy and maintain improvement in urinary incontinence 7
Herbal Supplements and Over-the-Counter Options
- There is limited evidence on the use of herbal supplements and over-the-counter options for treating urge urinary incontinence, and no medications are approved by the U.S. Food and Drug Administration for this condition 3