The Best OTC & Prescription Medications for Overactive Bladder & Incontinence

Understanding How Medications Can Help with Incontinence

Medication has a place for adult incontinence when bladder training, physical therapy and lifestyle changes won’t cut it. Always talk to your healthcare provider about your options. There are several types of incontinence, though these are the four main types: 

• Stress incontinence is very common and involves leaking urine from sneezing, coughing, jumping or any sudden movement.
• Urge incontinence (aka overactive bladder) gives people a sudden and frequent urge to go, leading to accidents and leaks. 
• Overflow incontinence is a type of incontinence where people feel a diminished need to pee at all and have slow urinary systems, causing leaks when their bladder is full.
• Functional incontinence happens when individuals cannot get to the bathroom in time due to physical disabilities or arthritis (or something blocking them from getting to the toilet).

The Best Over-The-Counter (OTC) Medications for Incontinence and Overactive Bladder

Note: Most adult incontinence issues are best resolved through prescription medication, but over-the-counter options are available to help reduce the number of bathroom trips and to help prevent leaks. OTC options are best suited for overactive bladder (OAB). 

Oxybutynin Transdermal Patches

This medication is only available over-the-counter for women but requires a prescription for men. Oxybutynin works by relaxing the bladder muscles to help improve OAB symptoms (a tight contraction of muscles in the pelvic region is typically why you experience OAB at all). The patches may cause side effects, including: 

• Dry mouth
• Constipation
• A rash at site
• An itching or burning sensation when the patch is applied
• Headaches
• Fatigue
• Blurred vision
• Upset stomach
• Cramping

Supplements for Overactive Bladder 

For a more natural approach, supplements and herbs could significantly help symptoms, but be sure to check whether they interact with your other medications first. Here are some supplements to try:

• Magnesium hydroxide: Magnesium helps relax and regulate muscle contraction, which causes overactive bladder. Side effects include diarrhea, vomiting and abdominal cramping.
• L-arginine: This amino acid helps the body regulate nitric oxide — a compound that plays an important role to keep the urinary tract healthy while reducing signals to the bladder to empty itself. This amino acid can be found in supplements as well as in certain foods, such as meat, dairy products, fish, walnuts, soy protein and certain cereals. 
• Cleavers & pumpkin seed extract: These herbs hold many benefits, including acting as an anti-inflammatory to help improve symptoms of OAB and to boost urinary health overall. However, studies are still being done to test results. Green tea extract and certain Chinese herbs can also be of great benefit.

Antidiarrheals for Bowel Incontinence 

Antidiarrheals can be found in any drug or convenience store, and they help to slow down and stop bowel incontinence, specifically if you’re experiencing loose stools. With certain antidiarrheals, like Imodium, side effects can include abdominal pain, dry mouth, drowsiness, dizziness, constipation, nausea and vomiting.

Urinary Acidifiers 

Urinary acidifiers help boost urinary tract health by maintaining a healthy acid-base balance in the blood and urine to help dissolve stones in the kidneys and bladder, which can develop from urinary-tract infections (UTIs). Like with any OTC medication, be sure to discuss with your healthcare provider first, as there are many potential side-effects:

• Nausea

• Vomiting

• Diarrhea

• Stomach pain

• UTI

Common Prescription Medications for Incontinence

Here’s what you can expect when you go to the doctor to discuss your prescription treatment options for incontinence: 

Anticholinergics/Antimuscarinics 

These drugs block the action of acetylcholine, a chemical involved in causing abnormal bladder contractions that make you feel like you need to go even when your bladder isn’t full (OAB). Toviaz (fesoterodine), Enablex (darifenacin) and Vesicare (solifenacin) are some of the heavily advertised brand names. Depending on your incontinence symptoms, your doctor may advise timed-release or immediate-release meds. Dry mouth is a common side effect, but you could also experience constipation or urinary retention, heartburn or a rapid heartbeat, blurry vision or even impaired memory and confusion.

Beta-3 Agonists 

Beta 3-Agonists are a group of medications that relax your bladder, allowing you to hold more urine. They work by activating receptors in your bladder, and are a great solution for OAB. Mirabegron (Myrbetriq) and vibegron (Gemtesa) are the two Beta 3-Agonist drugs available. The most common side effects include: 

• Elevated blood pressure
• Inability to empty your bladder
• Constipation
• Headache
• Dizziness
• Dry mouth
• UTIs
• Sinus irritation 

Estrogen Creams

The drop in estrogen production after a woman reaches menopause may explain why the supportive tissues around the bladder and urethra weaken and, in turn, worsen stress incontinence. Applying a low-dose topical (not oral) estrogen available in a vaginal cream, ring or patch may help blood flow and nerve function to relieve some stress incontinence or urge incontinence symptoms. Little research has been done to validate this therapy and there may be health reasons for you to avoid estrogen, but some women say it’s helpful. Estrogen may work better when combined with lifestyle changes, like pelvic floor exercises. Serious side effects are not common while safely using low doses of estrogen creams, however breast pain, itching around the vagina, headache, nausea and stinging around the genitals can occur in rare cases.

Imipramine

This tricyclic antidepressant has a dual action — it makes the bladder muscle relax and the smooth muscles at the bladder neck contract. Because of this, it may help with mixed, urge and stress incontinence. It’s often prescribed for nighttime dosing because it can cause drowsiness— and help with nighttime incontinence. Rare side effects are an irregular heartbeat and dizziness or fainting from reduced blood pressure if you stand up too quickly, especially if you’re older. Your doctor will need to evaluate its potential drug interactions if you’re taking medications.

Desmopressin

This is a synthetic version of antidiuretic hormone (ADH) that decreases the production of urine. While often used to help kids with bedwetting issues, it may reduce urinary incontinence in women. Serious side effects are uncommon, but there is the potential for water retention and sodium deficiency in the blood, which in rare cases can lead to seizures, brain swelling and even death. As with the other drugs prescribed for urinary incontinence, your doctor will need to evaluate your medical history and other drugs you’re taking before recommending this option.

Finding the Right Medication for You

If you’re dealing with incontinence, visit your healthcare provider to assess what type of incontinence you have, your medical history, the drugs you’re currently taking and other specific factors. This discussion can help your doctor determine which type of treatment or medication is best for your situation.