Your doctor or continence nurse may recommend one or more of the following options:

Medication for Stress Incontinence

If your main problem is stress incontinence, duloxetine (available in Europe) may be prescribed. Taken twice daily, duloxetine can reduce leakage episodes by about half, and about 1 in 10 women become completely dry. The most common side effect is nausea, which often improves within a few weeks (Drug and Therapeutics Bulletin 2007;45:29–32). Other side effects include dry mouth, fatigue and constipation. There have been concerns – but no proven link – about suicidal thoughts either during treatment or after stopping the medication (Current Problems in Pharmacovigilance 2006;31:2). It is important to continue pelvic floor muscle exercises alongside duloxetine for maximum benefit (Int Urogynecol J 2021 Jan;32:193–201).

Medications for Overactive Bladder

For overactive bladder, several medications can help calm bladder muscle activity and reduce urgency and frequency (Aust J Gen Pract 2020;49:593–598). There are two main types of drugs:

• Anticholinergic medications, which prevent the bladder from contracting prematurely.
• Beta-3 adrenergic agonists, which relax the bladder muscle so it can hold more urine.

It’s important to note that anticholinergic medications may cause memory changes or confusion, particularly in older adults.

Anticholinergic Medications 

• Oxybutynin and tolterodine: Often prescribed as extended-release tablets (taken once daily), which tend to cause fewer side effects than immediate-release oxybutynin forms. Oxybutynin is also available as a skin patch (applied twice weekly) or gel (applied daily), which may cause fewer side effects, but can sometimes cause skin rash or itching.
• Solifenacin: Taken once daily; less likely to cause dry mouth, especially at lower doses.
• Darifenacin: Also taken once daily, may cause constipation but does not increase confusion in older adults.
• Fesoterodine: Taken once daily, as effective as other bladder-calming drugs, with a lower risk of constipation.
• Trospium chloride: Taken once or twice daily, should not be taken with food. May have fewer side effects than other options.
• Imipramine and amitriptyline: May help with nighttime urination (nocturia), but their side effects can be severe and limit their use. 
• Desmopressin: Sometimes prescribed specifically for nighttime urination.

Beta-3 Agonists Medications

• Mirabegron: Taken once daily, relaxes the bladder muscles, allowing it to hold more urinate and reducing bladder frequency. It can, however, raise blood pressure.
• Vibegron: Taken once daily, works similarly to mirabegron, relaxing the bladder muscle to reduce frequency. It has been shown to be effective in men with BPH.

Special Devices

Certain devices are available to help keep the urethra closed and prevent leakage.

Hormone Treatment

Although systemic hormone replacement therapy (HRT) does not help incontinence – and may worsen it – vaginal estrogen creams, tablets, or rings (transvaginal or topical application) may reduce urgency and frequency symptoms.

Botulinum Toxin (Botox)

Botox injections into the bladder wall may calm the bladder muscle, especially in women with conditions like multiple sclerosis. The effects wear off over time and may need repeating. A possible side effect is difficulty emptying the bladder, so you’ll be taught how to use a catheter if needed.

Surgery for Stress Incontinence

Surgery aims to reposition and support the bladder neck and urethra:

• Tension-free vaginal tape (TVT) sling: Uses a synthetic tape placed under the urethra; about 62% of women are cured of leakage.
• Transobturator sling: Similar to TVT but with lower risk of bladder injury; about 56% cure rate.
• Burch colposuspension: A more major surgery, with about 50% cure rate; urgency can develop later.

Bulking Injections

Synthetic or natural (autologous) materials are injected into the walls of the urethra to support the sphincter to prevent urine leakage. The material is injected by inserting a needle alongside the urethra, or into the urethra and through its wall. A local anaesthetic is given to prevent pain. Most women need two or three injections, given at weekly intervals. The effects may diminish over time, and repeat injections may be needed.

Electrostimulation

A small electrode stimulates pelvic floor muscle contraction. The electrical current is tiny, so there is no need to worry. The apparatus is used for 15–30 minutes daily. This is generally used for severe cases that have not responded to other treatments.

First published on embarrassingproblems.com
Reviewed and edited by Dr Diane K. Newman
Last updated: July 2025 by Dr Diane K. Newman