Urinary incontinence (UI) describes a common condition where you leak urine beyond your control. It affects millions of women, including an estimated 78 million women in the United States alone. Within urinary incontinence, there are several sub-types:
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Stress incontinence: When you involuntarily pee a little (or a lot) when you do things like cough, sneeze, laugh, run, have sex, bend over, lift something heavy, or do anything that puts physical stress on your bladder.
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Urge incontinence: Urge incontinence is when you have a sudden urge to urinate that cannot be delayed. Urge incontinence occurs when the bladder muscles contract at the wrong time, causing the bladder to begin to squeeze in preparation for urination even if the bladder is not full.
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Functional incontinence: Functional incontinence is a form of urinary incontinence that occurs when an individual experiences involuntary urine leakage due to physical or mental impairments that prevent them from reaching the bathroom in time.
With so many people affected by this condition, and such variety in how it’s experienced, it is no surprise that the pharmaceutical market has tried to address urinary incontinence pharmacologically. When you’re faced with any frustrating health issue that affects your everyday life, it’s normal to wonder “is there a pill that would take care of this?” Today, we’ll talk about a few of the medication options on the market today, but you may want to explore non-pharmacological treatment options that we’ve written about in the past including:
What Type of Bladder Leaks Can Be Treated with Medication?
All treatments need to be personal to a patient and their specific incontinence cause and severity. “It is important for patients to understand that stress incontinence is not treated with medication, and while overactive bladder (OAB)/urgency urinary incontinence can be treated with medications, they have the potential for side effects,” says Dr. Jeannine Miranne. This is one of the reasons that many healthcare providers opt to start with lifestyle changes before escalating treatment to include surgeries or medications.
Says Dr. Miranne, “I favor trials of behavioral and dietary modifications and pelvic floor physical therapy in all patients with urinary incontinence (whether stress incontinence or urgency incontinence/overactive bladder). I also remind patients that all the treatments in the world may not help them if they are drinking way too much, or the wrong types of fluid.”
What Medications Are There for Treating Incontinence?
While there are other medications used “off-label” to treat incontinence — which means they’re being prescribed for a use that is not approved by the Food and Drug Administration (FDA) — today we’re just going to talk about the medications that are approved for treatment of UI.
Gemtesa (vibegron)
Gemtesa is a tablet form of a type of drug called a beta-3 adrenergic receptor agonist. It works by relaxing the detrusor muscle, which helps the bladder hold more urine and reduces the urgency and frequency of urination. This is how it treats overactive bladder.
Gemtesa is a newer drug on the market (launched 2021), so for some individuals it’s not covered by insurance and their personal cost may be very high. In a few years, a generic version may bring that cost down.
Says Dr. Miranne, “Gemtesa is more specific for the beta-3-receptors on the bladder (as compared with Myrbetriq/Mirabegron) and seems to have the least potential for side effects including cardiovascular side effects such as increase in blood pressure and pulse.”
Learn more about Gemtesa including side effects and drug interactions here
Myrbetriq (mirabegron)
Myrbetriq is another beta-3 adrenergic receptor agonist that you can take as a pill or granules mixed with water. Like Gemtesa, Myrbetriq causes relaxation of the detrusor smooth muscle of the urinary bladder to increase bladder capacity.
In a comparative study, patients preferred Gemtesa over Myrbetriq. Dr. Miranne also notes that Myrbetriq use can result in slight increase in blood pressure/pulse in ~10% of patients. However, Myrbetriq and Gemtesa are considered to have comparable efficacy and safety profiles. Individual coverage from insurance and your own doctor’s recommendation will factor into which of these two similar drugs you could be given.
Learn more about Myrbetriq including side effects and drug interactions here
The antimuscarinic/anticholinergic class
There are numerous drugs that fall into this class of medications, including oxybutynin, solifenacin, tolderodine, propiverine, trospium and several others. Medications in this class offered the first pharmacological treatments for urge incontinence and overactive bladder, providing much-needed relief from bothersome symptoms.
Anticholinergic/antimuscarinic medications also tend to be less expensive as they have been around longer and have generics. However, we now have data that suggests chronic cumulative use of these medications can increase the risk of cognitive side effects (confusion, memory loss, dementia) so many healthcare providers prefer the newer generation of beta-3 agonists.
That said, there is a time and place for these options. Dr. Miranne explains, “Sometimes patients’ symptoms are severe and don’t respond to conservative treatment. Or, patients may not be able to afford beta-3-agonists (Gemtesa/Vibegron and/or Myrbetriq/Mirabegron). In that case, trospium (brand name Sanctura) is my go-to anticholinergic given that theoretically it has less potential for cognitive side effects as it does not cross the blood-brain barrier due to its chemical structure. Anticholinergic medications also have the potential for dry eyes, dry mouth, and constipation so I talk to patients about managing these side effects if they decide to try anticholinergic therapy.”
To Sum It Up
While the FDA has approved several pharmaceutical treatment options for urge incontinence/overactive bladder, your personal care plan is a decision between you and your doctor, based on your situation. They’ll take into account your type of incontinence, severity, frequency of symptoms, along with other medications you take and any other lifestyle or health factors that could affect you taking a medication. They’ll also consider what other treatment options you’ve tried that could be helpful.
And while you’re waiting for your next appointment, stock up on safe, effective, and side-effect-free leak Pads and Liners in our shop. We’ve got you covered.
Disclaimer: This content is for informational purposes only, even if and regardless of whether it features the advice of physicians and medical practitioners. This content is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and should never be relied upon for specific medical advice.