Drugs for an overactive bladder promise to curb frequent bathroom breaks and bladder leaks.

But is taking medication really the best solution for regaining control of your bladder? Our experts at Consumer Reports Best Buy Drugs reviewed the evidence and here's what they found.

Don't Believe the Hype

Drug ads may leave out information you need in order to decide if medication is best for you, says Michael Hochman, M.D., an assistant professor of clinical medicine at the Keck School of Medicine at USC.

For example, ads for bladder drugs don’t mention some of these points:

  1. Symptoms may be addressed without drugs. About one-third of the time, bladder leaks and strong urges to go resolve in women within a year without treatment. In many cases, simple lifestyle changes, such as cutting back on certain fluids or doing exercises to strengthen muscles supporting the bladder, can greatly improve control.
  2. The drugs often don’t work well. According to an analysis by Consumer Reports Best Buy Drugs, most people who take these medications can expect only modest relief. Medication reduces the number of daily bathroom trips from 12 to 9 or 10, on average. People who experience bladder leaks can expect one or two fewer episodes per day.
  3. They cause side effects. More than half of those with what’s been dubbed “overactive bladder” stop taking medication within six months, often because of side effects such as dry mouth, blurry vision, constipation, and dizziness. Also, most of these drugs belong to a class of medication called anticholinergics, which commonly cause mental confusion, especially in older adults, and have been linked to an increased risk of dementia.

“There is a role for these drugs,” says Hochman, “but typically only after trying safer treatments first.”

Start With Your Doctor

What should you do if you’re experiencing bladder problems? First, speak up. The issue often goes unresolved, especially with men, Hochman says. “People may be embarrassed to bring up the subject, and busy physicians often neglect to ask about it.” But the symptoms can almost always be eased, he adds.

So start by working with a general practitioner, who can determine whether there may be an underlying cause for your symptoms. Urgency, incontinence, and urinary frequency can be caused by urinary tract infections, kidney stones, or a prostate infection or prostate enlargement in men. Medication you take to treat other conditions, such as anxiety, depression, high blood pressure, insomnia, and pain, can also lead to bladder leaks.

Your doctor might ask you to keep a diary of how often you urinate, when you have leaks, and how much liquid you consume. That will help define the problem and pinpoint triggers.

Try Lifestyle Strategies

Once contributing factors are ruled out, CR Best Buy Drugs’ experts, as well as major medical organizations, including the American College of Physicians and American Urological Association, recommend starting with nondrug measures.

Lifestyle changes that improve your overall health—shedding a few pounds if you’re overweight, and stopping smoking—can also reduce incontinence.

And eat plenty of fiber. Aim for 3 to 4 ounces of whole grains, 1½ to 2 cups of fruit, and 2 to 3 cups of vegetables per day to keep yourself regular. Constipation puts pressure on your bladder.

Other lifestyle changes depend on your particular symptoms and the type of incontinence you’re experiencing. Some people have both of these:

  • Stress incontinence. This is marked by urine leaks when you laugh, cough, sneeze, or lift heavy objects. Exercises called Kegels, which strengthen the muscles that control urine flow by repeatedly tightening and relaxing them, can be very effective at reducing related bladder leaks.

    Your doctor may be able to teach you to do Kegels. If you're having trouble mastering the exercises, he or she can refer you to a physical therapist who will use biofeedback or other techniques to help you better recognize when you’re effectively contracting the muscles.

    In addition, research shows that a pessary, a small device that fits into the vagina to support the bladder and uterus, improves symptoms for about half of women.

  • Urge incontinence. The most notable sign of urge incontinence (or overactive bladder) is a sudden, urgent need to urinate (with or without leaks). Kegels can help with that too, as can cutting back on bladder irritants such as alcohol, caffeine, and carbonated drinks.

    Your doctor can help you establish a schedule for bladder training, where you urinate at set times, gradually increasing the intervals between bathroom trips. Those approaches work for many people but require patience. Experts recommend trying bladder training for six weeks and daily Kegels for at least 15 weeks.

When to Consider Meds

If you have urge incontinence and have tried nondrug measures for several months but symptoms are still interfering with your quality of life, you might consider adding medication. (Drugs won’t work for stress incontinence.)

How do they work? In some people with urge incontinence, the bladder muscles contract at the wrong time, causing the uncomfortable feeling of urgency and often leaks. Drugs used to treat the condition relax the bladder muscles, which can increase the storage size of the bladder and reduce the urge to urinate.

Seven prescription drugs are available to treat urge incontinence: darifenacin (Enablex); fesoterodine (Toviaz); mirabegron (Myrbetriq); oxybutynin (Ditropan XL pills, Gelnique topical gel, and generic); solifenacin (Vesicare); tolterodine (Detrol, Detrol LA, and generic); and trospium (generic only).

Oxybutynin is also sold over-the-counter in patch form as Oxytrol for Women. But it’s unwise to use it—or any of the other medication­s—without discussing risks and benefits with your physician.

Based on analysis of the evidence by CR Best Buy Drugs, none of the drugs clearly works better than the others.

But if you and your doctor conclude that one is worth trying, consider generic prescription extended-release oxybutynin. It costs about twice as much as the short-acting drug if you’re paying out-of-pocket but offers the convenience of once-a-day dosing. In addition, research suggests that it has a somewhat lower risk of side effects than other forms of the drug, including the OTC patch, as well as some other bladder drugs, including short-acting tolterodine.

Watch closely for side effects, particularly memory problems or confusion, which can be subtle, Hochman says. Because of those risks, our experts advise against the drugs for anyone diagnosed with dementia.

If symptoms haven’t improved after 8 weeks, ask your doctor about adjusting the dose or trying a different option.

The Last Resort

Surgery may be an option for stress incontinence. The most common procedure is midurethral-sling surgery, where strips of synthetic mesh are implanted to support the neck of the bladder. It can be effective, but the surgery carries significant risks, including infection, difficulty urinating, and an increase in the severity of incontinence. For these reasons, it should be considered only as a last resort.

Editor's Note: These materials were made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by a multistate settlement of consumer fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).