Best Treatment for Bladder Leaks

Recent research strengthens the link between incontinence drugs and dementia risk. Here's how to find relief.

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

But is taking medications—most of them members of a class of drugs called anticholingerics—really the best solution for regaining control of your bladder?

Anticholinergics commonly cause mental confusion, especially in older adults, and have, in the past, been linked to an increased risk of dementia.

Now, a large analysis from the U.K., published last week in the journal BMJ, has found that anticholinergic drugs, especially those used for bladder problems, Parkinson’s disease, and depression, are associated with a higher likelihood of dementia in older adults even 20 years after use.

More on Bladder Health

“While this class of medications has long been known to be linked to memory troubles, it was not known whether the effects were permanent,” says Michael Hochman, M.D., an associate professor of clinical medicine at the Keck School of Medicine at the University of Southern California. “But this study suggests that the effects may not entirely reverse after stopping the medication.”

The research doesn’t prove that the drugs cause dementia—only that there is an association between the two. “However, this study does raise concerns, and anticholinergic medications for incontinence have several other well-established side effects,” Hochman says.

More than half of people 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.

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). (All are anticholinergics, except for mirabegron.)

Oxybutynin is also sold over the counter in patch form as Oxytrol for Women.

So when should you consider these meds? And are there other effective ways to ease bladder problems? Consider this expert advice.

What the Drug Ads Don't Say

Drug ads may leave out information you need to decide whether medication is best for you, Hochman says. For example:

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.

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 nine or 10, on average. People who experience bladder leaks can expect one or two fewer episodes per day.

Begin by Talking to Your Doctor

What should you do if you’re experiencing bladder problems? First, speak up. “People often don’t bring up issues of incontinence with their clinical providers, either due to embarrassment or because they feel there are no available options that can help—or that surgery may be the only option,” says Tomas Griebling, M.D., professor of urology and senior associate dean for medical education at the University of Kansas School of Medicine. But the symptoms can almost always be eased, Hochman says.

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 or kidney stones—or, in men, a prostate infection or prostate enlargement. 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 the triggers.

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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.

Avoid foods and beverages that seem to trigger bladder symptoms, Griebling says. “One of the most common is caffeine, which acts as both a diuretic and a direct bladder irritant (causing more urinary urgency and frequency).” Coffee, tea, cola, and chocolate all contain caffeine.

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.

Stay well-hydrated, too. “Many people attempt to self-treat symptoms by limiting fluid intake,” Griebling says. “While it is true that they will make less total urine, the urine that is produced will tend to be more strong and concentrated, and may actually cause more irritation to the lining of the bladder.”

Other lifestyle changes depend on your particular symptoms and the type of incontinence you’re experiencing. You may have one of the following two types or a mixture of both.

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. For more on Kegels, go to the National Institutes of Health website.

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.)

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

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.

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

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. (It’s unwise to use the OTC patch—or any of the other medication­s—without discussing risks and benefits with your physician.)

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 eight weeks, ask your doctor about adjusting the dose or trying a different option.

The Surgical Option

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.

Consumer Reports

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