Treatment of urge urinary incontinence

If changing your diet, or bladder training and pelvic floor exercises haven’t worked, your doctor may suggest medication to help treat urge incontinence.

Muscarinic receptor antagonists

Muscarinic receptor antagonists (also called anticholinergics) work by relaxing the bladder muscles. This helps calm the bladder, so you don’t feel the sudden need to pee as often and can avoid leaks.

There are different types of muscarinic receptor antagonist medications. Most come as tablets. Some are taken once a day and work for 24 hours, while others need to be taken more often but start working quickly. One type, Oxybutynin, also comes as a cream or skin patch if you don’t want to take a tablet.

What are the side effects?

These medicines usually have mild side effects, like:

• A dry mouth.
• Dry eyes.
• Constipation.
• Trouble peeing.
• Blurred vision, or dizziness.

In older adults, they may also affect memory or cause confusion, especially with Oxybutynin.

If the side effects bother you, your doctor can change the dose or try a different medication to help you feel better.

Mirabegron

Mirabegron is a medication used to treat urge incontinence. It works by relaxing the bladder muscle. This relaxation makes it easier for your bladder to hold urine for longer and reduces the sudden, urgent need to go to the bathroom.

What are the side effects?

Many people do well with Mirabegron, but some may have a few side effects, including:

• Headaches.
• Dry mouth.
• Dizziness.
• Constipation (when you have difficulty passing stool).
• Urinary tract infections (UTIs).

You shouldn’t take Mirabegron if you have a high blood pressure that isn’t treated with medication. It’s important to have your blood pressure under control first.

Oestrogen

Oestrogen is mostly used for stress incontinence, but it can also help people with urge incontinence by keeping the bladder, urethra, and nearby muscles strong and flexible.

Doctors usually give oestrogen as a cream, ring, or tablet that goes into the vagina instead of a pill or patch, because it helps the bladder better.

Electrical stimulation is a treatment for urinary incontinence that uses small electrical pulses to help the muscles or nerves in the pelvic area work better. This can help improve bladder control. 

Electrical stimulation can feel a little uncomfortable at first, but it is not painful. The treatment usually starts with a low level of intensity which may be increased, but only up to a certain point where you still feel comfortable.

Electrical stimulation is often used when other treatments, like changing your diet, bladder training or medications, haven’t worked.

There are 3 different types of electrical stimulations:

• Sacral nerve stimulation
• Tibial nerve stimulation
• Pelvic floor stimulation

Sacral nerve stimulation

Sacral nerve stimulation works by sending electrical pulses to the sacral nerves, which are located near the lower back and are responsible for controlling the bladder and pelvic floor muscles.

A small device called a neurostimulator is implanted under the skin in your lower back or buttocks. This device sends mild electrical pulses to the nerves that control your bladder.

The control unit is about the size of a mobile phone. You can use it to change how strong or how often the electrical signals are sent to the nerves that help control your bladder.

Tibial nerve stimulation

Tibial nerve stimulation uses gentle electrical pulses to help improve bladder control. It works by stimulating a nerve near your ankle called the tibial nerve. 

A small, thin needle is placed near the ankle, just above the heel, where the tibial nerve is. This needle is connected to a small device that sends gentle electrical pulses to the nerves around your pelvis. By activating the tibial nerve, this treatment helps lessen the sudden urge to pee and can help stop leaks.

The treatment is usually done in a series of sessions, with each session lasting about 30 minutes. If it works, you might need fewer sessions over time. It’s often used when other treatments haven’t worked well.

Pelvic floor stimulation

Your pelvic floor muscles are a group of muscles at the bottom of your pelvis that help you control when you urinate.

Pelvic floor stimulation helps to make the pelvic floor muscles stronger which helps with urinary incontinence. It uses a small electrical current to gently stimulate the muscles. For women, a probe is placed in the vagina, and for men, it’s placed in the anus.

Questions to ask your doctor

Here are some questions that can help you better understand how electrical stimulation works and if it's a good choice for you.

• How does electrical stimulation help with urinary incontinence?
• Is this treatment right for me and my type of incontinence?
• How many sessions will I need, and how long will each one last?
• Will the treatment hurt or be uncomfortable?
• Are there any side effects or risks I should know about?
• How soon will I start feeling better?
• Will I need more treatments after the first ones?
• How well does electrical stimulation work compared to other treatments?
• Can I use this treatment along with other treatments or medications?

If none of the other treatments have worked, your doctor may suggest surgery to help treat urge incontinence

Botulinum toxin injections

Botulinum toxin is a medicine that helps relax the nerves and muscles. You might have heard of it by the brand name Botox®. While many people know Botox® as a cosmetic treatment for wrinkles, it is also used to treat medical conditions, including bladder problems.

If you have trouble with urine leaks, your doctor may suggest botulinum toxin injections in your bladder to help manage it. This treatment is often used for overactive bladder and urge incontinence, as it helps to relax the bladder muscles. This means you will have more time to reach the bathroom when you feel the urge to go.

How it works

First, your doctor will numb your bladder with a special liquid so you don’t feel pain. Then, they will gently insert a thin tube with a small camera (cystoscope) through your urethra (the tube where urine comes out) and into your bladder. Using this, they will inject small amounts of botulinum toxin into the bladder wall.

Is this treatment right for you?

Your doctor will talk to you about if this treatment is right for you and explain possible side effects. Some people may have urinary tract infections (UTIs), trouble emptying their bladder, or need repeat treatments because the effects wear off over time.

The procedure is done with local anaesthesia, so you’ll be awake but won’t feel pain in your bladder.

Questions to ask your doctor

Here are some helpful questions to ask your doctor about botulinum toxin injections. 

These questions can help you understand the treatment better, so you can decide with your doctor if it is right for you.

• Is botulinum toxin the right treatment for me?
• How do the injections help with urinary incontinence?
• What side effects should I watch out for?
• How long will the treatment work before I need more injections?
• Are there any risks I should know about?
• How many injections will I need, and how often?
• What should I do before the procedure?
• Will the injections hurt, and what kind of numbing will be used?
• Are there other treatment options for my condition?
• How soon will I see results after the injections?

Cystoplasty

If other treatments haven’t helped with your urinary incontinence, your doctor might suggest a cystoplasty (bladder enlargement). In this surgery, part of your bowel is used to make your bladder bigger. This helps the bladder hold more urine and lowers the pressure when you urinate.

This surgery has some risks. One is that your bladder might not empty fully, and you may need a catheter to drain the leftover urine. There’s also a chance of scar tissue forming where the bowel tissue is attached, which could cause a blockage in the bladder.

A catheter is a small tube that is put into your body to help drain urine from your bladder. It’s used when you can’t empty your bladder on your own. The catheter can be put in through the tube where urine normally comes out, or through a small opening in the stomach area.

Questions to ask your doctor

Here are some simple questions to ask your doctor about cystoplasty for urinary incontinence:

• Is cystoplasty the right choice for me?
• How will this surgery help with my urinary incontinence?
• What risks or problems can come with this surgery?
• How long does the surgery take, and how long will it take to recover?
• Will I need to use a catheter after the surgery?
• How will my bladder work after the surgery?
• Are there other treatment options I should think about?
• What do I need to do to get ready for the surgery?
• What kind of anaesthesia will be used during the surgery?
• What can I expect while I recover?
• How long will it take to feel better after the surgery?
• Will I need more treatments later on?

These questions can help you understand the surgery and what to expect.

Urinary diversion

Urinary diversion is a big surgery that is only done when all other treatment options are not possible or have not worked. It involves removing the bladder and creating a new way for urine to leave the body using a piece of the intestine.

There are two main types:

• Stoma with a urine bag – In this option, urine leaves the body through a small opening in the belly called a stoma. A soft bag is placed over the stoma to collect urine. The bag is worn under clothing, and your doctor will show you how to care for it and empty it. This is a permanent change.

This video shows how a stoma bag is changed.

• New bladder (neobladder) – In some cases, a new bladder is made from part of the intestine, so that urine can pass through the body more naturally, but it will feel different. You may need to use a catheter to empty your bladder and wear pads while you learn to hold in urine and go to the toilet normally again.

  This surgery is done under general anaesthesia, meaning you’ll be asleep and won’t feel anything. It can be done with a large cut in the belly (open surgery) or with smaller cuts using special tools (keyhole or robotic surgery).

  This surgery is only done at specialised hospitals by doctors who are experts in this type of procedure.

  This is a big surgery, so your doctor will explain the possible long-term effects, like needing a catheter or urine bag permanently. It may take time to get used to these changes, but support will be available to help you.

Questions to ask your doctor

If you are thinking about urinary diversion, here are some important questions to ask your doctor:

• Do I really need urinary diversion, or are there other options?
• What are the benefits and risks of this surgery?
• How will this surgery change my daily life?
• What type of surgery is best for me? 
• How is the surgery done, and how long does it take?
• How long will I need to stay in the hospital?
• How long will it take to recover?
• How will I go to the bathroom after surgery?
• Will I need to use a urine bag or a catheter forever?
• How do I take care of a stoma or a new bladder?
• Can I still work, travel, and exercise?
• What problems could happen after surgery?
• What help can I get to make this change easier?

This chapter contains general information about treatment options for urge urinary incontinence. If you have any specific questions about your own medical situation you should consult your doctor or other professional healthcare provider. No website or leaflet can replace a personal conversation with your doctor.

Last updated: February 2025