Other treatments

After six weeks of bladder training NICE advises trying drug treatment if the patient has not experienced satisfactory improvement. 

Anticholinergics are commonly used and are currently POM, although it has been proposed that pharmacists could safely supply them OTC for overactive bladder. Oxybutynin has been supplied this way in some countries. Examples include oxybutynin, tolterodine and solifenacin. 

When dispensing one of these medicines NICE recommends an explanation is given to patients that side-effects of dry mouth and constipation indicate that the medicine is working. Of course, constipation can contribute to, or worsen, urinary incontinence and patients need a strategy to deal with that if it turns out to be a problem. Duloxetine and mirabegron are alternative treatments.  

Intravaginal oestrogens: These can help to relieve bladder symptoms in postmenopausal women with vaginal atrophy. Complementary therapies: NICE advises against their use here.

References & further information

• NICE Guideline NG123 (2019) Urinary incontinence and pelvic organ prolapse in women: management [NG123]
• Clinical Knowledge Summaries (CKS): Incontinence – urinary, in women
• NHS Health A-Z, Urinary incontinence.