Urge urinary incontinence
Involuntary urine leakage following a sudden strong urge. Patients cannot reach the toilet in time. More common in perimenopausal women and older adults of both sexes. Diagnosis requires bladder ultrasound with post-void residual, urinalysis and a voiding diary of at least 3 days.
ICD-10 N39.44 drugs
Also known as: Urgency urinary incontinence, Urge incontinence
Drugs used for this condition
- BFesoterodineSecond line · Muscarinic receptor antagonist for overactive bladderAEMPS approves fesoterodine for urge urinary incontinence in adults after behavioural therapy fails. The EIGHT trial (Chapple 2014, NEJM) showed fesoterodine 8 mg outperforms tolterodine 4 mg on daily incontinence episodes, but the gain is modest (around 0.5 episodes). Dry mouth reaches 28–35%, which drives 30–40% of patients to stop therapy within 6 months (Sears AUA 2020).
- BSolifenacinSecond line · Antimuscarinic for overactive bladderAEMPS approves solifenacin for urge urinary incontinence in adults after behavioural therapy fails. Cochrane 2012 pooled antimuscarinic data: they reduce incontinence episodes by 1–3 per day vs placebo. AEU 2023 prefers solifenacin in patients aged 18–65 with intact cognitive function due to M3 selectivity and tolerability.
- BTolterodineSecond line · Muscarinic receptor antagonist for overactive bladderAEMPS approves tolterodine for urge urinary incontinence in adults after behavioural therapy fails. Cochrane 2012 (CD003781) pooled antimuscarinic data: they reduce incontinence episodes by 1–3 per day vs placebo, NNT around 8. Dry mouth 20–30%, and around 35–40% of patients stop therapy at 6 months due to side effects.
- BTrospiumSecond line · Quaternary ammonium muscarinic blocker for overactive bladderAEMPS approves trospium for urge urinary incontinence in adults after behavioural therapy fails. The Madhuvrata meta-analysis (Cochrane 2012) showed trospium efficacy comparable to tertiary antimuscarinics with fewer cognitive side effects. In older patients with cognitive impairment (mild cognitive impairment, early dementia), AEU 2023 and AGS Beers 2023 position trospium as the muscarinic blocker of choice due to minimal blood-brain barrier penetration.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit