Classified as stress, urge, overflow, or functional. Stress incontinence responds well to pelvic floor exercises (Kegels) or vaginal pessaries, with severe cases potentially requiring medications like duloxetine or surgical intervention. For urge incontinence, OTC transdermal anticholinergic patches can reduce bladder overactivity, while prescription options like oral anticholinergics, beta-3 adrenergic agonists, or Botox injections may help in more severe cases. Seek medical attention for red-flag symptoms or new-onset incontinence.
January 13, 2025

Urinary Incontinence: Best Evidence for At-Home Management

Evidence-Based Over-The-Counter Guide

William Shen

William Shen

Co-founder & CPO

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This guide is based on clinical guidelines from the American College of Physicians and 6th International Consultation on Incontinence.

Urinary incontinence is the involuntary leakage of urine. Warning: New-onset urinary incontinence, especially with red flags (pain, blood, organ prolapse, incontinence after surgery, or numbness/tingling) should seek medical attention immediately as it could be an early sign of serious nerve damage that needs to be addressed.

Chronic urinary incontinence can be classified into stress, urge, overflow, or mixed types:

  • Stress incontinence: occurs following any activity associated with increased intra-abdominal pressure (e.g., coughing, sneezing) caused by muscle weakness

  • Urge incontinence: sudden urge to urinate, resulting in involuntary leakage of urine. Can be caused by infections and neurologic disorders, so please see a doctor before beginning self-treatment.

  • Overflow incontinence: leakage of urine due to bladder overfilling. caused by bladder outlet obstruction, such as benign prostate hyperplasia in men. 

  • Functional incontinence: type of incontinence in which the patient has normal bladder and/or bowel function but cannot access and/or use the toilet in time

Lifestyle modifications include reducing caffeine and alcohol intake, managing weight, and maintaining a regular voiding schedule.

General supportive recommendations:

Stress Incontinence

Stress incontinence occurs when physical activity or exertion (e.g., coughing, sneezing, laughing) causes unintentional urine leakage due to weakened pelvic floor muscles or a weak urinary sphincter.

First-line recommendations:

Prescription medications & interventions:

  • Duloxetine: An SNRI that increases sphincter contractility during exertion.

Surgical interventions: Sling procedures or urethral bulking agents may be recommended for severe cases.

Urge Incontinence

Urge incontinence involves sudden, intense urges to urinate, followed by involuntary leakage. May be a symptom of an overactive bladder. First-line treatment is available over-the-counter.

First-line recommendations:

  • Transdermal Anticholinergics: Reduces bladder overactivity in urge incontinence. Available without a prescription as a patch. Dose: 1 transdermal system (delivering 3.9 mg per day) twice weekly (every 3–4 days). Oxytrol for Women Overactive Bladder Transdermal Patch (FDA N202211).

Prescription medication & interventions:

  • Oral Anticholinergics (e.g., oxybutynin, tolterodine): Reduce bladder muscle overactivity.

  • Beta-3 adrenergic agonists (e.g., mirabegron): Relaxes the bladder muscle to prevent involuntary contractions.

  • Botox: Injection of botulinum toxin at different points in the bladder wall.

Citation

Abrams P, Andersson KE, Apostolidis A, et al. 6th International Consultation on Incontinence. Recommendations of the International Scientific Committee: Evaluation and Treatment of Urinary Incontinence, Pelvic Organ Prolapse and Faecal Incontinence. Neurourol Urodyn. 2018; 37(7): p.2271-2272. doi: 10.1002/nau.23551

Qaseem, A., Dallas, P., Forciea, M. A., Starkey, M., Denberg, T. D., Shekelle, P., & Clinical Guidelines Committee of the American College of Physicians*. (2014). Nonsurgical management of urinary incontinence in women: a clinical practice guideline from the American College of Physicians. Annals of internal medicine, 161(6), 429-440.

Irwin GM. Urinary Incontinence. Primary Care: Clinics in Office Practice. 2019; 46(2): p.233-242. doi: 10.1016/j.pop.2019.02.004

What OTC evidence is reviewed?

  • For each condition, we performed a literature review to find a recent widely cited expert group guideline published in the leading specialty-specific peer-reviewed journal or top general medical journal.

  • Based on the recommendations in the publication, we identify recommended active ingredients and devices that are available over-the-counter per FDA regulations.

What evidence is prioritized?

Levels of evidence considered:

  • Tier 1 (Safe and Definitely Effective): Professional field consensus or multiple randomized controlled clinical trials showing the same conclusion. Wherever possible, we use Tier 1 evidence for "first-line" recommendations.

  • Tier 2 (Safe and Probably Effective): Individual clinical trials which may be discordant or large-scale observational experience. Tier 2 evidence may inform "first-line", "second-line", or "supplement" recommendations.

  • Tier 3 (Safe and Maybe Effective): Mechanistic plausibility without high-quality clinical evidence of efficacy but high-quality evidence of safety. Tier 3 evidence may inform "second-line" or "supplement" recommendations.

How does MDandMe select recommended products?

  • Based on the top clinical recommendation, we evaluate products containing the recommended active agent with FDA-approved dosage based on price, average customer reviews, how often it is purchased, and how quickly it will ship to home. 

  • We provide public documentation of the active ingredients in our recommendations, using all 32 FDA monographs, Prescription-to-Nonprescription (Rx-to-OTC) Switches, as well as New Drug Application (NDA) approvals.

How does MDandMe select recommended devices?

  • Based on the top clinical recommendation, we evaluate devices that are FDA-cleared or comply with other medical guidelines (if not a FDA-regulated category) by reputability, price, and average customer reviews.

  • We provide public documentation of supporting evidence for each device.  

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