Urinary incontinence is a common symptom in women, more so in older people, with a significant impact on physical health and wellbeing. About 1 in 5 people have impaired continence. Symptom categorization at initial assessment is the key to guiding further therapy. Non-pharmacological options (bladder training for 6 weeks with guidance from a trained physiotherapist) are preferred and can be supported with biofeedback. If unsuccessful, anticholinergics are added and, rarely, surgical options need consideration.
Anticholinergics are the mainstay of pharmacological management of urge incontinence. The National Institute of Health and Clinical Excellence (NICE) recommends immediate release oxybutynin as the first-line agent, with recourse to others if there are adverse effects. The pharmacology, efficacy and adverse effect profile of the various anticholinergic drugs is reviewed, allowing the reader to make an informed choice of appropriate anticholinergics for urge incontinence.