If bladder training on its own does not work, or if it works only partly and you still have to pass urine too often, you may be offered a drug to help with this.
Before you start taking drugs for overactive bladder, your healthcare professional should explain how likely they are to work and that you might need to take them for 4 weeks before you see their full effect. They should discuss the possible side effects with you and explain that some side effects (such as a dry mouth and constipation) may show that the treatment is starting to have an effect. They should also talk with you about how often you will need to take the drugs and how they should be taken. Your choice of drugs will depend on any other health problems you may have, any other drugs you are taking and the likelihood of side effects.
If you have overactive bladder or mixed urinary incontinence (a mixture of stress and urgency symptoms), you should be offered a choice of drugs. If the first drug you try has too many unwanted side effects, your healthcare professional may offer you a different drug.
If you can't swallow medicines, your healthcare professional might offer you a patch of medication for overactive bladder to put on your skin.
If the drug you are taking is working and the side effects are not bothering you too much, your healthcare professional should not change your treatment.
You should be invited to a face-to-face or telephone appointment with your healthcare professional 4 weeks after the start of each new drug treatment to see how the treatment is working. If it is working well you should continue the treatment. If it is not working well or side effects are causing you problems, your healthcare professional may change the dose or offer you another drug to try, and should then invite you to another appointment 4 weeks later.
You don't have to wait 4 weeks to see your healthcare professional if the side effects are giving you trouble.
You may be invited to another face-to-face or telephone appointment with your healthcare professional if the treatment is found to be working well at the 4-week appointment but then doesn't continue to relieve your symptoms.
If you continue drug treatment you should have an annual review of the treatment with your GP (or every 6 months if you are over 75).
If drug treatment does not work, your healthcare professional should discuss other possible treatments with you. If you are thinking about having an operation, you should be offered urodynamic tests (see Finding out what is wrong and Making decisions about treatment).
If you would like to have further treatment but do not want to try another drug, or if drug treatment is not successful, your doctor will refer you to a specialist.
Mirabegron is a possible treatment for the symptoms of overactive bladder in some people. See Other NICE guidance for details of our guidance on mirabegron.