TReating Incontinence for Underlying Mental and Physical Health

Inclusion Criteria:

• Aged 60 years or older at the time of enrollment

• Female sex at birth, without surgical or hormonal gender re-assignment therapy

• Able to walk to the bathroom and use the toilet without assistance

• Report urinary incontinence starting at least 3 months prior to screening

• Report that at least half of incontinence episodes occur with a sudden or strongsensation of urgency

• Report 2 or more urgency incontinence episodes over a 7-day period

• Willing to provide informed consent and adhere to study procedures throughout thelength of the study

Exclusion Criteria:

• Prior clinician diagnosis of dementia, or a Montreal Cognitive Assessment (MOCA)score of 17 or lower on screening cognitive evaluation

• Current use of anticholinergic, beta-3-adrenergic agonist, or other medicationdesigned to improve urgency incontinence symptoms, or use in the past 1 month

• Initiation, discontinuation, or dose change of dementia medications (such asdonepezil, galantamine, memantine, rivastigmine) in the past 1 month (but candidateson stable doses are eligible)

• Initiation, discontinuation, or dose change of other drugs with stronganticholinergic effects (based on the Beers List) in the past 1 month (butcandidates on stable doses are eligible)

• Initiation, discontinuation, or dose change of other drugs that can affect urinaryfrequency, including diuretics, in the past 1 month (but candidates on stable dosesare eligible)

• Current urinary tract infection (UTI) based on screening urinalysis and culture (butcandidates can re-present for re-screening after undergoing treatment for UTI)

• History of allergy or sensitivity to either of the study medications or aningredient in the placebo or study medication capsule

• Severe hepatic impairment (Child-Pugh score B or greater) or renal impairment (creatinine clearance <30 mL/min) as a contraindication to both study medications

• Current bladder obstruction or urinary retention (defined by symptoms suggestingdifficulty emptying the bladder in addition to postvoid residual urine volumegreater than 150 cc by portable bladder ultrasound)

• Uncontrolled hypertension (based on measured systolic blood pressure greater than 180 or diastolic blood pressure greater than 110 mmHg) as a contraindication tobeta-3-adrenergic therapy

• Self-reported history of gastric retention, uncontrolled narrow angle glaucoma,myasthenia gravis, severe ulcerative colitis, or toxic megacolon ascontraindications for anticholinergic bladder therapy

• Use of drugs with adverse interactions with one of the study medications in the past 1 month, including potent CYP3A4 inhibitors, hepatic enzyme metabolism inducers,narrow therapeutic index drugs metabolized by CYP2D6, or intention to start takingone of these medications during the study treatment period

• History of bladder surgery, invasive intra-vesical therapy, or bulk bladderinjections in the past 3 months (more remote surgery will not be exclusionary), orintention to undergo one of these procedures in the study treatment period

• Use of other specialized incontinence therapy (electrostimulation, pelvicphysiotherapy, formal behavioral therapy overseen by certified practitioners) in thepast 3 months (more remote therapy will not be exclusionary), or intention toundergo one of these procedures in the study treatment period

• Inability to sign informed consent or complete questionnaires, interviews, or studytesting in English

• Other condition that would prevent the participant from completing study procedures,in the opinion of the investigators (e.g., uncontrolled psychosis)