Anticholinergic vs. Botox Comparison Study

Inclusion Criteria: * Subject has signed informed consent. * Females at least 21 years of age * Five or more urge urinary incontinence episodes on a three-day voiding diary. Urge incontinence episodes will be determined based on voiding diary and subject indication of coincident urge symptoms, allowing self-characterization of incontinence type. * Urge predominant (urge \>50% of total incontinent episodes) urinary incontinence based on self-reported characterization of incontinent episodes on diary. * Demonstrated ability (or have caregiver demonstrate ability) to perform clean intermittent self-catheterization in the event that this would be required. * Request for treatment for urge urinary incontinence. The patient may have tried other non-pharmacologic treatments for urge incontinence, such as supervised behavioral therapy, supervised physical therapy, unsupervised physical therapy, supervised biofeedback, and transvaginal electrical stimulation. * Subject has undergone 3-week washout period if subject were on anticholinergic therapy prior to enrollment. * Subject is able to complete all study related items and interviews. Exclusion Criteria: * Any previous therapy with trospium chloride, solifenacin, or darifenacin * Failed three or more anticholinergic drugs. * Contraindication to anticholinergic therapy, specifically with solifenacin or trospium. * Current symptomatic urinary tract infection that has not resolved prior to randomization. * Uncontrolled narrow-angle glaucoma * Gastric retention * Baseline need for intermittent self catheterization * PVR \>150ml on 2 occasions with void(s) of greater than 150ml * Surgical treatment for stress incontinence (sling, Burch or urethral injection) or pelvic organ prolapse recommended or planned at enrollment by study investigator(s). * Any prior intra-detrusor botulinum toxin A injections * Previous or currently implanted neuromodulation (sacral or tibial). * Surgically altered detrusor muscle, such as augmentation cystoplasty. * Known allergy to botulinum toxin A. * Women with known neurologic disease believed to potentially affect urinary function (Multiple sclerosis, spinal cord injuries, myasthenia gravis, Charcot-Marie-Tooth disease). * Known allergy to lidocaine. * Currently pregnant or lactating patients or patients planning pregnancy within the next year. * Sexually active premenopausal women with a uterus who have either not had a tubal ligation or are not on a medically approved form of contraception for at least 3 months prior to and throughout the duration of the study. * Cystoscopic findings that preclude injection, in the opinion of the investigator. * Current or prior bladder malignancy. * In the opinion of the investigator, inability to understand diary instructions and complete 3-day voiding diary. * Subjects who are on anticoagulant therapy,excluding aspirin * Subject has been previously diagnosed with interstitial cystitis or chronic pelvic pain syndrome. * Subjects with hematuria who have not undergone a clinically appropriate evaluation. * Subjects taking aminoglycosides at the time of injection. * Serum creatinine level greater than twice the upper limit of normal within the previous year. * Two or more hospitalizations for medical conditions in the previous year. * Plans to move out of area in the next 6 months.