What are the over-the-counter (OTC) remedies for overactive bladder (OAB)?

From the Guidelines

Behavioral therapies, such as fluid management, caffeine reduction, physical activity/exercise, dietary modifications, and mindfulness, should be offered to all patients with overactive bladder (OAB) as they offer excellent safety and few adverse effects, as recommended by the AUA/SUFU guideline on the diagnosis and treatment of idiopathic overactive bladder 1. When considering over-the-counter remedies for overactive bladder, it is essential to prioritize approaches that reduce morbidity, mortality, and improve quality of life. Some key points to consider include:

• Limiting bladder irritants such as caffeine, alcohol, spicy foods, and artificial sweeteners can help reduce symptoms.
• Timed voiding (urinating on a schedule rather than waiting until urgency occurs) and double voiding (urinating, waiting a few minutes, then trying again) may also provide relief.
• Bladder training techniques, pelvic floor exercises, and dietary modifications are other non-prescription options that can help manage OAB symptoms.
• Antimuscarinics like Oxytrol (oxybutynin transdermal patch) are available without prescription for women, but it is crucial to weigh the benefits and risks, considering the potential side effects such as dry mouth, constipation, and skin irritation at the application site. The AUA/SUFU guideline emphasizes the importance of shared decision-making to select the best therapy or therapies, regardless of invasiveness, based on the patient’s needs, desires, and side effect tolerance 1. For persistent or severe symptoms, consulting a healthcare provider is recommended as prescription medications or other treatments may be necessary 1. It is also important to note that the diagnosis of OAB should be made after a thorough evaluation, including a physical exam and urinalysis, and that telemedicine can be a viable option for patients with OAB, but may not allow for all elements of the initial in-office evaluation 1. Ultimately, the goal of treatment is to maximize symptom control and quality of life, while minimizing adverse events and burden of disease, as stated in the purpose of the AUA/SUFU guideline on the diagnosis and treatment of idiopathic overactive bladder 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Overactive Bladder Over-the-Counter Remedies

• Overactive bladder (OAB) is a common chronic condition that can be treated with various remedies, including lifestyle modifications and behavioural interventions 2.
• Behavioural interventions, such as bladder training, pelvic floor muscle (PFM) exercises, and multicomponent behavioural training, can be effective in improving symptoms of OAB and urgency urinary incontinence (UUI) 2, 3, 4.
• Bladder training, which involves a progressive voiding schedule together with relaxation and distraction for urgency suppression, may be more effective than anticholinergics in curing or improving OAB symptoms, with fewer adverse events 3.
• Pelvic floor muscle training (PFMT) may also be effective in reducing OAB symptoms, particularly in women, although the evidence is limited and more high-quality studies are needed to confirm its effectiveness 4, 5, 6.
• Lifestyle modifications, such as eliminating bladder irritants from the diet, managing fluid intake, weight control, and smoking cessation, can also help improve symptoms of OAB 2.

Treatment Options

• Bladder training versus no treatment: may cure or improve OAB symptoms, with low-certainty evidence 3.
• Bladder training versus anticholinergics: may be more effective in curing or improving OAB symptoms, with low-certainty evidence 3.
• Bladder training versus PFMT: may have no difference in efficacy or safety, with very low-certainty evidence 3.
• PFMT versus inactive control or usual care: may reduce OAB symptoms, particularly in women, although the evidence is limited and more high-quality studies are needed to confirm its effectiveness 6.

Limitations and Future Research

• Most studies on bladder training and PFMT have low or very low-certainty evidence, and more well-designed trials are needed to reach a firm conclusion 3, 6.
• There is a need for high-quality, randomized controlled trials on the effect of PFMT on the inhibition of detrusor contraction in human beings 5.
• The efficacy of PFMT in combination with other treatments, such as pharmacotherapy, also requires investigation 5.