From the Guidelines
Overactive bladder (OAB) should be managed with behavioral therapies as the first line of treatment, as recommended by the AUA/SUFU guideline on the diagnosis and treatment of idiopathic overactive bladder 1.
Treatment Approach
The treatment approach for OAB and bladder voiding (BV) issues should prioritize behavioral modifications, including:
- Scheduled voiding
- Fluid management
- Pelvic floor exercises These modifications can help improve symptoms and quality of life for patients with OAB.
Medications
If behavioral modifications are insufficient, medications such as:
- Anticholinergics (oxybutynin 5mg twice daily, solifenacin 5-10mg daily, or tolterodine 2-4mg daily)
- Beta-3 agonists (mirabegron 25-50mg daily) can be effective in reducing urgency, frequency, and urgency urinary incontinence, as supported by the AUA/SUFU guideline 1.
Bladder Voiding Problems
For bladder voiding problems, the approach depends on the underlying cause.
- Alpha-blockers like tamsulosin 0.4mg daily may help men with prostatic obstruction
- Intermittent catheterization might be necessary for those with neurological causes
Additional Considerations
Both conditions require proper hydration (1.5-2 liters daily) while avoiding bladder irritants like caffeine, alcohol, and spicy foods. Patients should expect gradual improvement over 4-6 weeks and should consult a healthcare provider if symptoms worsen or if they experience side effects like dry mouth, constipation, or urinary retention.
Combination Therapy
In patients with OAB whose symptoms do not adequately respond to monotherapy, combination therapy with behavioral therapy, non-invasive therapy, pharmacotherapy, and/or minimally invasive therapies may be considered, as suggested by the AUA/SUFU guideline 1.
From the Research
Overactive Bladder (OAB) and Bacterial Vaginosis (BV)
- OAB is a symptomatic diagnosis based on the presence of urgency, with or without urge incontinence, and usually accompanied by frequency and nocturia, in the absence of obvious pathologic or metabolic disease 2.
- The initial management of OAB requires an integrated approach using behavioral and pharmacologic methods, including patient education, fluid and dietary management, and pelvic floor exercises 2, 3.
- Pharmacological treatments for OAB include anticholinergic medications such as oxybutynin, but may have adverse effects such as dry mouth, constipation, and blurred vision 2, 3.
Bacterial Vaginosis (BV)
- BV is a common but treatable condition, with effective available treatments including oral and intravaginal metronidazole and clindamycin, and oral tinidazole 4, 5, 6.
- However, as many as 50% of women with BV experience recurrence within 1 year of treatment, due to factors such as persistence of residual infection, resistance, and reinfection 4.
- Alternative strategies for treating BV may include antimicrobial substances, probiotics, prebiotics, and acidifying agents, as well as new formulation strategies and drug delivery systems 6.