From the Guidelines
Treatments for overactive bladder should start with behavioral therapies, such as fluid management, caffeine reduction, physical activity/exercise, dietary modifications, and mindfulness, as recommended by the AUA/SUFU guideline 1.
Overview of Treatment Options
The treatment of overactive bladder (OAB) involves a range of approaches, from lifestyle modifications to medications and procedures. The goal is to manage symptoms effectively while minimizing adverse effects and improving the patient's quality of life.
Behavioral Therapies
- Bladder training: This involves gradually increasing the intervals between voiding to improve bladder capacity and reduce frequency.
- Pelvic floor exercises (Kegels): Strengthening the pelvic floor muscles can help control urination.
- Fluid management: Adjusting fluid intake to avoid excessive urine production.
- Dietary modifications: Avoiding irritants like caffeine, alcohol, and spicy foods.
Medication Options
If behavioral therapies are insufficient, medication can be considered:
- Anticholinergics: Such as oxybutynin, tolterodine, solifenacin, and darifenacin.
- Beta-3 agonists: Like mirabegron, which has fewer side effects compared to anticholinergics.
Advanced Treatment Options
For patients not responding to medications:
- Botox injections into the bladder: To reduce muscle contractions.
- Nerve stimulation therapy (InterStim): To block nerve signals triggering urgency.
- Percutaneous tibial nerve stimulation (PTNS): A minimally invasive procedure to stimulate the tibial nerve.
Importance of Shared Decision-Making
The choice of treatment should be based on shared decision-making between the clinician and the patient, considering evidence-based recommendations, patient values, and preferences 1. This approach ensures that the treatment plan is personalized and aims to maximize symptom control while minimizing adverse events and burden of disease.
Recent Guidelines
Recent guidelines from the AUA/SUFU emphasize the importance of offering behavioral therapies to all patients with OAB as a first-line treatment, given their efficacy, safety, and minimal side effects 1. The guidelines also support the use of pharmacologic therapies, minimally invasive therapies, and, in some cases, invasive therapies, depending on the patient's response to initial treatments and their individual preferences and needs.
From the FDA Drug Label
1 INDICATIONS AND USAGE
1.1 Adult Overactive Bladder (OAB) Mirabegron Monotherapy Mirabegron extended-release tablets are indicated for the treatment of OAB in adult patients with symptoms of urge urinary incontinence, urgency, and urinary frequency.
14 CLINICAL STUDIES
- 1 Mirabegron Monotherapy for Adult OAB Mirabegron was evaluated in three, 12-week, double-blind, randomized, placebo-controlled, parallel group, multicenter clinical trials in patients with overactive bladder with symptoms of urge urinary incontinence, urgency, and urinary frequency (Studies 1,2, and 3)
Possible treatments for overactive bladder include:
- Mirabegron extended-release tablets, which are indicated for the treatment of OAB in adult patients with symptoms of urge urinary incontinence, urgency, and urinary frequency 2, 2.
- The efficacy of mirabegron was demonstrated in three 12-week clinical trials, which showed significant improvements in incontinence episodes, micturition frequency, and volume voided per micturition compared to placebo 2.
From the Research
Possible Treatments for Overactive Bladder
- Behavioural interventions, including lifestyle modifications, are effective treatments for overactive bladder (OAB) and urgency urinary incontinence (UUI) 3
- These interventions include:
- Patient education on healthy bladder habits
- Establishment of normal voiding intervals
- Elimination of bladder irritants from the diet
- Management of fluid intake
- Weight control
- Management of bowel regularity
- Smoking cessation
- Specific training techniques, such as bladder training and multicomponent behavioural training, can also be effective in treating OAB and UUI 3
- Pharmacological options, such as mirabegron, tolterodine, and oxybutynin, have been shown to be effective in treating OAB symptoms 4, 5, 6, 7
- Mirabegron, in particular, has been shown to be well-tolerated and effective in treating OAB symptoms, with significant improvements in micturition frequency, urgency incontinence, and mean volume voided/micturition 4, 6, 7
- Other treatment options, such as botulinum toxin-A (BTX-A) injections and nerve stimulation, may also be effective in treating OAB, although more research is needed to fully understand their efficacy and safety 6
- Combination therapy, such as the addition of mirabegron to an α1-blocker, may also be effective in treating OAB symptoms in men 6