From the Guidelines
The treatment for urge urinary incontinence should begin with bladder training, as recommended by the American College of Physicians 1, and may include pharmacologic treatment with antimuscarinic medications or beta-3 agonists if bladder training is unsuccessful, as supported by the AUA/SUFU guideline 1.
Key Considerations
- Bladder training involves scheduled voiding times that gradually increase in intervals and is a first-line treatment for urge urinary incontinence.
- Pharmacologic treatment options include anticholinergics like oxybutynin, tolterodine, or solifenacin, as well as beta-3 adrenergic agonists like mirabegron, which have been shown to improve urinary urgency, frequency, and/or urgency urinary incontinence 1.
- The choice of pharmacologic agent should be based on tolerability, adverse effect profile, ease of use, and cost of medication, as recommended by the American College of Physicians 1.
Treatment Approach
- Patients should start with bladder training and may also benefit from pelvic floor muscle exercises (Kegels) performed 3 times daily with 10-15 repetitions each time.
- Fluid management is important, including limiting caffeine, alcohol, and evening fluid intake to help reduce symptoms.
- For patients who do not respond to medications, more advanced options may include botulinum toxin injections into the bladder, posterior tibial nerve stimulation, or sacral neuromodulation, which can help reduce involuntary bladder contractions that cause the sudden, intense urge to urinate.
Individualized Treatment
- Treatment should be individualized based on symptom severity, comorbidities, and patient preferences, with regular follow-up to assess effectiveness and adjust therapy as needed.
- The AUA/SUFU guideline recommends offering antimuscarinic medications or beta-3 agonists to patients with OAB to improve urinary urgency, frequency, and/or urgency urinary incontinence, with a strong recommendation and Grade A evidence level 1.
From the FDA Drug Label
Mirabegron extended-release tablets are indicated for the treatment of OAB in adult patients with symptoms of urge urinary incontinence, urgency, and urinary frequency. The recommended starting dosage of mirabegron extended-release tablets is 25 mg orally once daily. If needed, increase to the maximum dosage of mirabegron extended-release tablets 50 mg orally once daily after 4 to 8 weeks.
The treatment for urge urinary incontinence is mirabegron extended-release tablets, with a recommended starting dose of 25 mg orally once daily, which can be increased to a maximum dose of 50 mg orally once daily after 4 to 8 weeks, as indicated in the drug label 2.
- Key points:
- Mirabegron is used to treat overactive bladder (OAB) with symptoms of urge urinary incontinence, urgency, and urinary frequency.
- The recommended dosage is 25 mg orally once daily, with a possible increase to 50 mg orally once daily after 4 to 8 weeks.
- Tolterodine is also used to treat OAB with symptoms of urge urinary incontinence, urgency, and frequency, as shown in the drug label 3.
From the Research
Treatment Options for Urge Urinary Incontinence
The treatment for urge urinary incontinence typically involves a combination of behavioral modifications, lifestyle changes, and pharmacologic therapies.
- Behavioral interventions, such as bladder training and pelvic floor muscle exercises, are considered first-line treatments for urge incontinence 4, 5, 6.
- These interventions aim to improve symptoms by educating patients on healthy bladder habits, lifestyle modifications, and specific training techniques to re-establish normal voiding intervals and continence 5.
- Pharmacologic therapy with anticholinergic medications is another option for treating urge incontinence, although it is not recommended for older adults due to adverse effects 4, 7.
- Other medication options for urge incontinence include mirabegron and onabotulinumtoxinA 4.
- Neuromodulation devices, such as posterior tibial nerve stimulators, and sacral nerve stimulators are also available for treating urge incontinence that does not respond to behavioral therapy 4.
Lifestyle Modifications and Behavioral Interventions
Lifestyle modifications and behavioral interventions play a crucial role in the treatment of urge urinary incontinence.
- These interventions include patient education on healthy bladder habits, lifestyle modifications, and specific training techniques to re-establish normal voiding intervals and continence 5.
- Examples of lifestyle modifications include the establishment of normal voiding intervals, elimination of bladder irritants from the diet, management of fluid intake, weight control, management of bowel regularity, and smoking cessation 5.
- Behavioral interventions, such as bladder training and pelvic floor muscle exercises, have been shown to be effective in improving symptoms of urge incontinence 4, 5, 6.
Pharmacologic Therapies
Pharmacologic therapies are also available for the treatment of urge urinary incontinence.
- Anticholinergic medications are commonly used to treat urge incontinence, although they can have troublesome side-effects and are not recommended for older adults 4, 7.
- Other medication options, such as mirabegron and onabotulinumtoxinA, are also available for treating urge incontinence 4.
- The choice of pharmacologic therapy depends on the individual patient's needs and medical history, and should be guided by a healthcare professional 7.