What is the treatment for overactive bladder?

From the Guidelines

Treatment for overactive bladder should begin with behavioral modifications, including bladder training, scheduled voiding, pelvic floor exercises, and lifestyle changes, as recommended by the most recent guidelines 1. The goal of these modifications is to reduce symptoms of urinary urgency, frequency, and potential incontinence, thereby improving the patient's quality of life.

• Behavioral therapies, such as fluid management, caffeine reduction, physical activity, dietary modifications, and mindfulness, offer patients with overactive bladder some efficacy, excellent safety, and few adverse effects 1.
• If behavioral modifications are insufficient, anticholinergic medications such as oxybutynin, solifenacin, tolterodine, or trospium, or beta-3 agonists like mirabegron, can be considered as the next line of treatment 1.
• For patients who do not respond to medications, more advanced options, including botulinum toxin injections, sacral neuromodulation, or percutaneous tibial nerve stimulation, can be offered, as these treatments have been associated with high success rates and durable efficacy 1.
• The treatment approach should be individualized, taking into account the patient's needs, desires, and side effect tolerance, and may involve a combination of therapies from different categories, as emphasized in the latest guidelines 1. Key considerations in the treatment of overactive bladder include:
• Reducing involuntary bladder muscle contractions or normalizing nerve signals between the bladder and brain
• Addressing underlying causes of urinary urgency, frequency, and potential incontinence
• Improving the patient's quality of life by reducing symptoms and minimizing adverse events
• Encouraging patient participation in the treatment decision-making process through shared decision-making 1.

From the FDA Drug Label

Mirabegron extended-release tablets are a beta-3 adrenergic agonist indicated for the treatment of: Overactive bladder (OAB) in adult patients with symptoms of urge urinary incontinence, urgency, and urinary frequency. The recommended starting dose of mirabegron extended-release tablets is 25 mg orally once daily. After 4 to 8 weeks, the mirabegron extended-release tablets dose may be increased to 50 mg orally once daily.

The treatment for overactive bladder is mirabegron extended-release tablets, with a recommended starting dose of 25 mg orally once daily, which may be increased to 50 mg orally once daily after 4 to 8 weeks 2.

• Key points:
  • Indication: Overactive bladder (OAB) in adult patients with symptoms of urge urinary incontinence, urgency, and urinary frequency
  • Dosage: 25 mg orally once daily, increased to 50 mg orally once daily after 4 to 8 weeks if needed
  • Administration: Swallow mirabegron extended-release tablets whole with water, do not chew, divide, or crush, take with or without food 2.

From the Research

Treatment Options for Overactive Bladder

The treatment for overactive bladder (OAB) typically involves a combination of lifestyle modifications, behavioral therapies, and pharmacological interventions.

• Lifestyle modifications:
  • Weight reduction 3
  • Decrease in exposure to bladder stimulants 3
  • Fluid optimization 3, 4
  • Pelvic floor exercises 5, 3
  • Caffeine reduction 4
• Behavioral therapies:
  • Bladder training regimens 5
  • Timed or prophylactic voiding 5
  • Keeping of micturition charts or bladder diaries 5
• Pharmacological interventions:
  • Antimuscarinic agents 5, 6, 3, 7
  • Beta-3 adrenoceptor agonists (e.g. mirabegron) 6, 7
  • Onabotulinumtoxin-A (Onabot-A) bladder injections 7
• Other treatment options:
  • Sacral nerve stimulation (SNS) 7
  • Posterior tibial nerve stimulation 7
  • Neuromodulation and augmentation cystoplasty for patients who do not respond to initial treatments 5

Effectiveness of Treatment Options

The effectiveness of these treatment options may vary depending on individual patient factors.

• Antimuscarinics and beta-3 agonists have been shown to be effective in reducing OAB symptoms, but may have adverse effects such as dry mouth, constipation, and blurred vision 5, 6, 7
• Onabot-A bladder injections and SNS have been shown to be effective in reducing OAB symptoms, but may have adverse effects such as acute urinary retention and urinary tract infections 7
• Lifestyle modifications and behavioral therapies may be effective in reducing OAB symptoms and improving quality of life, but may require long-term commitment and adherence 5, 3, 4