How do you manage bladder irritability?

From the Guidelines

Managing bladder irritability requires a multifaceted approach that includes behavioral modifications, lifestyle changes, and potentially medication, with the goal of reducing symptoms and improving quality of life. The most recent and highest quality study, 1, suggests that modifying certain behaviors can improve symptoms in some patients. This includes altering fluid intake, avoiding certain foods known to be common bladder irritants, and using techniques such as heat or cold application over the bladder or perineum.

Some key strategies for managing bladder irritability include:

• Modifying fluid intake to avoid excessive urine concentration or volume
• Avoiding bladder irritants such as caffeine, alcohol, and spicy foods
• Implementing timed voiding to retrain the bladder
• Practicing pelvic floor muscle relaxation and bladder training with urge suppression
• Managing stress and anxiety through techniques such as meditation or imagery

In terms of medication, antimuscarinics like oxybutynin or solifenacin can reduce bladder contractions, while mirabegron works through a different mechanism with fewer dry mouth side effects, as noted in 1 and 1. However, the choice of medication should be based on tolerability, adverse effect profile, ease of use, and cost, with consideration of the patient's individual characteristics and symptoms.

The most effective approach will likely involve a combination of these strategies, tailored to the individual patient's needs and symptoms, with regular follow-up and adjustment as needed to optimize outcomes and improve quality of life. It is essential to consult a healthcare provider if symptoms persist despite these measures, as bladder irritability may indicate underlying conditions requiring specific treatment.

From the FDA Drug Label

The co-primary efficacy endpoints in all 3 trials were (1) change from baseline to end of treatment (Week 12) in mean number of incontinence episodes per 24 hours and (2) change from baseline to end of treatment (Week 12) in mean number of micturitions per 24 hours, based on a 3-day micturition diary An important secondary endpoint was the change from baseline to end of treatment (Week 12) in mean volume voided per micturition.

Managing bladder irritability can be achieved with mirabegron, as it has been shown to be effective in treating the symptoms of overactive bladder (OAB), including urge urinary incontinence, urgency, and urinary frequency.

• The medication has been evaluated in three 12-week clinical trials, which demonstrated its efficacy in reducing the number of incontinence episodes and micturitions per 24 hours.
• Mirabegron also increased the mean volume voided per micturition, indicating an improvement in bladder function.
• The recommended dose of mirabegron is 25 mg or 50 mg once daily, and it should be administered with caution to patients taking muscarinic antagonist medications for the treatment of OAB and in patients with clinically significant bladder outflow obstruction (BOO) due to the risk of urinary retention 2.

From the Research

Managing Bladder Irritability

To manage bladder irritability, several strategies can be employed, including lifestyle modifications and behavioural interventions.

• Behavioural interventions are effective treatments for overactive bladder (OAB) and urgency urinary incontinence (UUI) 3.
• These interventions include patient education on healthy bladder habits, lifestyle modifications such as 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 3.
• Specific training techniques aimed at re-establishing normal voiding intervals and continence, such as bladder training and multicomponent behavioural training, can also be effective 3.

Pharmacological Interventions

In addition to lifestyle modifications and behavioural interventions, pharmacological interventions can also be used to manage bladder irritability.

• Antimuscarinics, such as tolterodine and oxybutynin, can be effective in reducing symptoms of OAB 4.
• β3-adrenoreceptor agonists, such as mirabegron, can also be effective in reducing symptoms of OAB, with a good safety profile 5, 6.
• Combination therapy, such as mirabegron plus solifenacin, can provide effective and well-tolerated treatment for patients with OAB 5.
• Mirabegron add-on therapy to tamsulosin can also be effective in improving OAB symptoms in men with lower urinary tract symptoms (LUTS) 7.

Key Considerations

When managing bladder irritability, it is essential to consider the individual patient's needs and circumstances.

• A comprehensive treatment plan should be developed, taking into account the patient's medical history, lifestyle, and preferences 3.
• Patient education and support are crucial in helping patients manage their bladder irritability and improve their quality of life 3.