How do you treat bladder dysfunction?

From the Guidelines

Bladder dysfunction treatment should start with lifestyle modifications, including pelvic floor muscle training (PFMT) and bladder training, as these interventions are effective, have few adverse effects, and are cheaper than pharmacologic therapies 1.

Treatment Approach

The treatment approach for bladder dysfunction depends on the specific type and cause of the condition.

• For stress urinary incontinence, pelvic floor muscle training (PFMT) is recommended as a first-line treatment, with surgical interventions such as synthetic midurethral slings or autologous fascial slings considered for more severe cases 1.
• For overactive bladder, medications such as anticholinergics or beta-3 agonists can help reduce urgency and frequency, while bladder training and lifestyle modifications can also be effective 1.
• For urinary retention, alpha-blockers may improve outflow, while intermittent self-catheterization might be necessary in more severe cases.
• For neurogenic bladder, a combination approach is often needed, potentially including timed voiding, medications, and catheterization.

Lifestyle Modifications

Lifestyle modifications are an essential part of bladder dysfunction treatment.

• Reducing fluid intake before bedtime and limiting bladder irritants like caffeine and alcohol can help alleviate symptoms.
• Practicing pelvic floor exercises (Kegels) regularly can help strengthen the pelvic floor and improve control.
• Bladder training techniques, which involve scheduled voiding times to gradually increase the interval between urinations, can also be effective in improving bladder function.

Advanced Treatments

More advanced treatments, such as botulinum toxin injections into the bladder, nerve stimulation therapy, or surgical interventions, may be considered for refractory cases or for patients who have not responded to conservative management.

• These treatments work by either relaxing an overactive bladder muscle, strengthening the pelvic floor to improve control, or facilitating complete bladder emptying, depending on the specific dysfunction present.
• However, these treatments may have a higher risk of adverse effects and complications, and should be carefully considered and discussed with a healthcare professional 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. Oxybutynin chloride is indicated for the relief of symptoms of bladder instability associated with voiding in patients with uninhibited neurogenic or reflex neurogenic bladder (i.e., urgency, frequency, urinary leakage, urge incontinence, dysuria).

Treatment options for bladder dysfunction include:

• Mirabegron (PO) for adult Overactive Bladder (OAB) symptoms 2
• Oxybutynin (PO) for relief of symptoms of bladder instability associated with voiding in patients with uninhibited neurogenic or reflex neurogenic bladder 3

From the Research

Treatment Options for Bladder Dysfunction

Bladder dysfunction can be treated through various methods, including:

• Pharmacologic treatment, which is the mainstay in the management of bladder dysfunction, particularly for overactive bladder symptoms 4
• Lifestyle modifications and behavioural interventions, such as establishing normal voiding intervals, eliminating bladder irritants from the diet, managing fluid intake, weight control, and smoking cessation 5
• Minimally invasive lifestyle changes to major surgical interventions, depending on the severity of the condition and patient-reported nuisance or medical necessity 4

Medications for Bladder Dysfunction

Medications used to treat bladder dysfunction include:

• Antimuscarinics, which are the most commonly used medications for overactive bladder dysfunction 4, 6
• Beta agonists, phosphodiesterase inhibitors, tricyclic antidepressants, and the gamma aminobutyric acid (GABA)-B agonist baclofen, which can be added or substituted when antimuscarinics are not tolerated or ineffective 4
• Alpha adrenergic antagonists, which can be used for difficulty emptying 4

Alternative Therapies

Alternative therapies for bladder dysfunction include:

• Intravesical options, such as botulinum toxin, which works by decreasing the activity of the detrusor smooth muscle, thereby decreasing overactive bladder symptoms 4, 6
• Percutaneous nerve stimulation, which may also be used to treat overactive bladder symptoms 4
• Sacral neuromodulation, which is more invasive but has been successful in treating overactive bladder 6
• Emerging treatments, such as targeted secretion inhibitors, liposome integrated botulinum toxin A, and gene therapy, which appear promising 6

Comparison of Treatment Options

Comparing the effects of anticholinergic drugs with various non-pharmacologic therapies for non-neurogenic overactive bladder syndrome in adults, studies have found that:

• Anticholinergic drugs are more effective than bladder training alone in improving symptoms 7
• Combining anticholinergic drugs with bladder training may be more effective than anticholinergic drugs alone, but the evidence is limited 7
• Electrical stimulation modalities, such as percutaneous posterior tibial nerve stimulation, may be a better option for patients who are refractory to anticholinergic therapy 7