What are the treatment options for Overactive Bladder (OAB)?

From the Guidelines

Overactive bladder treatment should begin with lifestyle modifications, including behavioral therapies, before progressing to medications and more advanced therapies, as recommended by the most recent guidelines 1. The treatment options for Overactive Bladder (OAB) can be categorized into several groups, including:

• Behavioral therapies: actions that patients with OAB can perform at home to directly address and improve their OAB symptoms, such as timed voiding, urgency suppression, fluid management, and bladder irritant avoidance 1.
• Pharmacologic therapies: prescription medications that are taken to directly treat bladder symptoms, including beta-3 agonists and antimuscarinic medications 1.
• Minimally invasive therapies: treatments that are procedural or surgical but with low risk of complication or adverse events, such as botulinum toxin injection of the bladder, sacral neuromodulation, and percutaneous tibial nerve stimulation 1. Some key points to consider when treating OAB include:
• The importance of shared decision-making to select the best therapy or therapies, regardless of invasiveness, based on the patient’s needs, desires, and side effect tolerance 1.
• The need for a thorough evaluation, including urinalysis and physical examination, to rule out other potential causes of symptoms 1.
• The potential benefits and limitations of each treatment option, including the risk of adverse events and the need for repeated treatments or interventions 1. Overall, the goal of treatment for OAB is to maximize symptom control and quality of life, while minimizing adverse events and burden of disease 1. The most effective treatment approach will depend on the individual patient’s needs and circumstances, and may involve a combination of lifestyle modifications, medications, and more advanced therapies 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.

Treatment Options for Overactive Bladder (OAB):

• Mirabegron monotherapy
• Dosage: 25 mg orally once daily, increasing to 50 mg orally once daily after 4 to 8 weeks if needed 2 2 2

From the Research

Treatment Options for Overactive Bladder (OAB)

The treatment options for Overactive Bladder (OAB) can be categorized into several approaches, including:

• Behavioral therapies:
  • Lifestyle modifications, such as weight reduction, decrease in exposure to bladder stimulants, and fluid optimization 3
  • Pelvic floor exercises, including pelvic floor muscle rehabilitation and training 4
  • Bladder training and dietary modification 4
• Pharmacologic therapies:
  • Antimuscarinic agents, such as oxybutynin, which can help reduce symptoms of OAB 5, 3
  • Newer agents that are more bladder selective, which may have fewer side effects 5
• Alternative therapies:
  • Neuromodulation, including sacral nerve stimulation and peripheral neuromodulation of the posterior tibial nerve 6, 7
  • Intravesical botulinum toxin A injections, which can help reduce detrusor activity 6, 7
  • Augmentation cystoplasty, a surgical procedure to increase bladder capacity 5, 6
• Surgical interventions:
  • Urinary diversion, a surgical procedure to redirect the flow of urine 6

First-Line and Second-Line Treatments

First-line treatments for OAB typically include lifestyle modifications, pelvic floor exercises, and pharmacologic therapies 6, 3. Second-line treatments, which are considered for patients who do not respond to first-line treatments, may include more invasive procedures such as neuromodulation, intravesical botulinum toxin A injections, and surgical interventions 6, 7.

Considerations for Treatment

The choice of treatment for OAB depends on various factors, including the severity of symptoms, patient preferences, and the presence of underlying medical conditions 5. It is essential to educate patients about the functioning of the lower urinary tract system, fluid and dietary management, and the importance of keeping a micturition chart or bladder diary 5. Additionally, patients who do not respond to initial treatments may require a review by a urology specialist to determine the best course of treatment 3.