From the Guidelines
Overactive bladder (OAB) should be initially managed with behavioral therapies, including fluid management, bladder training, and pelvic floor exercises, as these offer excellent safety and few adverse effects, as recommended by the most recent guideline 1.
Key Considerations
- Behavioral therapies are recommended as first-line treatment for OAB due to their efficacy, safety, and minimal side effects 1.
- Lifestyle modifications such as limiting caffeine, alcohol, and spicy foods can help reduce symptoms.
- For patients who do not respond to behavioral therapies, medication options including anticholinergics and beta-3 agonists can be considered, with the choice of medication depending on patient-specific factors and potential side effects 1.
Treatment Options
- Behavioral therapies:
- Fluid management
- Bladder training
- Pelvic floor exercises
- Medications:
- Anticholinergics (e.g., oxybutynin, solifenacin, tolterodine)
- Beta-3 agonists (e.g., mirabegron)
- Advanced options for patients who do not respond to medications:
- Botox injections into the bladder
- Percutaneous tibial nerve stimulation
- Sacral neuromodulation
Monitoring and Adjustment
- Maintaining a bladder diary to track symptoms and triggers is helpful for monitoring treatment effectiveness.
- Treatment may need adjustment over time to maintain symptom control, and patient preferences and values should be taken into account when selecting treatment options 1.
From the FDA Drug Label
Mirabegron was evaluated in three, 12-week, double-blind, randomized, placebo-controlled, parallel group, multicenter clinical trials in patients with overactive bladder with symptoms of urge urinary incontinence, urgency, and urinary frequency (Studies 1,2, and 3) 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.
Mirabegron is used to treat overactive bladder in adult patients with symptoms of urge urinary incontinence, urgency, and urinary frequency. The recommended starting dose is 25 mg orally once daily, which can be increased to a maximum dose of 50 mg orally once daily after 4 to 8 weeks if needed 2, 2, 2.
From the Research
Definition and Impact of Overactive Bladder
- Overactive bladder (OAB) is a symptom-based syndrome characterized by the presence of urgency, which is defined as a sudden and compelling desire to void that cannot be postponed 3.
- OAB may significantly impact quality of life, and numerous treatment options exist, including behavioral therapies and traditional therapies such as pharmacological therapy and neuromodulation 3.
Treatment Options for Overactive Bladder
- Behavioral therapies, such as pelvic floor muscle rehabilitation, bladder training, and dietary modification, are considered the mainstay of treatment for urinary incontinence in general 3.
- Lifestyle modifications, including 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, are effective treatments for OAB and urgency urinary incontinence (UUI) 4.
- Pelvic floor muscle training, bladder training, and multicomponent behavioral training are specific training techniques aimed at re-establishing normal voiding intervals and continence 4.
Risk Factors and Management of Overactive Bladder
- Obesity, smoking, and consumption of carbonated drinks are risk factors for OAB, while there is less support for the contributory role of caffeine or the impact of caffeine reduction 3.
- Reducing fluid intake can improve OAB symptoms, with a general consensus that caffeine reduction may be beneficial 5.
- Management of fluid intake, including the types of fluids drank, the timing of fluid intake, and the effects of exercise and outside ambient temperature on OAB symptoms, requires further clinical trials 5.
Conservative Therapy for Overactive Bladder
- Conservative treatment with pelvic floor exercises, with or without biofeedback, electric stimulation, and behavioral modification, are excellent modalities that can be effective in the motivated patient 6.
- Pelvic floor exercises have been shown to be effective in the treatment of overactive bladder, and guidelines for patient selection are available 6.