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

From the Guidelines

Overactive bladder treatment should begin with lifestyle modifications, including reducing fluid intake, scheduling bathroom trips, and performing pelvic floor exercises, before progressing to medications and advanced therapies, as recommended by the most recent guidelines 1. The treatment of overactive bladder (OAB) is a stepwise approach that prioritizes the patient's quality of life and symptom severity.

• Lifestyle modifications are the first line of treatment, including:
  • Reducing fluid intake, especially caffeine and alcohol
  • Scheduling bathroom trips
  • Performing pelvic floor exercises (Kegels)
• If lifestyle modifications are insufficient, medications such as anticholinergic medications (e.g., oxybutynin, solifenacin, tolterodine) or beta-3 agonists (e.g., mirabegron) can be prescribed 1.
• For patients who do not respond to medications, more advanced options include:
  • Botox injections into the bladder (100-200 units, lasting 6-9 months)
  • Posterior tibial nerve stimulation (weekly 30-minute sessions for 12 weeks)
  • Sacral neuromodulation via an implanted device These treatments work by reducing inappropriate bladder muscle contractions or normalizing the neural signals between the bladder and brain 1. Treatment should be individualized based on symptom severity, comorbidities, and patient preferences, with regular follow-up to assess effectiveness and adjust therapy as needed 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.

Overactive Bladder Treatment: Mirabegron is 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 is 25 mg orally once daily.
• The dose can be increased to 50 mg orally once daily after 4 to 8 weeks if needed. 2 2 2

From the Research

Overactive Bladder Treatment Options

• First-line treatment for overactive bladder (OAB) includes conservative measures such as weight reduction, decrease in exposure to bladder stimulants, fluid optimisation, and pelvic floor exercises 3, 4.
• Behavioral interventions, including lifestyle modifications and pelvic floor muscle therapy, are effective treatments for OAB and urgency urinary incontinence (UUI) 5, 4.
• Pharmacological treatments for OAB include anticholinergic medications such as oxybutynin, and antimuscarinic agents or beta 3 adrenergic agonists 3, 6.
• Minimally invasive procedures, such as intravesical botulinum toxin A injections, may be recommended for patients who are unresponsive to pharmacological treatment 3, 6.
• Third-line therapies, including onabotulinumtoxinA, posterior tibial nerve stimulation, and sacral neuromodulation, may be considered for refractory OAB, but surgical intervention should be a last resort 6.

Lifestyle Modifications and Behavioral Interventions

• Lifestyle modifications, such as establishment of normal voiding intervals, elimination of bladder irritants from the diet, management of fluid intake, weight control, and smoking cessation, can help improve symptoms of OAB and UUI 4.
• Behavioral interventions, including bladder training, multicomponent behavioral training, and pelvic floor muscle exercises, can help re-establish normal voiding intervals and continence 4, 7.
• Patient education on healthy bladder habits and lifestyle modifications is an important aspect of OAB treatment 4.

Future Directions

• New therapies, such as potassium channel activators, voltage-gated calcium channel blockers, and phosphodiesterase inhibitors, are being developed for the treatment of OAB 6.
• Combination therapy with antimuscarinics and beta 3 adrenergic agonists may provide greater efficacy than monotherapy for OAB treatment 6.
• Estrogen therapy may be effective in alleviating urinary incontinence in postmenopausal women with OAB 6.