What is the diagnosis and treatment for Overactive Bladder (OAB)?

From the Guidelines

Overactive bladder (OAB) should be managed with behavioral therapies as the first-line treatment, as recommended by the most recent guidelines 1. The American Urological Association (AUA) and the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) guideline on the diagnosis and treatment of idiopathic overactive bladder emphasizes the importance of behavioral therapies, including fluid management, caffeine reduction, physical activity/exercise, dietary modifications, and mindfulness, as they offer excellent safety and few adverse effects 1. Some key points to consider when managing OAB include:

• Behavioral therapies, such as bladder training, have been extensively studied and are recommended based on strong evidence 1
• The success of behavioral therapies is highly dependent on patient acceptance, adherence, and compliance 1
• Other treatment options, such as pharmacologic therapies, non-invasive therapies, and minimally invasive therapies, may be considered if behavioral therapies are not effective 1
• It is essential to maintain a bladder diary to track symptoms and treatment effectiveness and consult a healthcare provider if symptoms persist or worsen despite treatment 1
• The treatment approach should be personalized, taking into account evidence-based recommendations, as well as patient values and preferences 1

From the FDA Drug Label

Tolterodine tartrate tablets are indicated for the treatment of overactive bladder with symptoms of urge urinary incontinence, urgency, and frequency. Overactive bladder happens when you cannot control your bladder muscle. When the muscle contracts too often or cannot be controlled, you get symptoms of overactive bladder, which are leakage of urine (urge urinary incontinence), needing to urinate right away (urgency), and needing to urinate often (frequency)

The term "overreactive bladder" is not directly mentioned in the provided drug labels. However, based on the information about overactive bladder, it can be inferred that "overreactive bladder" might be referring to the same condition.

• Overactive bladder is characterized by symptoms such as urge urinary incontinence, urgency, and frequency.
• The provided drug labels discuss the treatment of overactive bladder with tolterodine tartrate tablets, but they do not explicitly address "overreactive bladder" 2, 2, 2.

From the Research

Definition and Prevalence of Overactive Bladder

• Overactive bladder (OAB) is a common syndrome characterized by unstable bladder contractions, resulting in urinary urgency, frequency, and nocturia in the absence of detectable disease 3.
• Large studies suggest that more than 10% of the general population is symptomatic 3.
• Around 16% to 45% of adults have overactive bladder symptoms, which include urgency with frequency and/or urge incontinence 4.

Treatment Options for Overactive Bladder

• First-line treatment for OAB comprises conservative measures, including weight reduction, a decrease in exposure to bladder stimulants, fluid optimization, and pelvic floor exercises 3.
• Pharmacological treatments for OAB include anticholinergic medications such as oxybutynin 3.
• Other treatment options include minimally invasive procedures like intravesical botulinum toxin A injections, and invasive procedures for patients in specific circumstances 3.
• Bladder training is also a widely prescribed first-line treatment for OAB, which may cure or improve OAB compared to no treatment, and may be more effective than anticholinergics with fewer adverse events 5.

Comparison of Anticholinergic Drugs

• Tolterodine and oxybutynin are well-established anticholinergic drugs for the management of OAB, but they have anticholinergic side effects that lead to poor tolerability 6.
• Newer agents like trospium, solifenacin, and darifenacin have been approved for the treatment of OAB, which are more selective for the bladder and have better tolerability 6.
• Studies have shown that these newer agents decrease the frequency of incontinence episodes, the number of voids per day, and the number and severity of urgency episodes compared to placebo 6.
• Head-to-head studies have suggested similar effectiveness across the class, although the newer agents are better tolerated 6.
• Tolterodine has equivalent efficacy to oxybutynin, but with less severe adverse effects, making it a more tolerable option for patients 7.

Efficacy and Safety of Anticholinergic Drugs

• Tolterodine and oxybutynin have been shown to be effective in increasing volume voided/micturition and decreasing micturitions per 24 hours and incontinence episodes per 24 hours compared to placebo 7.
• Tolterodine is significantly better tolerated than oxybutynin, with less frequent and intense dry mouth, dose reduction, and patient withdrawals 7.
• Solifenacin has been shown to produce a somewhat greater decrease in the number of incontinence episodes than extended-release tolterodine, with no difference in tolerability 6.
• Fesoterodine may be preferred for superior efficacy, but it has a higher risk of withdrawal due to adverse events and higher risk of dry mouth compared to extended-release tolterodine 4.