From the Guidelines
Treatment for female overactive bladder should begin with behavioral modifications, including bladder training and pelvic floor exercises, as recommended by the most recent guidelines 1.
Behavioral Modifications
- Bladder training: scheduled voiding times that gradually increase
- Pelvic floor exercises (Kegels): to strengthen muscles that control urination
- Limit bladder irritants: caffeine, alcohol, and spicy foods
- Maintain proper fluid intake: without excessive amounts before bedtime
Medications
If behavioral modifications are insufficient, medications may be prescribed, including:
- Anticholinergics: oxybutynin (2.5-5mg twice daily), tolterodine (2-4mg daily), or solifenacin (5-10mg daily)
- Beta-3 adrenergic agonists: mirabegron (25-50mg daily) with fewer side effects
Advanced Options
For women not responding to these treatments, advanced options include:
- Botulinum toxin injections into the bladder
- Nerve stimulation therapy
- Rarely, surgery
These treatments aim to reduce morbidity, mortality, and improve quality of life by managing overactive bladder symptoms, as emphasized in the guidelines 1. The choice of treatment should be individualized, considering patient preferences and values, as well as the potential benefits and risks of each option 1.
Note: The evidence from 1 is not considered as it is older and less relevant to the current guidelines. The most recent and highest quality study 1 is prioritized to ensure the best possible outcome in terms of morbidity, mortality, and quality of life.
From the FDA Drug Label
1 INDICATIONS AND USAGE
1.1 Adult Overactive Bladder (OAB) Mirabegron Monotherapy Mirabegron extended-release tablets are indicated for the treatment of OAB in adult patients with symptoms of urge urinary incontinence, urgency, and urinary frequency.
Treatment for Female Overactive Bladder:
- Mirabegron extended-release tablets are indicated for the treatment of Overactive Bladder (OAB) in adult patients, including females, with symptoms of urge urinary incontinence, urgency, and urinary frequency 2.
- The pharmacokinetics of mirabegron were found to be higher in females than in males, with Cmax and AUC approximately 40% to 50% higher in females than in males 2.
- However, when corrected for differences in body weight, the mirabegron systemic exposure was 20% to 30% higher in females compared to males 2.
From the Research
Treatment Options for Female Overactive Bladder
- Behavioral modification is often the first line of treatment, including attention to total daily fluid intake, avoidance of bladder irritants, treatment of constipation, weight loss, timed voiding, urge-suppression techniques, and pelvic floor physical therapy 3, 4, 5
- Pharmacologic treatments include antimuscarinic agents and β adrenergic agents, which can be used following or in conjunction with behavioral treatment 3, 4, 5
- For patients refractory to behavioral therapy and oral medications, consideration should be given to referral to a specialist for discussion of more advanced therapies such as sacral neuromodulation, percutaneous tibial nerve stimulation, and intradetrusor injection of onabotulinumtoxinA 3, 4, 5
- A stepwise approach to treatment through first-, second-, and third-line therapies is recommended, recognizing this may not be appropriate for all patients 5
Comparison of Medications
- Solifenacin and mirabegron are two medications commonly used to treat overactive bladder, with mirabegron being associated with fewer treatment-related adverse events 6
- Both solifenacin and mirabegron are effective in relieving symptoms of OAB, but mirabegron may be a better option as a first-line treatment due to its lower side effect profile 6
Management and Treatment Goals
- The aim of treatment is to improve patient quality of life and reduce patient and health system costs 4
- Treatment should be tailored to the individual patient, taking into account their specific symptoms, medical history, and preferences 3, 4, 5
- Patients should be carefully monitored and counseled appropriately on available treatment options to optimize symptom control and set realistic expectations 5