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

From the Guidelines

Treatment for overactive bladder should begin with behavioral modifications, including bladder training techniques, pelvic floor exercises, and fluid management, as these approaches have been shown to be effective in managing symptoms with minimal side effects 1.

Initial Treatment Approach

• Start with bladder training techniques like scheduled voiding, pelvic floor exercises (Kegels), and fluid management by limiting caffeine, alcohol, and evening fluid intake.
• These approaches can help reduce symptoms of overactive bladder and improve quality of life.

Medication Options

• If behavioral modifications are not sufficient, anticholinergic medications such as oxybutynin (5mg 2-3 times daily), solifenacin (5-10mg daily), or tolterodine (2-4mg daily) can be considered 1.
• Beta-3 agonists like mirabegron (25-50mg daily) offer an alternative with fewer side effects like dry mouth and constipation.

Advanced Treatment Options

• 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), or sacral neuromodulation 1.
• These treatments work by reducing inappropriate bladder muscle contractions or normalizing the neural signals between the bladder and brain.

Additional Considerations

• Weight loss for overweight patients and treating constipation can also significantly improve symptoms, as excess weight increases abdominal pressure on the bladder, while constipation can worsen urinary urgency and frequency 1.
• A shared decision-making approach should be used to select the best therapy or therapies for each patient, taking into account their individual needs, desires, and side effect tolerance 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 for Overactive Bladder: 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 a maximum of 50 mg orally once daily after 4 to 8 weeks if needed. 2 2 2

From the Research

Treatment Options for Overactive Bladder

• First-line treatment comprises conservative measures including:
  • Weight reduction 3, 4, 5
  • Decrease in exposure to bladder stimulants 3, 4, 5
  • Fluid optimisation 3, 4, 5
  • Pelvic floor exercises 3, 4, 5
• Pharmacological treatments for OAB include:
  • Anticholinergic medications such as oxybutynin 3
  • Antimuscarinic agents and β adrenergic agents 4
  • β3 -adrenoceptor agonists 6
• For patients refractory to pharmacological treatment, options include:
  • Minimally invasive procedures such as intravesical botulinum toxin A injections 3, 4, 6, 7
  • Sacral neuromodulation 4, 6
  • Percutaneous tibial nerve stimulation 4, 6
  • Reconstructive surgery 7

Approach to Treatment

• A stepwise approach to treatment through first-, second-, and third-line therapies is recommended 6
• Patients should be carefully monitored and counseled appropriately on available treatment options 6
• Referral to a specialist (eg, a urologist or urogynecologist) may be necessary for discussion of more advanced therapies 3, 4