From the Guidelines
Urinary urgency should be managed with a combination of behavioral modifications and medication, prioritizing anticholinergics or beta-3 agonists as first-line treatment options, as recommended by the American Urological Association in their 2019 guideline amendment 1. To address urinary urgency, it is essential to understand that it is a hallmark symptom of overactive bladder (OAB) syndrome, characterized by a sudden, compelling desire to pass urine that is difficult to defer 1. The International Continence Society defines OAB as the presence of urinary urgency, usually accompanied by frequency and nocturia, with or without urgency urinary incontinence (UUI), in the absence of urinary tract infection or other obvious pathology 1.
Behavioral Modifications
Behavioral modifications are a crucial component of managing urinary urgency, including:
- Scheduled voiding every 2-3 hours
- Limiting fluid intake in the evening
- Reducing caffeine and alcohol consumption
- Performing pelvic floor exercises (Kegels) daily
Medication Options
For medication options, the following can be considered:
- Anticholinergics like oxybutynin (5mg twice daily) or tolterodine (2mg twice daily) to relax the bladder muscle
- Beta-3 agonists such as mirabegron (25-50mg daily) as an alternative with fewer side effects like dry mouth
Advanced Treatments
If symptoms persist, consider combination therapy or consult a urologist for advanced treatments like Botox injections or nerve stimulation therapy. It is also essential to rule out infection with a urinalysis before starting treatment, as urgency with pain, fever, or blood in urine requires immediate medical attention to address potential underlying causes 1.
From the FDA Drug Label
Oxybutynin chloride thus decreases urgency and the frequency of both incontinent episodes and voluntary urination. The oxybutynin drug label directly supports that oxybutynin decreases urinary urgency.
- Key points:
- Oxybutynin chloride relaxes bladder smooth muscle
- Oxybutynin chloride increases bladder capacity and diminishes the frequency of uninhibited contractions of the detrusor muscle
- Oxybutynin chloride delays the initial desire to void 2
From the Research
Urinary Urgency
- Urinary urgency is a symptom of overactive bladder (OAB) and urgency urinary incontinence (UUI) 3
- Behavioural interventions, such as bladder training and pelvic floor muscle exercises, are effective treatments for OAB and UUI 3
- A stepped-care approach that advances from least invasive (behavioral modification) to more invasive (surgery) interventions is recommended for the treatment of urinary incontinence 4
Treatment Options
- Bladder retraining and pelvic floor muscle exercises are first-line treatments for persons without cognitive impairment who present with urge incontinence 4
- Neuromodulation devices, such as posterior tibial nerve stimulators, are an option for urge incontinence that does not respond to behavioral therapy 4
- Pharmacologic therapy with anticholinergic medications is another option for treating urge incontinence if behavioral therapy is unsuccessful, but is not recommended in older adults due to adverse effects 4
- Other medication options for urge incontinence include mirabegron and onabotulinumtoxinA 4
Pelvic Floor Muscle Exercise
- Pelvic floor muscle exercise (PFME) is defined as exercise to improve pelvic floor muscle strength, power, endurance, relaxation, or a combination of these parameters 5
- PFME strengthens the pelvic floor muscles to provide urethral support to prevent urine leakage and suppress urgency 5
- PFME has been recommended as first-line treatment for stress urinary incontinence 5
Bladder Training
- Bladder training aims to increase the interval between voids and is widely used for the treatment of urinary incontinence 6
- The limited evidence available suggests that bladder training may be helpful for the treatment of urinary incontinence, but this conclusion can only be tentative as the trials were of variable quality and of small size with wide confidence intervals around the point estimates of effect 6