From the Guidelines
Overactive bladder (OAB) and urinary tract infections (UTIs) should be managed as distinct conditions, with OAB treatment prioritizing behavioral modifications and medications, while UTIs are treated with antibiotics, and preventive measures are considered for recurrent UTIs alongside OAB. When managing OAB, first-line treatment includes behavioral modifications such as timed voiding, fluid management, and pelvic floor exercises, as recommended by the AUA/SUFU guideline on the diagnosis and treatment of idiopathic overactive bladder 1. Medications for OAB include anticholinergics like oxybutynin, solifenacin, or tolterodine, and beta-3 agonists like mirabegron. For UTIs, treatment typically involves antibiotics such as nitrofurantoin, trimethoprim-sulfamethoxazole, or fosfomycin. It's essential to distinguish between these conditions as OAB is a chronic condition characterized by urgency with or without incontinence, while UTIs are acute infections causing pain, burning, and sometimes fever. Some key points to consider in managing OAB and UTIs include:
- Behavioral therapies, such as fluid management and bladder training, offer patients with OAB some efficacy, excellent safety, and few adverse effects 1.
- Minimally invasive treatment options for OAB, such as sacral neuromodulation, tibial nerve stimulation, and intradetrusor botulinum toxin injection, have been associated with high success rates, durable efficacy, and excellent patient satisfaction 1.
- For recurrent UTIs, preventive measures like increased fluid intake, urinating after intercourse, and possibly low-dose prophylactic antibiotics may be recommended, with the goal of reducing the risk of UTI recurrence and improving quality of life 1. The connection between OAB and UTIs lies in how inflammation from UTIs can trigger or worsen OAB symptoms by sensitizing bladder nerves, while incomplete bladder emptying in some OAB patients can increase UTI risk. Therefore, a comprehensive management plan should consider both conditions and prioritize treatments that improve morbidity, mortality, and quality of life.
From the Research
Overactive Bladder (OAB) and Urinary Tract Infection (UTI)
- OAB is a symptomatic diagnosis based on the presence of urgency, with or without urge incontinence, and usually accompanied by frequency and nocturia, in the absence of obvious pathologic or metabolic disease 2.
- The initial management of OAB requires an integrated approach using behavioral and pharmacologic methods, including patient education, fluid and dietary management, and pelvic floor exercises 2.
- Treatment for OAB involves anti-muscarinic agents and beta 3-adrenoceptor agonists, which may increase the risk of UTI 3.
- However, a study found that the risk of UTI was not influenced by the targeted drugs or adherence during the follow-up period, regardless of UTI history or sex 3.
Diagnosis and Management of OAB
- Behavioral therapy is recommended as a first choice for OAB management, followed by pharmacologic treatment (anticholinergics, β3-adrenoceptor agonists) as second-line treatment 4.
- OnabotulinumtoxinA, peripheral tibial nerve stimulation, and sacral nerve stimulation are recommended as third-line therapy for patients refractory or intolerant to first- and second-line treatments 4.
- A practical primary care approach to OAB involves distinguishing the uncomplicated patient from the complicated one, identifying confounding conditions, and referring patients when necessary 5.
UTI Treatment
- Sulfonamides, trimethoprim-sulfamethoxazole, nitrofurantoin, and nalidixic acid are commonly used antimicrobials for UTI treatment, with sulfonamides being the agent of first choice 6.
- Trimethoprim-sulfamethoxazole is a very effective combination agent, but is more expensive than sulfonamides and is usually reserved for initial treatment 6.