From the Guidelines
The primary agents used for urge urinary incontinence are antimuscarinic medications and beta-3 agonists, as recommended by the most recent guidelines. According to the AUA/SUFU guideline on the diagnosis and treatment of idiopathic overactive bladder 1, clinicians should offer antimuscarinic medications or beta-3 agonists to patients with OAB to improve urinary urgency, frequency, and/or urgency urinary incontinence.
Treatment Options
The following are some of the key treatment options:
- Antimuscarinic medications, such as oxybutynin, tolterodine, solifenacin, darifenacin, trospium, and fesoterodine, which work by blocking acetylcholine receptors in the bladder, reducing involuntary detrusor muscle contractions.
- Beta-3 agonists, such as mirabegron, which relaxes the detrusor muscle through a different mechanism.
Treatment Approach
Treatment typically begins with behavioral modifications like fluid management and bladder training before adding medications. Start with lower doses and titrate up as needed for efficacy while monitoring for side effects. Antimuscarinics commonly cause dry mouth, constipation, and cognitive effects (especially in older adults), while mirabegron may cause hypertension. For patients with inadequate response to oral medications, advanced options include botulinum toxin (Botox) injections into the bladder wall, percutaneous tibial nerve stimulation, or sacral neuromodulation. Patients should be reassessed regularly to evaluate treatment efficacy and adjust therapy as needed, as recommended by previous guidelines 2, 3.
From the FDA Drug Label
Solifenacin succinate tablets are indicated for the treatment of adults with overactive bladder with symptoms of urge urinary incontinence, urgency, and urinary frequency. BOTOX is a prescription medicine that is injected into muscles and used: to treat overactive bladder symptoms such as a strong need to urinate with leaking or wetting accidents (urge urinary incontinence), a strong need to urinate right away (urgency) and urinating often (frequency) in adults when another type of medicine (anticholinergic) does not work well enough or cannot be taken
The agents used for urge urinary incontinence are:
- Solifenacin (PO) 4
- OnabotulinumtoxinA (IM) 5 Key points:
- Solifenacin is used for the treatment of adults with overactive bladder with symptoms of urge urinary incontinence.
- OnabotulinumtoxinA is used to treat overactive bladder symptoms such as urge urinary incontinence in adults when another type of medicine does not work well enough or cannot be taken.
From the Research
Agents Used for Urge Urinary Incontinence
The following agents are used to treat urge urinary incontinence:
- Antimuscarinic agents, such as: + Tolterodine 6, 7 + Oxybutynin 6, 7, 8, 9 + Propiverine 7 + Solifenacin 7, 8 + Darifenacin 7 + Trospium 7, 8 + Imidafenacin 7 + Fesoterodine 7
- β3-adrenergic agents, such as: + Mirabegron 10
- Botulinum neurotoxin 10
Combination Therapy
Combination therapy of antimuscarinic agents and β3-agonists may offer an alternative treatment for patients with symptoms refractory to first-line monotherapy 10. Combination of different antimuscarinic agents, such as oxybutynin and trospium or oxybutynin and solifenacin, may also be effective in treating neurogenic overactive bladder 8.
Delivery Forms
Different delivery forms of oxybutynin, such as extended-release and transdermal forms, have been developed to improve its tolerability and safety profile 9.