Overactive Bladder (OAB)

  • Medical Author: Pamela I. Ellsworth, MD
  • Medical Editor: William C. Shiel Jr., MD, FACP, FACR
    William C. Shiel Jr., MD, FACP, FACR

    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

Quick GuideFoods and Drinks That Trigger Leaky Bladder in Pictures

Foods and Drinks That Trigger Leaky Bladder in Pictures

What is the role of medications in treating overactive bladder?

There are several medications recommended for the treatment of overactive bladder. Using these medications in conjunction with behavioral therapies has shown to increase the success rate for the treatment of overactive bladder.

The main goals of OAB treatment are to

  1. reduce urinary urgency and frequency,
  2. increase voided volume (bladder capacity), and
  3. decrease urge incontinence (reduce leakage episodes).

Typically, the medications for overactive bladder start to work within one to two weeks, and optimal relief of OAB symptoms is usually achieved by six weeks. The most common medications (anticholinergics), bladder relaxants, target to decrease the overactivity of the detrusor muscle. Anticholinergics should be used under the direction of the physician prescribing them. They may have some common side effects, including dry mouth, constipation, facial flushing, blurry vision, and confusion (in the elderly). There are multiple anticholinergic therapies approved for the treatment of overactive bladder. They all are similar in their ability to treat the symptoms of overactive bladder but differ in the frequency and type of side effects as well as method of use. Some are once daily, some are topical treatments applied to the skin, and some come in different doses, allowing one to increase the dose if needed. Lastly, several of these medications are now available in generic forms.

Anticholinergic class

  • Oxybutynin (Ditropan) prevents urge incontinence by relaxing the detrusor muscle. This is typically taken two to three times a day (Ditropan XL is extended release, taken once a day). This medication was the first-generation therapy available, and its main side effects include dry mouth (60%) and constipation. Ditropan patch (Oxytrol) is also available with fewer side effects, but it releases a smaller dose than the oral form. The patch is placed on the skin once to twice weekly, and it may cause some local skin irritation.
  • Tolterodine (Detrol, Detrol LA) is indicated for the treatment of an overactive bladder with symptoms of urinary frequency, urgency, or urge incontinence. This medication affects the salivary glands less than oxybutynin, thus, it is better tolerated with fewer side effects (dry mouth). Detrol is usually prescribed twice a day, whereas the long-acting type (Detrol LA) is taken only once a day.
  • Trospium chloride (Sanctura) is available in both a once a day and twice a day therapy. Trospium is less likely to get into the brain and is broken down differently than other medications, which may be beneficial in some individuals.
  • Solifenacin (Vesicare) is a relatively newer medication in this group. It is generally similar to tolterodine, but it has a longer half-life and needs to be taken once a day.
  • Darifenacin (Enablex) is also a newer anticholinergic medicine for treating overactive bladder with fewer side effects, such as confusion. Therefore, it may be more helpful in the elderly with underlying dementia. This medication is also typically taken once a day.
  • Fesoterodine fumarate (Toviaz) is indicated for the treatment of overactive bladder with symptoms of urge urinary incontinence, urgency, and frequency. The medication is taken once daily. Common side effects include constipation and dry mouth.

Contraindications: The use of anticholinergics in individuals with narrow-angle glaucoma is not recommended without approval from an eye specialist. The side effects of anticholinergic medications for OAB may be increased with the use of other medications, thus it is important to always review current medications with the prescribing physician prior to starting an anticholinergic.

B3-Agonist class

  • Mirabegron (Myrbetriq) is a new type of medication, a beta 3-adrenoceptor agonist, to treat overactive bladder that is not an anticholinergic and can be used alone or more recently is being tested in combination with anticholinergic medications. Unlike anticholinergic medications that work to prevent the bladder muscle from contracting, the beta-3 adrenoceptor agonists work on the bladder to help it to relax. As these medications have a very different mechanism of action, they have different side effects. The side effects include increased blood pressure, incomplete bladder emptying, sinus irritation, constipation, and dry mouth (< 2%-3%). Currently, mirabegron is the only drug of this type that is FDA approved, however, other similar agents are being studied.
    • It is recommended that blood pressure checks be performed when starting mirabegron.

Botox injection class

Injection of botulinum toxin into the bladder is considered a third-line therapy for the treatment of overactive bladder and is used in individuals who have tried and failed and/or cannot tolerate the side effects of medical therapy and/or has contraindications to the use of medications to treat overactive bladder.

  • OnabotulinumtoxinA (Botox) is a toxin that is injected directly into the bladder muscle with a cystoscope and may be repeated every four to six months. The effects of the toxin are to prevent the release of chemicals from the nerves that supply the bladder, preventing stimulation of the bladder muscle. As the chemical cannot spread very far when injected, to treat the bladder adequately, multiple injections of a small amount of the toxin are necessary for the treatment to be effective. In most individuals, this can be done in the office. The treatment does not cause permanent changes and thus will require periodic retreatments for the effect to be continued. Serious side effects are unusual but may include difficulty breathing, difficulty swallowing, difficulty talking, muscle weakness, and more commonly, urinary tract infection and urinary retention. Individuals undergoing injection of Botox into the bladder muscle must be willing to perform clean, intermittent catheterization to empty the bladder.
  • The effect of Botox is not permanent, thus repeat injections are needed to maintain the improvement, typically once every six to 16 months.
  • Estrogen, either oral or vaginal, may be helpful in conjunction with other treatments for postmenopausal women with urinary incontinence.

Another third-line therapy is neuromodulation.

Neuromodulation is a newer method of treating overactive bladder with electrical stimulation that results in reorganization of the spinal reflexes involved in bladder control. There are two types of neuromodulation available: percutaneous tibial nerve stimulation (PTNS) and sacral neuromodulation (Interstim). PTNS is performed in the office and is usually performed once a week for 12 weeks with periodic therapies thereafter to maintain a response. It involves placing a small needle into the area near the ankle and administering electrical stimulation. Sacral neuromodulation is usually performed in two stages. The first stage involves the placement of wires (leads) into areas in the sacrum and then using a small generator to test the response to stimulation. If there is a 50% or more improvement in symptoms the wires (leads) are internalized and an internal generator is placed, typically under the skin near the buttocks.

Surgery is rarely necessary in treating overactive bladder unless symptoms are debilitating and unresponsive to other treatments. Reconstructive bladder surgery (cystoplasty) is the most common surgical procedure. This surgery involves enlarging the size of the bladder by using part of the intestine.

Are there alternative therapies for OAB?

There is limited information on the effects of acupuncture on OAB symptoms. However, small studies have demonstrated improvements in OAB symptoms.

Select herbal therapies have also demonstrated improvement in OAB symptoms in small studies.

Medically Reviewed by a Doctor on 9/14/2016

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