Materiały źródłowe

• #1 Overactive bladder syndrome: Management and treatment options – PubMed

  https://pubmed.ncbi.nlm.nih.gov/32864677/

  Overactive bladder (OAB) is a common syndrome in the community characterised by unstable bladder contractions, resulting in urinary urgency, frequency and nocturia in the absence of detectable disease. […] The aim of this article is to summarise the stepwise treatment for OAB that seeks to improve patient quality of life and reduce patient and health system costs. […] First-line treatment comprises conservative measures including weight reduction, a decrease in exposure to bladder stimulants, fluid optimisation and pelvic floor exercises. Pharmacological treatments for OAB include anticholinergic medications such as oxybutynin. If the patient is unresponsive to pharmacological treatment, a review by a urology specialist is appropriate. Recommendations may include minimally invasive procedures such as intravesical botulinum toxin A injections, reserving the invasive procedures for patients in specific circumstances.

• #2 Treatment Options for Overactive Bladder

  https://www.webmd.com/urinary-incontinence-oab/overactive-bladder-treatment-finding-best-options

  Overactive bladder treatment has many approaches, from medication, to behavioral changes, to a combination of both. […] Bladder training and pelvic floor exercises are just two natural treatments for overactive bladder. […] Bladder training helps change the way you use the bathroom. […] Pelvic floor exercises, called Kegels, you tighten, hold, and then relax the muscles that you use to start and stop the flow of urination. […] Anticholinergic medications are widely used in the treatment of overactive bladder (OAB). […] The drugs mirabegron (Myrbetriq) and vibegron (Gemtesa) called beta-3 adrenergic agonists. […] Another type of drug for overactive bladder is the tricyclic antidepressant imipramine hydrochloride (Tofranil), which also relaxes bladder muscles. […] Botox (Onabotulinumtoxin A) can be injected into the bladder muscle, causing it to relax.

• #3 Overactive bladder – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/overactive-bladder/diagnosis-treatment/drc-20355721

  A mix of treatments may be best to relieve overactive bladder symptoms. […] Behavioral therapies are the first choice in helping manage an overactive bladder. They often work and have no side effects. Behavioral therapies may include: […] Kegel exercises can help strengthen the pelvic floor muscles. […] After menopause, vaginal estrogen therapy can help strengthen the muscles and tissues in the urethra and vaginal area. Vaginal estrogen comes in creams, suppositories, tablets or rings. It can improve symptoms of overactive bladder. […] Medicines that relax the bladder can help relieve symptoms of overactive bladder and reduce episodes of urge incontinence. […] OnabotulinumtoxinA (ON-ah-boch-yoo-lih-num-tox-in-A), also called Botox, is a protein from the bacteria that cause botulism illness. Small doses shot into bladder tissues can relax the muscles and increase the amount of urine the bladder can hold.

• #4 Medical management of overactive bladder

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2938554/

  Overactive bladder (OAB), as defined by the International Continence Society, is characterized by a symptom complex including urinary urgency with or without urge incontinence, usually associated with frequency and nocturia. […] OAB can be diagnosed easily and managed effectively with both non-pharmacological and pharmacological therapies. The first-line treatments are lifestyle interventions, bladder training, pelvic floor muscle exercises and anticholinergic drugs. […] Antimuscarinics are the drug class of choice for OAB symptoms; with proven efficacy, and adverse event profiles that differ somewhat. […] Non-surgical treatment is the mainstay and should include lifestyle, including dietary modifications, bladder retraining and pelvic floor training with or without biofeedback; these are combined with pharmacotherapy with antimuscarinics as appropriate.

• #5

  https://www.nhs.uk/conditions/urinary-incontinence/treatment/

  If you’ve been diagnosed with urge incontinence, one of the first treatments you may be offered is bladder training. […] While incontinence products are not a treatment for urinary incontinence, you might find them useful for managing your condition while you’re waiting to be assessed or waiting for treatment to start helping. […] If stress incontinence does not significantly improve with lifestyle changes or exercises, surgery will usually be recommended as the next step. […] However, if you’re unsuitable for surgery or want to avoid an operation, you may benefit from an antidepressant medicine called duloxetine. […] If bladder training is not effective for your urge incontinence, a GP may prescribe a medicine called an antimuscarinic, also called an anticholinergic. […] Antimuscarinics may also be prescribed if you have overactive bladder syndrome, which is the frequent urge to urinate that can happen with or without urinary incontinence.

• #6 Overactive Bladder Treatment & Management: Approach Considerations, Behavioral Therapy, Pharmacologic Therapy

  https://emedicine.medscape.com/article/459340-treatment

  Behavioral therapy, also called behavioral modification, is a treatment approach that aims to alter an individuals actions or environment to improve bladder control. […] Bladder training involves a program of patient education and a scheduled voiding regimen. The goals of bladder training are as follows: Normalize urinary frequency, Improve control over bladder urgency, Increase bladder capacity, Decrease incontinence episodes, Progressively prolong voiding intervals, Improve the patients confidence in bladder control. […] A program of bladder retraining involves becoming aware of patterns of incontinence episodes and relearning skills necessary for storage and proper emptying of the bladder. Bladder retraining alone is successful in 75% of patients treated for urge incontinence. […] PFMT involves exercises designed to improve the function of the pelvic floor muscles. The rationale for use of PFMT in urgency urinary incontinence and OAB is that contraction of the pelvic floor muscles can reflexively or voluntarily inhibit contraction of the detrusor muscle.

• #7 Overactive bladder – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/overactive-bladder/diagnosis-treatment/drc-20355721

  A mix of treatments may be best to relieve overactive bladder symptoms. […] Behavioral therapies are the first choice in helping manage an overactive bladder. They often work and have no side effects. Behavioral therapies may include: […] Kegel exercises can help strengthen the pelvic floor muscles. […] After menopause, vaginal estrogen therapy can help strengthen the muscles and tissues in the urethra and vaginal area. Vaginal estrogen comes in creams, suppositories, tablets or rings. It can improve symptoms of overactive bladder. […] Medicines that relax the bladder can help relieve symptoms of overactive bladder and reduce episodes of urge incontinence. […] OnabotulinumtoxinA (ON-ah-boch-yoo-lih-num-tox-in-A), also called Botox, is a protein from the bacteria that cause botulism illness. Small doses shot into bladder tissues can relax the muscles and increase the amount of urine the bladder can hold.

• #8 Pelvic Floor Physical Therapy for Overactive Bladder

  https://www.healthline.com/health/overactive-bladder/pelvic-floor-physical-therapy-overactive-bladder

  People with overactive bladder (OAB) experience a strong and sudden urge to urinate. […] OAB can be uncomfortable and even painful at times. The condition can greatly affect your quality of life and can lead to emotional distress. Fortunately, treatment can help you manage symptoms. […] One treatment option for urge incontinence due to OAB is a specialized form of physical therapy known as pelvic floor physical therapy. […] Pelvic floor physical therapy is a form of physical therapy that helps you to properly engage the pelvic floor muscles that regulate the release of urine and feces. If you have OAB, pelvic floor physical therapy may help you to control sudden or frequent urges to urinate. […] To help with these OAB symptoms, it’s important to keep the pelvic floor muscles strong so they can properly support the bladder and other organs. Pelvic floor physical therapy helps you to identify and strengthen these muscles.

• #9 Get Overactive Bladder Treatment | Cleveland Clinic

  https://my.clevelandclinic.org/services/overactive-bladder-treatment

  But you dont have to live like that. Cleveland Clinics healthcare providers have helped develop the leading treatment options for overactive bladder. We can help improve your bladder control and restore your confidence. […] Cleveland Clinic offers many different options to help you feel in control of your overactive bladder. Weve developed a step-wise approach to treatment. This means we start with lifestyle changes and exercises. If these dont work, well quickly move to more advanced treatments. Well talk to you about all of the options at your first appointment so you understand the process and what to expect from your treatment. […] You might be able to manage your overactive bladder by making small, but important, lifestyle changes, like: Staying away from caffeine and alcohol. Having a bathroom schedule. Keeping a bladder diary (what and how much you drink and eat, how often you pee, if you leak, if youre able to reach the bathroom in time, etc.).

• #10 Natural Remedies for an Overactive Bladder

  https://www.healthline.com/health/overactive-bladder/home-remedies

  Corn silk is the waste material from corn cultivation. […] It may help with strengthening and restoring mucous membranes in the urinary tract to prevent incontinence, according to the International Continence Society. […] Pumpkin seeds are packed with omega-3 fatty acids, which have anti-inflammatory properties. One study found that pumpkin seed oil improves abnormal urinary function and reduces symptoms of OAB. […] Research shows that women who are overweight and have incontinence had less episodes of OAB. One study found that women with obesity who lose 10 percent of their body weight saw improved bladder control by 50 percent. […] Kegel exercises strengthen the muscles to minimize involuntary contractions and improve posture. It’s also one of the safest behavioral therapies without side effects and complications.

• #11 Natural Remedies for an Overactive Bladder

  https://www.healthline.com/health/overactive-bladder/home-remedies

  Corn silk is the waste material from corn cultivation. […] It may help with strengthening and restoring mucous membranes in the urinary tract to prevent incontinence, according to the International Continence Society. […] Pumpkin seeds are packed with omega-3 fatty acids, which have anti-inflammatory properties. One study found that pumpkin seed oil improves abnormal urinary function and reduces symptoms of OAB. […] Research shows that women who are overweight and have incontinence had less episodes of OAB. One study found that women with obesity who lose 10 percent of their body weight saw improved bladder control by 50 percent. […] Kegel exercises strengthen the muscles to minimize involuntary contractions and improve posture. It’s also one of the safest behavioral therapies without side effects and complications.

• #12 Overactive Bladder (OAB): Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/14248-overactive-bladder

  Overactive bladder is a collection of symptoms that may affect how often you pee and your urgency. Treatment includes changing certain behaviors, medications and nerve stimulation. […] Different treatments can help fix your overactive bladder. Treatments may include changing certain behaviors, medications and nerve stimulation (neuromodulation). […] You can make many changes to your behavior to help fix your overactive bladder. […] Managing your weight can reduce pressure on your bladder, which may contribute to bladder control problems. […] Yes, nerve stimulation can help improve OAB. Your nerves help tell your brain that your bladder is full. By treating your nerves, you can improve your bladder control. […] A healthcare provider may prescribe medication. Medications can help restore normal bladder function. Commonly prescribed medications for overactive bladder include: Anticholinergic medications help regulate muscle spasms in your bladder.

• #13 Urgency urinary incontinence/overactive bladder (OAB) in females: Treatment – UpToDate

  https://www.uptodate.com/contents/urgency-urinary-incontinence-overactive-bladder-oab-in-females-treatment

  Urgency urinary incontinence describes the involuntary loss of urine associated with urgency (ie, having the urge to void immediately preceding or accompanying involuntary urine leakage). Overactive bladder (OAB) is a syndrome characterized by urinary urgency, with or without incontinence, that is often accompanied by nocturia and urinary frequency. Both are treated with a step-wise approach that includes behavior modification, pharmacotherapy, and procedures. […] This topic will discuss the treatment of both urgency urinary incontinence and OAB in females. […] During this process, patients are also counseled about lifestyle and behavioral changes (eg, smoking cessation, weight loss for individuals with obesity, appropriate fluid intake) as well as over-the-counter products (eg, pads, incontinence underwear, urine-wicking devices) to help them manage their incontinence symptoms. […] Evaluation of female urinary incontinence is discussed in detail separately.

• #14 Natural Remedies for an Overactive Bladder

  https://www.healthline.com/health/overactive-bladder/home-remedies

  Bladder retraining can help reboot your bladder muscles. The idea is to let the urge to urinate pass before going to the bathroom and gradually work your way toward longer holding times. […] Talk to a doctor if your symptoms are interfering with your overall health. Let them know if you’ve tried these remedies. Your doctor will work with you to find an appropriate treatment. This may include OAB medications or surgery.

• #15 Overactive Bladder in Children Treatment & Management: Approach Considerations, Behavioral Therapy, Medical Care

  https://emedicine.medscape.com/article/459696-treatment

  Initial management of overactive bladder (OAB) involves a behavioral and cognitive approach. The child and caregiver must be educated on normal bladder and sphincter function. Dietary changes are helpful in some children, particularly those who drink caffeinated or acidic fluids and those with increased fluid intake. […] Pharmacologic treatment is initiated if behavioral therapy fails or symptoms are severe. Surgical treatment may be considered if behavioral therapy and pharmacologic therapy fail. […] Voiding regimens are instituted in all children with OAB. Voiding is recommended every 2-3 hours while the child is awake. […] In children who do not empty their bladder completely (increased postvoid residual volume), the practitioner should institute a double voiding regimen, whereby the child voids and then waits a minute or two and tries to void again, to improve bladder emptying.

• #16 Overactive Bladder (OAB): Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/14248-overactive-bladder

  Pelvic floor exercises and changes to your lifestyle may take six to eight weeks before you start to see results. […] Lifestyle adjustments can help reduce your risk of developing an overactive bladder. […] Treatment can be challenging to manage, and symptoms may never completely disappear. But many people are satisfied with the treatment they receive and often experience a dramatic improvement in their quality of life.

• #17 Overactive bladder syndrome Management and treatment options

  https://www.racgp.org.au/afp/2012/november/overactive-bladder-syndrome

  Overactive bladder syndrome is a symptom-based clinical diagnosis. The management of overactive bladder syndrome involves exclusion of underlying pathology. First line treatment includes lifestyle interventions, pelvic floor exercises, bladder training and antimuscarinic agents. Failure of conservative management necessitates urology referral. Second line therapies are more invasive, and include botulinum toxin, neuromodulation or surgical interventions such as augmentation cystoplasty or urinary diversion. […] This can be initiated in the primary care setting. It includes a combination of lifestyle interventions, bladder training and behavioural modification. Antimuscarinic medications can be added if these measures fail to control symptoms. […] Behavioural treatments have been shown to be effective in older adults, reducing leakage by 50-80%. Behavioural training requires a highly motivated patient, and 20-30% will become dry.

• #18 AUA Releases Guideline on Diagnosis and Treatment of Overactive Bladder | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/0601/p800.html

  Behavioral therapies (e.g., bladder training, bladder-control strategies, pelvic floor muscle training, fluid management) should be offered as first-line therapy to all patients with overactive bladder. […] Antimuscarinic agents may be used in combination with behavioral strategies. […] Limited evidence suggests that initiating behavioral and pharmacologic therapy simultaneously may improve outcomes, including frequency, voided volume, incontinence, and symptom distress. […] Second-line therapies for overactive bladder include oral antimuscarinics (e.g., darifenacin [Enablex], fesoterodine [Toviaz], oxybutynin [Ditropan], solifenacin [Vesicare], tolterodine [Detrol], trospium [Sanctura]). […] If symptoms are not adequately controlled or if adverse effects become intolerable with one antimuscarinic agent, the dosage should be modified or a different agent should be tried.

• #19 Medical management of overactive bladder

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2938554/

  Antimuscranics are established first line treatment options for OAB symptoms. In randomized controlled trials they are more effective than placebo as shown in a recent meta-analysis. […] The market with antimuscarinic pharmacotherapy is lucrative with many players in the industry constantly investigating newer molecules with greater efficacy and fewer side effects; the race to find the next blockbuster is on. […] OAB can be diagnosed easily and managed effectively with both non-pharmacological and pharmacological therapies. The first-line treatments are lifestyle interventions, bladder training, pelvic floor muscle exercises and anticholinergic drugs.

• #20 Bladder control: Medications for urinary problems

  https://www.mayoclinic.org/diseases-conditions/urinary-incontinence/in-depth/bladder-control-problems/art-20044220

  When other options for bladder control don’t work, medication may help. Learn what medications are available and their possible side effects. […] Medications are available for people who often have sudden, intense urges to urinate, also called overactive bladder. They’re also available to people who have urine leaks that can happen along with overactive bladder. This is called urge incontinence. […] Here’s a look at drugs commonly used to treat bladder control problems and their possible side effects. Medications combined with behavioral treatment might be more effective than medication alone. […] Anticholinergic drugs block the action of the chemical messenger acetylcholine. Acetylcholine sends signals to your brain that trigger bladder contractions associated with an overactive bladder.

• #21 Overactive Bladder Treatment & Management: Approach Considerations, Behavioral Therapy, Pharmacologic Therapy

  https://emedicine.medscape.com/article/459340-treatment

  Biofeedback-assisted behavioral therapy teaches patients how to control normal physiologic responses of the bladder and pelvic floor muscles that mediate incontinence. […] Anticholinergic agents are currently the first-line pharmacologic therapy for OAB. These agents are thought to act primarily by inhibiting involuntary detrusor muscle contractions (at the level of the efferent pathway), but identification of muscarinic receptors in the urothelium/suburothelium suggests that they may also affect the afferent sensory pathway. […] Detrusor injections of onabotulinumtoxinA are approved by the FDA for the treatment of adults with OAB who cannot use, or do not adequately respond to, anticholinergic medication. Most of the effects of botulinum toxin are thought to be the result of inhibition of the release of acetylcholine from the presynaptic nerve terminal, which prevents stimulation of the detrusor muscle.

• #22 Treatment Options for Overactive Bladder

  https://www.webmd.com/urinary-incontinence-oab/overactive-bladder-treatment-finding-best-options

  Overactive bladder treatment has many approaches, from medication, to behavioral changes, to a combination of both. […] Bladder training and pelvic floor exercises are just two natural treatments for overactive bladder. […] Bladder training helps change the way you use the bathroom. […] Pelvic floor exercises, called Kegels, you tighten, hold, and then relax the muscles that you use to start and stop the flow of urination. […] Anticholinergic medications are widely used in the treatment of overactive bladder (OAB). […] The drugs mirabegron (Myrbetriq) and vibegron (Gemtesa) called beta-3 adrenergic agonists. […] Another type of drug for overactive bladder is the tricyclic antidepressant imipramine hydrochloride (Tofranil), which also relaxes bladder muscles. […] Botox (Onabotulinumtoxin A) can be injected into the bladder muscle, causing it to relax.

• #23 Overactive Bladder in Children Treatment & Management: Approach Considerations, Behavioral Therapy, Medical Care

  https://emedicine.medscape.com/article/459696-treatment

  In children who fail to improve with such voiding regimens, biofeedback-assisted therapy and pharmacologic therapy are the next treatment options. […] The use of anticholinergic therapy in the management of OAB is predicated on the concept that parasympathetic-mediated stimulation of muscarinic receptors (M3 primarily) in the bladder leads to detrusor overactivity. Anticholinergic/antimuscarinic agents have been demonstrated to increase bladder capacity, to improve bladder compliance, and to decrease uninhibited detrusor contractions. […] Currently, the most commonly used anticholinergic for the treatment of OAB in children is extended-release oxybutynin (Ditropan XL). […] If behavioral therapy fails or the child has severe symptoms, pharmacologic therapy is instituted. […] Solifenacin (Vesicare), an agent commonly used in adults, was studied in small series of children.

• #24 Treatment options for overactive bladder (OAB)

  https://www.urineincontinence.com.au/overactive-bladder/treatment-options-overactive-bladder-oab

  Many drug therapies are available to treat OAB. […] There are 2 main classes of drugs available to treat this problem- anticholinergic medications and selective beta-3 adrenergic agonists. […] Both of these classes of medication are thought to act: By changing abnormal nerve signalling in the nerve pathways of the bladder and By relaxing the bladder muscle and helping to prevent involuntary bladder muscle contractions. […] Anticholinergic medications include (listed in alphabetical order; no hierarchy is implied): Darifenacin marketed as Enablex, Oxybutynin, Solifenacin marketed as Vesicare, Tolterodine marketed as Detrusitol. […] Selective beta-3 adrenergic agonist medications: First released in 2014 in Australia for the treatment of overactive bladder, Mirabegron (marketed as Betmiga) is the first drug of this class to be commercially available. […] There are other surgical options available for overactive bladder.

• #25

  https://www.nhs.uk/conditions/urinary-incontinence/treatment/

  If you’ve been diagnosed with urge incontinence, one of the first treatments you may be offered is bladder training. […] While incontinence products are not a treatment for urinary incontinence, you might find them useful for managing your condition while you’re waiting to be assessed or waiting for treatment to start helping. […] If stress incontinence does not significantly improve with lifestyle changes or exercises, surgery will usually be recommended as the next step. […] However, if you’re unsuitable for surgery or want to avoid an operation, you may benefit from an antidepressant medicine called duloxetine. […] If bladder training is not effective for your urge incontinence, a GP may prescribe a medicine called an antimuscarinic, also called an anticholinergic. […] Antimuscarinics may also be prescribed if you have overactive bladder syndrome, which is the frequent urge to urinate that can happen with or without urinary incontinence.

• #26 Treatment for Overactive Bladder – ODPRN

  https://odprn.ca/research/core-themes/drug-class-reviews/overactive-bladder-agents/

  The ODPRN has completed a drug class review of treatments for overactive bladder (OAB). […] Anticholinergics are the main medications used to treat OAB; there are six of them available in Canada and their listing and formulations on public drug plans vary, some also have generic versions available. Another drug, mirabegron, has also recently become available and is increasingly being used. […] Solifenacin is the most cost effective therapy for the treatment of OAB; however, if solifenacin is not effective for a patient, then oxybutynin IR is also a cost-effective option. […] Use of oxybutynin IR or solifenacin or tolterodine extended release (ER) as initial therapy; all other currently listed OAB medications Limited Use. […] Oxybutynin IR, solifenacin, and tolterodine ER are considered first line therapy based on arguments of efficacy, safety and cost-effectiveness. […] For patients unable to swallow, we recommend listing oxybutynin gel (Gelnique) under the Exceptional Access Program. […] All anticholinergics, including oxybutynin IR, should have a Therapeutic Note, cautioning about the use of the drugs in the elderly.

• #27 Treatment options for overactive bladder (OAB)

  https://www.urineincontinence.com.au/overactive-bladder/treatment-options-overactive-bladder-oab

  Many drug therapies are available to treat OAB. […] There are 2 main classes of drugs available to treat this problem- anticholinergic medications and selective beta-3 adrenergic agonists. […] Both of these classes of medication are thought to act: By changing abnormal nerve signalling in the nerve pathways of the bladder and By relaxing the bladder muscle and helping to prevent involuntary bladder muscle contractions. […] Anticholinergic medications include (listed in alphabetical order; no hierarchy is implied): Darifenacin marketed as Enablex, Oxybutynin, Solifenacin marketed as Vesicare, Tolterodine marketed as Detrusitol. […] Selective beta-3 adrenergic agonist medications: First released in 2014 in Australia for the treatment of overactive bladder, Mirabegron (marketed as Betmiga) is the first drug of this class to be commercially available. […] There are other surgical options available for overactive bladder.

• #28

  https://www.nhs.uk/conditions/urinary-incontinence/treatment/

  If you’ve been diagnosed with urge incontinence, one of the first treatments you may be offered is bladder training. […] While incontinence products are not a treatment for urinary incontinence, you might find them useful for managing your condition while you’re waiting to be assessed or waiting for treatment to start helping. […] If stress incontinence does not significantly improve with lifestyle changes or exercises, surgery will usually be recommended as the next step. […] However, if you’re unsuitable for surgery or want to avoid an operation, you may benefit from an antidepressant medicine called duloxetine. […] If bladder training is not effective for your urge incontinence, a GP may prescribe a medicine called an antimuscarinic, also called an anticholinergic. […] Antimuscarinics may also be prescribed if you have overactive bladder syndrome, which is the frequent urge to urinate that can happen with or without urinary incontinence.

• #29 AUA Releases Guideline on Diagnosis and Treatment of Overactive Bladder | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/0601/p800.html

  Behavioral therapies (e.g., bladder training, bladder-control strategies, pelvic floor muscle training, fluid management) should be offered as first-line therapy to all patients with overactive bladder. […] Antimuscarinic agents may be used in combination with behavioral strategies. […] Limited evidence suggests that initiating behavioral and pharmacologic therapy simultaneously may improve outcomes, including frequency, voided volume, incontinence, and symptom distress. […] Second-line therapies for overactive bladder include oral antimuscarinics (e.g., darifenacin [Enablex], fesoterodine [Toviaz], oxybutynin [Ditropan], solifenacin [Vesicare], tolterodine [Detrol], trospium [Sanctura]). […] If symptoms are not adequately controlled or if adverse effects become intolerable with one antimuscarinic agent, the dosage should be modified or a different agent should be tried.

• #30 Side Effects of Overactive Bladder Medication | Poison Control

  https://www.poison.org/articles/overactive-bladder-medical-treatment-side-effects-181

  Antimuscarinic medications’ side effects include dry mouth, constipation, dry or itchy eyes, blurred vision, indigestion, urinary tract infection, urinary retention, and drowsiness. […] Mirabegron (Myrbetriq), is a beta-3-adrenergic agonist that works in OAB by increasing bladder capacity through relaxing the bladder muscles. The most commonly reported side effects associated with mirabegron are high blood pressure, urinary tract infection, and headaches. […] Patients on OAB drug therapy frequently experience side effects. Report any side effects at each visit to a healthcare provider.

• #31 The AUA/SUFU Guideline on the Diagnosis and Treatment of Idiopathic Overactive Bladder – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/idiopathic-overactive-bladder

  Clinicians may offer select non-invasive therapies to all patients with OAB. […] In patients with OAB whose symptoms do not adequately respond to monotherapy, clinicians may combine one or more of the following: behavioral therapy, non-invasive therapy, pharmacotherapy, and/or minimally invasive therapies. […] Clinicians should offer antimuscarinic medications or beta-3 agonists to patients with OAB to improve urinary urgency, frequency, and/or urgency urinary incontinence. […] Clinicians should counsel patients with OAB on the side effects of all oral medication options; treatment should be chosen based on side effect profiles and in the context of shared decision-making. […] Clinicians should use antimuscarinic medications with extreme caution in patients with OAB who have narrow-angle glaucoma, impaired gastric emptying, or a history of urinary retention.

• #32 Lesson: Managing Overactive Bladder Syndrome

  https://journalce.powerpak.com/ce/managing-overactive-bladder-in-syndrome

  Antimuscarinic medications have been the mainstay of pharmacologic therapy for OAB since the early 1970s with the introduction of flavoxate (Urispas) and oxybutynin (Ditropan). […] The combination of pelvic floor exercises and other behavioral therapies with pharmacotherapy appears more effective than either approach alone. […] Medications are generally considered second line following the noninvasive, nonpharmacologic therapies described above. […] Two primary classes of medications are available for the treatment of OAB and include cholinergic muscarinic receptor antagonists (antimuscarinics) and -3 adrenergic receptor agonists (-3 agonists). […] The clinical effectiveness of both mirabegron and vibegron appears to be at least similar to that of the antimuscarinics, although -adrenergic medications may be more effective at reducing nocturia episodes.

• #33 Overactive Bladder Medications

  https://sesamecare.com/blog/best-overactive-bladder-medications?srsltid=AfmBOoqBgBvzfrTIPVUP4mfP2z81bloVykgtIxeonlFARODHiPH-Iu8C

  When activated, these receptors relax the smooth muscles surrounding the bladder, which helps reduce the frequency and urgency of urination and can improve urinary retention. […] Antidepressants can be used to treat OAB by affecting the communication between nerves and muscles in the bladder. […] These medications often have an anticholinergic effect, similar to other OAB medications, where they inhibit the action of acetylcholine, a neurotransmitter responsible for bladder contractions. […] By doing so, antidepressants can help relax the bladder muscles, reduce the urgency to urinate and improve control over bladder function. […] Topical estrogen is sometimes used to treat overactive bladder, particularly in postmenopausal women. […] Estrogen therapy may help reduce urinary tract infections and urinary incontinence that can be associated with the hormonal changes of menopause.

• #34 Bladder control: Medications for urinary problems

  https://www.mayoclinic.org/diseases-conditions/urinary-incontinence/in-depth/bladder-control-problems/art-20044220

  Mirabegron is a medication approved to treat certain types of urinary incontinence. It relaxes the bladder muscle and can increase how much urine the bladder can hold. […] Injections of Botox into the bladder muscle might benefit people who have an overactive bladder or urge incontinence. Botox blocks the actions of acetylcholine and paralyzes the bladder muscle. […] Applying low-dose, topical estrogen may help. The medication comes in the form of a vaginal cream, ring or patch. The estrogen may help restore the tissues in the vagina and urinary tract to relieve some symptoms. […] Imipramine (Tofranil) is a tricyclic antidepressant. It makes the bladder muscle relax, while causing the smooth muscles at the bladder neck to contract. It may be used to treat mixed incontinence, which is a combination of urge and stress incontinence.

• #35 Treatment options for overactive bladder (OAB)

  https://www.urineincontinence.com.au/overactive-bladder/treatment-options-overactive-bladder-oab

  Many drug therapies are available to treat OAB. […] There are 2 main classes of drugs available to treat this problem- anticholinergic medications and selective beta-3 adrenergic agonists. […] Both of these classes of medication are thought to act: By changing abnormal nerve signalling in the nerve pathways of the bladder and By relaxing the bladder muscle and helping to prevent involuntary bladder muscle contractions. […] Anticholinergic medications include (listed in alphabetical order; no hierarchy is implied): Darifenacin marketed as Enablex, Oxybutynin, Solifenacin marketed as Vesicare, Tolterodine marketed as Detrusitol. […] Selective beta-3 adrenergic agonist medications: First released in 2014 in Australia for the treatment of overactive bladder, Mirabegron (marketed as Betmiga) is the first drug of this class to be commercially available. […] There are other surgical options available for overactive bladder.

• #36 Treatment Options for Overactive Bladder

  https://www.webmd.com/urinary-incontinence-oab/overactive-bladder-treatment-finding-best-options

  Overactive bladder treatment has many approaches, from medication, to behavioral changes, to a combination of both. […] Bladder training and pelvic floor exercises are just two natural treatments for overactive bladder. […] Bladder training helps change the way you use the bathroom. […] Pelvic floor exercises, called Kegels, you tighten, hold, and then relax the muscles that you use to start and stop the flow of urination. […] Anticholinergic medications are widely used in the treatment of overactive bladder (OAB). […] The drugs mirabegron (Myrbetriq) and vibegron (Gemtesa) called beta-3 adrenergic agonists. […] Another type of drug for overactive bladder is the tricyclic antidepressant imipramine hydrochloride (Tofranil), which also relaxes bladder muscles. […] Botox (Onabotulinumtoxin A) can be injected into the bladder muscle, causing it to relax.

• #37 What To Do About an Overactive Bladder | News & Stories | DHMC and Clinics

  https://www.dartmouth-hitchcock.org/stories/article/what-do-about-overactive-bladder

  Do you pee frequently, particularly at night and need to go immediately? […] Many people with OAB don’t seek treatment because they feel embarrassed to discuss their symptoms, but treatment can help. […] There are four options: […] Lifestyle changes These include dietary modifications, better fluid management and behavioral changes. […] Pelvic floor physical therapy These are intended to strengthen pelvic muscles. […] Medication Be aware that some OAB medications prescribed in the past can have significant side effects. […] Advanced therapy Bladder injection therapy with Botox can reduce the number of incontinence episodes to about two to three a day, but Botox also comes with risks such as urinary tract infections for people over 30 years old. […] Another option is nerve stimulation therapies, like tibial and sacral nerve stimulation. […] For older women, OAB can be particularly difficult to treat, so be sure to contact your health provider to perform a thorough assessment to identify the right treatment for you.

• #38 Overactive bladder – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/overactive-bladder/diagnosis-treatment/drc-20355721

  A mix of treatments may be best to relieve overactive bladder symptoms. […] Behavioral therapies are the first choice in helping manage an overactive bladder. They often work and have no side effects. Behavioral therapies may include: […] Kegel exercises can help strengthen the pelvic floor muscles. […] After menopause, vaginal estrogen therapy can help strengthen the muscles and tissues in the urethra and vaginal area. Vaginal estrogen comes in creams, suppositories, tablets or rings. It can improve symptoms of overactive bladder. […] Medicines that relax the bladder can help relieve symptoms of overactive bladder and reduce episodes of urge incontinence. […] OnabotulinumtoxinA (ON-ah-boch-yoo-lih-num-tox-in-A), also called Botox, is a protein from the bacteria that cause botulism illness. Small doses shot into bladder tissues can relax the muscles and increase the amount of urine the bladder can hold.

• #39 Treatment Options for Overactive Bladder

  https://www.webmd.com/urinary-incontinence-oab/overactive-bladder-treatment-finding-best-options

  Studies have found that the lack of estrogen that occurs after menopause can affect urination, and some women are treated for OAB with estrogen. […] In rare cases when all OAB treatment fails and the overactive bladder is severe, doctors may recommend one of several types of surgery. […] A procedure called bladder augmentation uses part of the bowel to increase bladder capacity. […] Another procedure implants a small device, similar to a pacemaker, under the skin. […] The doctor places a needle on nerves near your ankle that affect bladder control. […] An overactive bladder doesn’t have to get in the way of your daily life.

• #40 Treatment Options for Overactive Bladder

  https://www.webmd.com/urinary-incontinence-oab/overactive-bladder-treatment-finding-best-options

  Overactive bladder treatment has many approaches, from medication, to behavioral changes, to a combination of both. […] Bladder training and pelvic floor exercises are just two natural treatments for overactive bladder. […] Bladder training helps change the way you use the bathroom. […] Pelvic floor exercises, called Kegels, you tighten, hold, and then relax the muscles that you use to start and stop the flow of urination. […] Anticholinergic medications are widely used in the treatment of overactive bladder (OAB). […] The drugs mirabegron (Myrbetriq) and vibegron (Gemtesa) called beta-3 adrenergic agonists. […] Another type of drug for overactive bladder is the tricyclic antidepressant imipramine hydrochloride (Tofranil), which also relaxes bladder muscles. […] Botox (Onabotulinumtoxin A) can be injected into the bladder muscle, causing it to relax.

• #41 Bladder control: Medications for urinary problems

  https://www.mayoclinic.org/diseases-conditions/urinary-incontinence/in-depth/bladder-control-problems/art-20044220

  Mirabegron is a medication approved to treat certain types of urinary incontinence. It relaxes the bladder muscle and can increase how much urine the bladder can hold. […] Injections of Botox into the bladder muscle might benefit people who have an overactive bladder or urge incontinence. Botox blocks the actions of acetylcholine and paralyzes the bladder muscle. […] Applying low-dose, topical estrogen may help. The medication comes in the form of a vaginal cream, ring or patch. The estrogen may help restore the tissues in the vagina and urinary tract to relieve some symptoms. […] Imipramine (Tofranil) is a tricyclic antidepressant. It makes the bladder muscle relax, while causing the smooth muscles at the bladder neck to contract. It may be used to treat mixed incontinence, which is a combination of urge and stress incontinence.

• #42 Bladder control: Medications for urinary problems

  https://www.mayoclinic.org/diseases-conditions/urinary-incontinence/in-depth/bladder-control-problems/art-20044220

  Duloxetine (Cymbalta, Drizalma Sprinkle) is a serotonin and norepinephrine reuptake inhibitor that is approved to treat depression and anxiety. It can help relax the muscles that control urination and improve bladder leaks in some people. […] Your health care provider can help you decide if you need medicine to treat bladder leaks. Discuss which one might be best for you.

• #43

  https://www.nhs.uk/conditions/urinary-incontinence/treatment/

  If you’ve been diagnosed with urge incontinence, one of the first treatments you may be offered is bladder training. […] While incontinence products are not a treatment for urinary incontinence, you might find them useful for managing your condition while you’re waiting to be assessed or waiting for treatment to start helping. […] If stress incontinence does not significantly improve with lifestyle changes or exercises, surgery will usually be recommended as the next step. […] However, if you’re unsuitable for surgery or want to avoid an operation, you may benefit from an antidepressant medicine called duloxetine. […] If bladder training is not effective for your urge incontinence, a GP may prescribe a medicine called an antimuscarinic, also called an anticholinergic. […] Antimuscarinics may also be prescribed if you have overactive bladder syndrome, which is the frequent urge to urinate that can happen with or without urinary incontinence.

• #44

  https://www.nhs.uk/conditions/urinary-incontinence/treatment/

  If antimuscarinics are unsuitable for you, they have not helped urge incontinence, or have unpleasant side effects, you may be offered an alternative medicine, such as mirabegron or vibegron. […] A low-dose version of a medicine called desmopressin may be used to treat nocturia, which is the frequent need to get up during the night to urinate, by helping to reduce the amount of urine produced by the kidneys.

• #45 The AUA/SUFU Guideline on the Diagnosis and Treatment of Idiopathic Overactive Bladder – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/idiopathic-overactive-bladder

  Clinicians should assess patients with OAB who have initiated pharmacotherapy for efficacy and for onset of treatment side effects. […] In patients with OAB who experience intolerable side effects or who do not achieve adequate improvement with an OAB medication, clinicians may offer a different medication in the same class or a different class of medication to obtain greater tolerability and/or efficacy. […] In patients with OAB who do not achieve adequate improvement with a single OAB medication, clinicians may offer combination therapy with a medication from a different class. […] Clinicians may offer minimally invasive procedures to patients who are unable or unwilling to undergo behavioral, non-invasive, or pharmacologic therapies. […] Clinicians may offer patients with OAB, in the context of shared decision making, minimally invasive therapies without requiring trials of behavioral, non-invasive, or pharmacologic management.

• #46 Lesson: Managing Overactive Bladder Syndrome

  https://journalce.powerpak.com/ce/managing-overactive-bladder-in-syndrome

  If monotherapy is not effective, due to their differing mechanisms of action, combination therapy with antimuscarinics and -3 agonists may provide improved symptom relief and a higher likelihood of achieving continence than using monotherapy. […] Antimuscarinic medications should be avoided in patients aged 65 years, those at increased risk of falls, and those with cognitive impairments. […] -3 agonists may be preferred over antimuscarinic medications in older women. […] Minimally invasive therapies may be preferable over noninvasive and pharmacologic therapies in some older women.

• #47 Overactive bladder syndrome: Management and treatment options

  https://www1.racgp.org.au/ajgp/2020/september/overactive-bladder-syndrome

  Conservative measures are a reasonable first-line management strategy depending on the burden of disease faced by the patient. Communication with and education of the patient, and potentially caregivers, is important with early management. […] In combination with conservative treatment, pharmacotherapy is the mainstay of treatment for OAB, with multiple anticholinergic agents and a new b3 agonist available. […] If conservative treatment and pharmacotherapy do not improve symptoms, minimally invasive treatments such as botulinum toxin A injections, sacral nerve neuromodulation and peripheral tibial nerve stimulation can be trialled. […] When conservative and minimally invasive treatments have failed, bladder augmentation cystoplasty may be considered to treat urge incontinence caused by neurogenic bladder dysfunction.

• #48 Overactive bladder – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/overactive-bladder/diagnosis-treatment/drc-20355721

  During sacral nerve stimulation, a surgically implanted device delivers electrical impulses to the nerves that regulate bladder activity. […] Surgery to treat overactive bladder is only for people with severe symptoms who don’t respond to other treatments. The goal is to improve the bladder’s ability to store urine and reduce pressure in the bladder.

• #49 Treatment Options for Overactive Bladder

  https://www.webmd.com/urinary-incontinence-oab/overactive-bladder-treatment-finding-best-options

  Overactive bladder treatment has many approaches, from medication, to behavioral changes, to a combination of both. […] Bladder training and pelvic floor exercises are just two natural treatments for overactive bladder. […] Bladder training helps change the way you use the bathroom. […] Pelvic floor exercises, called Kegels, you tighten, hold, and then relax the muscles that you use to start and stop the flow of urination. […] Anticholinergic medications are widely used in the treatment of overactive bladder (OAB). […] The drugs mirabegron (Myrbetriq) and vibegron (Gemtesa) called beta-3 adrenergic agonists. […] Another type of drug for overactive bladder is the tricyclic antidepressant imipramine hydrochloride (Tofranil), which also relaxes bladder muscles. […] Botox (Onabotulinumtoxin A) can be injected into the bladder muscle, causing it to relax.

• #50 Bladder control: Medications for urinary problems

  https://www.mayoclinic.org/diseases-conditions/urinary-incontinence/in-depth/bladder-control-problems/art-20044220

  Mirabegron is a medication approved to treat certain types of urinary incontinence. It relaxes the bladder muscle and can increase how much urine the bladder can hold. […] Injections of Botox into the bladder muscle might benefit people who have an overactive bladder or urge incontinence. Botox blocks the actions of acetylcholine and paralyzes the bladder muscle. […] Applying low-dose, topical estrogen may help. The medication comes in the form of a vaginal cream, ring or patch. The estrogen may help restore the tissues in the vagina and urinary tract to relieve some symptoms. […] Imipramine (Tofranil) is a tricyclic antidepressant. It makes the bladder muscle relax, while causing the smooth muscles at the bladder neck to contract. It may be used to treat mixed incontinence, which is a combination of urge and stress incontinence.

• #51 Urgency Urinary Incontinence (Overactive Bladder) – UChicago Medicine

  https://www.uchicagomedicine.org/conditions-services/obgyn/urogynecology/urinary-incontinence/urgency-urinary-incontinence-overactive-bladder

  Many women choose to have procedures for urgency urinary incontinence instead of, or in combination with, lifestyle treatments and medications. […] Sacral neuromodulation is a minimally invasive procedure that effectively treats urgency urinary incontinence, urgency/frequency, urinary retention and anal incontinence by providing gentle stimulation to the nerves that control the bladder and bowel. […] Onabotulinum toxin A (Botox) can be injected into the bladder muscle during an office visit. The injection relaxes the bladder muscles and is highly effective at reducing urgency urinary incontinence episodes.

• #52 What To Do About an Overactive Bladder | News & Stories | DHMC and Clinics

  https://www.dartmouth-hitchcock.org/stories/article/what-do-about-overactive-bladder

  Do you pee frequently, particularly at night and need to go immediately? […] Many people with OAB don’t seek treatment because they feel embarrassed to discuss their symptoms, but treatment can help. […] There are four options: […] Lifestyle changes These include dietary modifications, better fluid management and behavioral changes. […] Pelvic floor physical therapy These are intended to strengthen pelvic muscles. […] Medication Be aware that some OAB medications prescribed in the past can have significant side effects. […] Advanced therapy Bladder injection therapy with Botox can reduce the number of incontinence episodes to about two to three a day, but Botox also comes with risks such as urinary tract infections for people over 30 years old. […] Another option is nerve stimulation therapies, like tibial and sacral nerve stimulation. […] For older women, OAB can be particularly difficult to treat, so be sure to contact your health provider to perform a thorough assessment to identify the right treatment for you.

• #53 Overactive bladder – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/overactive-bladder/diagnosis-treatment/drc-20355721

  During sacral nerve stimulation, a surgically implanted device delivers electrical impulses to the nerves that regulate bladder activity. […] Surgery to treat overactive bladder is only for people with severe symptoms who don’t respond to other treatments. The goal is to improve the bladder’s ability to store urine and reduce pressure in the bladder.

• #54 Overactive Bladder in Women | Gynecology | Henry Ford Health – Detroit, MI

  https://www.henryford.com/services/gynecology/pelvic-disorders/overactive-bladder

  OAB medications: We offer a variety of oral medications that relax the detrusor muscle and prevent bladder contractions. […] Botulinum toxin (Botox) injections: We can inject Botox directly into your bladder wall to help relax the muscle and reduce contractions. This treatment needs to be repeated once or twice a year. […] Nerve stimulators: The tibial and sacral nerves give signals to the bladder to contract and release urine. We use innovative nerve stimulation techniques to change your bladder’s reflexes and reduce the urgent need to go. […] Surgery: If other treatments have not worked, your doctor may recommend surgery. Our experts use a variety of minimally invasive, robotic techniques to surgically treat overactive bladder.

• #55 Get Overactive Bladder Treatment | Cleveland Clinic

  https://my.clevelandclinic.org/services/overactive-bladder-treatment

  Cleveland Clinic researchers have helped develop and test unique nerve stimulation methods to treat OAB. […] Tibial nerve stimulation targets a nerve that runs from your ankle up toward your bladder. We can stimulate this nerve with a very small needle. Well repeat this half-hour, in-office procedure once a week for 12 weeks and then once a month for as long as it helps. […] Cleveland Clinic urologists have been doing this procedure for over 30 years. Well place two thin wires through the skin near your tailbone and into your sacral nerve using X-ray guidance. Then, well attach the wires to a very small temporary stimulator and tape the stimulator down near your buttock. The stimulator will send electrical signals to your sacral nerve, which can help calm signals to and from your bladder. […] If it does, we can implant the stimulator permanently during an in-office visit. The devices battery lasts 10 to 15 years.

• #56 6 OAB Treatments to Try Instead of Oral Meds | Urology Associates; CO

  https://www.denverurology.com/urology-blog/overactive-bladder-treatments/

  We provide a range of treatment options to find the best option for each of our patients. […] Lifestyle changes, also known as behavioral therapy, are often the first step when looking to manage overactive bladder. […] A vaginal pessary is a small, removable device that is inserted into the vagina to reduce OAB symptoms caused by bladder prolapse. […] Another possible treatment option for OAB is injections of Botox into the bladder muscle. […] Stimulating the bladder nerves, or neuromodulation therapy, delivers electrical pulses to the nerves to change how they work. […] InterStim Therapy uses an implantable device to send mild electrical pulses to the sacral nerve. […] Percutaneous tibial nerve stimulation (PTNS) is a nonsurgical treatment that is completed with multiple office visits. […] Surgery to treat OAB is only for those who have tried other alternative treatments without seeing an improvement. If surgery is needed, the goal is to reduce the pressure on the bladder and improve the bladders ability to store urine.

• #57 Get Overactive Bladder Treatment | Cleveland Clinic

  https://my.clevelandclinic.org/services/overactive-bladder-treatment

  Cleveland Clinic researchers have helped develop and test unique nerve stimulation methods to treat OAB. […] Tibial nerve stimulation targets a nerve that runs from your ankle up toward your bladder. We can stimulate this nerve with a very small needle. Well repeat this half-hour, in-office procedure once a week for 12 weeks and then once a month for as long as it helps. […] Cleveland Clinic urologists have been doing this procedure for over 30 years. Well place two thin wires through the skin near your tailbone and into your sacral nerve using X-ray guidance. Then, well attach the wires to a very small temporary stimulator and tape the stimulator down near your buttock. The stimulator will send electrical signals to your sacral nerve, which can help calm signals to and from your bladder. […] If it does, we can implant the stimulator permanently during an in-office visit. The devices battery lasts 10 to 15 years.

• #58 Bladder control: Medications for urinary problems

  https://www.mayoclinic.org/diseases-conditions/urinary-incontinence/in-depth/bladder-control-problems/art-20044220

  Mirabegron is a medication approved to treat certain types of urinary incontinence. It relaxes the bladder muscle and can increase how much urine the bladder can hold. […] Injections of Botox into the bladder muscle might benefit people who have an overactive bladder or urge incontinence. Botox blocks the actions of acetylcholine and paralyzes the bladder muscle. […] Applying low-dose, topical estrogen may help. The medication comes in the form of a vaginal cream, ring or patch. The estrogen may help restore the tissues in the vagina and urinary tract to relieve some symptoms. […] Imipramine (Tofranil) is a tricyclic antidepressant. It makes the bladder muscle relax, while causing the smooth muscles at the bladder neck to contract. It may be used to treat mixed incontinence, which is a combination of urge and stress incontinence.

• #59 Overactive bladder – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/overactive-bladder/diagnosis-treatment/drc-20355721

  During sacral nerve stimulation, a surgically implanted device delivers electrical impulses to the nerves that regulate bladder activity. […] Surgery to treat overactive bladder is only for people with severe symptoms who don’t respond to other treatments. The goal is to improve the bladder’s ability to store urine and reduce pressure in the bladder.

• #60 Overactive Bladder Treatment & Management: Approach Considerations, Behavioral Therapy, Pharmacologic Therapy

  https://emedicine.medscape.com/article/459340-treatment

  A combined treatment approach using behavioral and pharmaceutical interventions is effective in most patients with OAB. Several drugs that have been proven safe and efficacious in clinical trials have been approved for the treatment of OAB. Behavioral interventions, such as the following, should be part of every treatment plan: Limiting bladder irritants (eg, caffeine, alcohol), Bladder training, Urgency suppression techniques, including pelvic floor muscle exercises (consultation with a pelvic floor physical therapist may be helpful). […] Surgery is rarely used to treat OAB and is reserved for patients in whom pharmacologic and behavioral therapy fail. Various surgical options are available, including sacral nerve neuromodulation and, rarely, bladder augmentation. Percutaneous tibial nerve stimulation is a minimally invasive option for patients in whom pharmacologic therapy fails or is contraindicated.

• #61 Treatment Options for Overactive Bladder

  https://www.webmd.com/urinary-incontinence-oab/overactive-bladder-treatment-finding-best-options

  Studies have found that the lack of estrogen that occurs after menopause can affect urination, and some women are treated for OAB with estrogen. […] In rare cases when all OAB treatment fails and the overactive bladder is severe, doctors may recommend one of several types of surgery. […] A procedure called bladder augmentation uses part of the bowel to increase bladder capacity. […] Another procedure implants a small device, similar to a pacemaker, under the skin. […] The doctor places a needle on nerves near your ankle that affect bladder control. […] An overactive bladder doesn’t have to get in the way of your daily life.

• #62 Overactive bladder syndrome: Management and treatment options

  https://www1.racgp.org.au/ajgp/2020/september/overactive-bladder-syndrome

  Conservative measures are a reasonable first-line management strategy depending on the burden of disease faced by the patient. Communication with and education of the patient, and potentially caregivers, is important with early management. […] In combination with conservative treatment, pharmacotherapy is the mainstay of treatment for OAB, with multiple anticholinergic agents and a new b3 agonist available. […] If conservative treatment and pharmacotherapy do not improve symptoms, minimally invasive treatments such as botulinum toxin A injections, sacral nerve neuromodulation and peripheral tibial nerve stimulation can be trialled. […] When conservative and minimally invasive treatments have failed, bladder augmentation cystoplasty may be considered to treat urge incontinence caused by neurogenic bladder dysfunction.

• #63 Overactive Bladder | Loma Linda University Health

  https://lluh.org/conditions/overactive-bladder

  Botox, used in small doses directly injected into bladder tissues, can be an effective treatment. […] Regulating the nerve impulses to your bladder can improve overactive bladder symptoms. […] Surgery to treat overactive bladder is reserved for people with severe symptoms who don’t respond well to other treatments. […] This procedure uses pieces of your bowel to replace a portion of your bladder. […] This procedure is used as a last resort and involves removing the bladder and surgically constructing a replacement bladder (neobladder) or an opening in the body (stoma) to attach a bag on the skin to collect urine.

• #64 Overactive Bladder Treatment & Management: Approach Considerations, Behavioral Therapy, Pharmacologic Therapy

  https://emedicine.medscape.com/article/459340-treatment

  If a specific cause of overactive bladder (OAB) symptoms is identified, it should be addressed; for example, urinary tract infection (UTI) should be treated with antibiotics, while atrophic urethritis can be treated with topical application of estrogen vaginal cream. For idiopathic OAB, the three main treatment approaches are behavioral therapy, pharmacotherapy, and surgery. The choice of a particular treatment depends on the severity of the symptoms and the extent that the symptoms interfere with the patients lifestyle. […] Guidelines for the treatment of OAB by the American Urological Association (AUA) and the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction (SUFU) include the following recommendations: First-line therapy Behavioral therapies and education should be offered first; behavioral therapies may be combined with pharmacologic management. Second-line therapy Antimuscarinics (extended-release preparations should be used instead of immediate-release preparations when possible) or beta 3adrenoceptor agonists should be offered; transdermal oxybutynin may be offered. If an antimuscarinic provides inadequate symptom relief or produces unacceptable adverse effects, then dose modification, a different antimuscarinic medication, or a beta3-adrenoceptor agonist may be tried. Third-line therapy Intradetrusor injection of onabotulinumtoxinA is an option for carefully selected and thoroughly counseled patients with severe refractory OAB symptoms or those who are not candidates for second-line therapy. Other third-line options are peripheral tibial nerve stimulation (PTNS), which may be offered to carefully selected patients, and sacral neuromodulation (SNS), which is an option for carefully selected patients who are not candidates for second-line therapy or who have severe refractory OAB symptoms despite such therapy, and who are willing to undergo a surgical procedure. Fourth-line therapy In rare cases, augmentation cystoplasty or urinary diversion may be considered for severe, refractory, complicated OAB.

• #65 The AUA/SUFU Guideline on the Diagnosis and Treatment of Idiopathic Overactive Bladder – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/idiopathic-overactive-bladder

  Clinicians may offer select non-invasive therapies to all patients with OAB. […] In patients with OAB whose symptoms do not adequately respond to monotherapy, clinicians may combine one or more of the following: behavioral therapy, non-invasive therapy, pharmacotherapy, and/or minimally invasive therapies. […] Clinicians should offer antimuscarinic medications or beta-3 agonists to patients with OAB to improve urinary urgency, frequency, and/or urgency urinary incontinence. […] Clinicians should counsel patients with OAB on the side effects of all oral medication options; treatment should be chosen based on side effect profiles and in the context of shared decision-making. […] Clinicians should use antimuscarinic medications with extreme caution in patients with OAB who have narrow-angle glaucoma, impaired gastric emptying, or a history of urinary retention.

• #66 Lesson: Managing Overactive Bladder Syndrome

  https://journalce.powerpak.com/ce/managing-overactive-bladder-in-syndrome

  Antimuscarinic medications have been the mainstay of pharmacologic therapy for OAB since the early 1970s with the introduction of flavoxate (Urispas) and oxybutynin (Ditropan). […] The combination of pelvic floor exercises and other behavioral therapies with pharmacotherapy appears more effective than either approach alone. […] Medications are generally considered second line following the noninvasive, nonpharmacologic therapies described above. […] Two primary classes of medications are available for the treatment of OAB and include cholinergic muscarinic receptor antagonists (antimuscarinics) and -3 adrenergic receptor agonists (-3 agonists). […] The clinical effectiveness of both mirabegron and vibegron appears to be at least similar to that of the antimuscarinics, although -adrenergic medications may be more effective at reducing nocturia episodes.

• #67 AUA Releases Guideline on Diagnosis and Treatment of Overactive Bladder | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/0601/p800.html

  Behavioral therapies (e.g., bladder training, bladder-control strategies, pelvic floor muscle training, fluid management) should be offered as first-line therapy to all patients with overactive bladder. […] Antimuscarinic agents may be used in combination with behavioral strategies. […] Limited evidence suggests that initiating behavioral and pharmacologic therapy simultaneously may improve outcomes, including frequency, voided volume, incontinence, and symptom distress. […] Second-line therapies for overactive bladder include oral antimuscarinics (e.g., darifenacin [Enablex], fesoterodine [Toviaz], oxybutynin [Ditropan], solifenacin [Vesicare], tolterodine [Detrol], trospium [Sanctura]). […] If symptoms are not adequately controlled or if adverse effects become intolerable with one antimuscarinic agent, the dosage should be modified or a different agent should be tried.

• #68 Overactive bladder syndrome Management and treatment options

  https://www.racgp.org.au/afp/2012/november/overactive-bladder-syndrome

  Bladder training has been found to reduce daily urinary frequency and lower daily urinary incontinence compared to antimuscarinics alone. […] In the primary care setting, patients presenting with typical overactive bladder symptoms can be treated empirically with an antimuscarinic agent and obtain clinical benefit without the need for invasive urodynamic procedures. […] If treatment with an antimuscarinic fails due to inadequate symptom control or unacceptable adverse effects, a second antimuscarinic (or duloxetine) can be trialled before considering second or third line therapies and a urological opinion. […] Intravesical botulinum toxin A (BoNT/A) prevents acetylcholine release at the neuromuscular junction, resulting in temporary chemodenervation and muscle relaxation for up to 6 months.

• #69 Lesson: Managing Overactive Bladder Syndrome

  https://journalce.powerpak.com/ce/managing-overactive-bladder-in-syndrome

  If monotherapy is not effective, due to their differing mechanisms of action, combination therapy with antimuscarinics and -3 agonists may provide improved symptom relief and a higher likelihood of achieving continence than using monotherapy. […] Antimuscarinic medications should be avoided in patients aged 65 years, those at increased risk of falls, and those with cognitive impairments. […] -3 agonists may be preferred over antimuscarinic medications in older women. […] Minimally invasive therapies may be preferable over noninvasive and pharmacologic therapies in some older women.

• #70 What To Do About an Overactive Bladder | News & Stories | DHMC and Clinics

  https://www.dartmouth-hitchcock.org/stories/article/what-do-about-overactive-bladder

  Do you pee frequently, particularly at night and need to go immediately? […] Many people with OAB don’t seek treatment because they feel embarrassed to discuss their symptoms, but treatment can help. […] There are four options: […] Lifestyle changes These include dietary modifications, better fluid management and behavioral changes. […] Pelvic floor physical therapy These are intended to strengthen pelvic muscles. […] Medication Be aware that some OAB medications prescribed in the past can have significant side effects. […] Advanced therapy Bladder injection therapy with Botox can reduce the number of incontinence episodes to about two to three a day, but Botox also comes with risks such as urinary tract infections for people over 30 years old. […] Another option is nerve stimulation therapies, like tibial and sacral nerve stimulation. […] For older women, OAB can be particularly difficult to treat, so be sure to contact your health provider to perform a thorough assessment to identify the right treatment for you.

• #71 Overactive Bladder in Children Treatment & Management: Approach Considerations, Behavioral Therapy, Medical Care

  https://emedicine.medscape.com/article/459696-treatment

  Initial management of overactive bladder (OAB) involves a behavioral and cognitive approach. The child and caregiver must be educated on normal bladder and sphincter function. Dietary changes are helpful in some children, particularly those who drink caffeinated or acidic fluids and those with increased fluid intake. […] Pharmacologic treatment is initiated if behavioral therapy fails or symptoms are severe. Surgical treatment may be considered if behavioral therapy and pharmacologic therapy fail. […] Voiding regimens are instituted in all children with OAB. Voiding is recommended every 2-3 hours while the child is awake. […] In children who do not empty their bladder completely (increased postvoid residual volume), the practitioner should institute a double voiding regimen, whereby the child voids and then waits a minute or two and tries to void again, to improve bladder emptying.

• #72 Overactive Bladder in Children Treatment & Management: Approach Considerations, Behavioral Therapy, Medical Care

  https://emedicine.medscape.com/article/459696-treatment

  In children who fail to improve with such voiding regimens, biofeedback-assisted therapy and pharmacologic therapy are the next treatment options. […] The use of anticholinergic therapy in the management of OAB is predicated on the concept that parasympathetic-mediated stimulation of muscarinic receptors (M3 primarily) in the bladder leads to detrusor overactivity. Anticholinergic/antimuscarinic agents have been demonstrated to increase bladder capacity, to improve bladder compliance, and to decrease uninhibited detrusor contractions. […] Currently, the most commonly used anticholinergic for the treatment of OAB in children is extended-release oxybutynin (Ditropan XL). […] If behavioral therapy fails or the child has severe symptoms, pharmacologic therapy is instituted. […] Solifenacin (Vesicare), an agent commonly used in adults, was studied in small series of children.

• #73 Overactive Bladder in Children Treatment & Management: Approach Considerations, Behavioral Therapy, Medical Care

  https://emedicine.medscape.com/article/459696-treatment

  Mirabegron is a beta 3 adrenoreceptor agonist that facilitates relaxation of the bladder. […] Intravesical injection of botulinum toxin is currently being used to treat pediatric detrusor overactivity, particularly cases with a neurogenic cause. […] Although neuromodulation is used more commonly in adults, this treatment approach has been used in children in whom behavioral and pharmacologic therapy fails. […] Surgical procedures such as bladder augmentation or autoaugmentation are rarely needed in children with idiopathic OAB but may be indicated in children with neurogenic OAB refractory to medical therapy.

• #74 The AUA/SUFU Guideline on the Diagnosis and Treatment of Idiopathic Overactive Bladder – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/idiopathic-overactive-bladder

  Clinicians should assess patients with OAB who have initiated pharmacotherapy for efficacy and for onset of treatment side effects. […] In patients with OAB who experience intolerable side effects or who do not achieve adequate improvement with an OAB medication, clinicians may offer a different medication in the same class or a different class of medication to obtain greater tolerability and/or efficacy. […] In patients with OAB who do not achieve adequate improvement with a single OAB medication, clinicians may offer combination therapy with a medication from a different class. […] Clinicians may offer minimally invasive procedures to patients who are unable or unwilling to undergo behavioral, non-invasive, or pharmacologic therapies. […] Clinicians may offer patients with OAB, in the context of shared decision making, minimally invasive therapies without requiring trials of behavioral, non-invasive, or pharmacologic management.

• #75 The AUA/SUFU Guideline on the Diagnosis and Treatment of Idiopathic Overactive Bladder – American Urological Association

  https://www.auanet.org/guidelines-and-quality/guidelines/idiopathic-overactive-bladder

  In patients with OAB who have an inadequate response to, or have experienced intolerable side effects from, pharmacotherapy or behavioral therapy, clinicians should offer sacral neuromodulation, percutaneous tibial nerve stimulation, and/or intradetrusor botulinum toxin injection. […] Clinicians should only recommend chronic indwelling urethral or suprapubic catheters to patients with OAB when OAB therapies are contraindicated, ineffective, or no longer desired by the patient and always in the context of shared decision-making due to risk of harm. […] Clinicians may offer patients with BPH and bothersome OAB, in the context of shared decision-making, initial management with non-invasive therapies, pharmacotherapy, or minimally invasive therapies. […] Clinicians should offer patients with BPH and OAB monotherapy with antimuscarinic medications or beta-3 agonists, or combination therapy with an alpha blocker and an antimuscarinic medication or beta-3 agonist.

• #76 Bladder control: Medications for urinary problems

  https://www.mayoclinic.org/diseases-conditions/urinary-incontinence/in-depth/bladder-control-problems/art-20044220

  Mirabegron is a medication approved to treat certain types of urinary incontinence. It relaxes the bladder muscle and can increase how much urine the bladder can hold. […] Injections of Botox into the bladder muscle might benefit people who have an overactive bladder or urge incontinence. Botox blocks the actions of acetylcholine and paralyzes the bladder muscle. […] Applying low-dose, topical estrogen may help. The medication comes in the form of a vaginal cream, ring or patch. The estrogen may help restore the tissues in the vagina and urinary tract to relieve some symptoms. […] Imipramine (Tofranil) is a tricyclic antidepressant. It makes the bladder muscle relax, while causing the smooth muscles at the bladder neck to contract. It may be used to treat mixed incontinence, which is a combination of urge and stress incontinence.

• #77 Overactive Bladder (OAB): Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/14248-overactive-bladder

  Pelvic floor exercises and changes to your lifestyle may take six to eight weeks before you start to see results. […] Lifestyle adjustments can help reduce your risk of developing an overactive bladder. […] Treatment can be challenging to manage, and symptoms may never completely disappear. But many people are satisfied with the treatment they receive and often experience a dramatic improvement in their quality of life.

• #78 Overactive Bladder: Symptoms, Treatment, Medications & Causes

  https://www.emedicinehealth.com/overactive_bladder/article_em.htm

  A new class of medication called beta-3 adrenergic agonists may result in less dry mouth and constipation and anticholinergic medications. […] The insertion of nerve stimulators has been approved for treating overactive bladder, which is refractory (unresponsive) to other more common therapies mentioned above. […] Traditional surgery is rarely used in treating overactive bladder and is reserved for cases unresponsive to all other forms of therapy. Reconstructive bladder surgery is the most commonly performed procedure. […] Generally, the prognosis for overactive bladder is favorable. A majority of individuals with this condition are successfully treated via behavioral and medical therapies.

• #79 Overactive Bladder Treatment – Brigham and Women’s Hospital

  https://www.brighamandwomens.org/obgyn/urogynecology/overactive-bladder

  Women with OAB commonly experience a sudden and strong desire (urgency) to urinate that cannot be delayed. […] OAB is a chronic condition like diabetes and high blood pressure. The treatment is long term, but good control is achievable. Many women with OAB also have stress urinary incontinence (loss of urine with cough, sneeze, or activity). Treatment options below may help both incontinence subtypes. […] Timed toileting: Going to the bathroom at regular intervals, except when asleep, will help empty the bladder better and reduce urine loss. […] Pelvic floor physical therapy can also help those who experience pelvic pain, constipation, and difficulty emptying the bladder. […] Commonly used medications for OAB are known as anticholinergics. […] Vaginal estrogen (in the form of a cream, tab, or ring) is a commonly prescribed treatment for OAB. […] PTNS is designed to treat OAB symptoms by slowing down and softening signals to and from the bladder. […] In this procedure, Botulinum toxin (Botox) is injected into the muscle which wraps around the bladder. […] Interstim may help patients who have failed nonsurgical treatments.

• #80 Overactive bladder syndrome: Management and treatment options

  https://www1.racgp.org.au/ajgp/2020/september/overactive-bladder-syndrome

  Overactive bladder (OAB) is a common syndrome characterised by unstable bladder contractions, resulting in urinary urgency, frequency and nocturia. First-line treatment comprises conservative measures including weight reduction, a decrease in exposure to bladder stimulants, fluid optimisation and pelvic floor exercises. Pharmacological treatments for OAB include anticholinergic medications such as oxybutynin. If the patient is unresponsive to pharmacological treatment, a review by a urology specialist is appropriate. Recommendations may include minimally invasive procedures such as intravesical botulinum toxin A injections, reserving the invasive procedures for patients in specific circumstances. […] Once a diagnosis of OAB has been made, most patients can progress through a stepwise treatment path from conservative options to medical and finally surgical treatments. Each step should be trialled for a period of at least four weeks. Following progression to the next step of the treatment regimen, it is critical to continue the preceding steps.

• #81 Overactive Bladder (OAB): Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/14248-overactive-bladder

  Overactive bladder is a collection of symptoms that may affect how often you pee and your urgency. Treatment includes changing certain behaviors, medications and nerve stimulation. […] Different treatments can help fix your overactive bladder. Treatments may include changing certain behaviors, medications and nerve stimulation (neuromodulation). […] You can make many changes to your behavior to help fix your overactive bladder. […] Managing your weight can reduce pressure on your bladder, which may contribute to bladder control problems. […] Yes, nerve stimulation can help improve OAB. Your nerves help tell your brain that your bladder is full. By treating your nerves, you can improve your bladder control. […] A healthcare provider may prescribe medication. Medications can help restore normal bladder function. Commonly prescribed medications for overactive bladder include: Anticholinergic medications help regulate muscle spasms in your bladder.

• #82 Treatment Options for Overactive Bladder

  https://www.webmd.com/urinary-incontinence-oab/overactive-bladder-treatment-finding-best-options

  Studies have found that the lack of estrogen that occurs after menopause can affect urination, and some women are treated for OAB with estrogen. […] In rare cases when all OAB treatment fails and the overactive bladder is severe, doctors may recommend one of several types of surgery. […] A procedure called bladder augmentation uses part of the bowel to increase bladder capacity. […] Another procedure implants a small device, similar to a pacemaker, under the skin. […] The doctor places a needle on nerves near your ankle that affect bladder control. […] An overactive bladder doesn’t have to get in the way of your daily life.

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