Best Medication Options for an Overactive Bladder

Overactive bladder (OAB) is a common condition that affects approximately 30% of men and 40% of women in the United States. Symptoms caused by an overactive bladder can be bothersome and cause embarrassment, lowering the quality of life as it can affect many life aspects. Behavioral interventions, lifestyle changes, medications, and surgical procedures can be used to manage OAB symptoms. Please continue reading to find out what causes OAB, risk factors, symptoms, diagnosis, and the best medications for OAB treatment.

What are the symptoms of an overactive bladder?

Overactive bladder is a condition in which you have a sudden urge to urinate, frequent urination (8 or more times in a 24-hour period), nocturia (waking up more than twice at night to urinate), and urgency urinary incontinence (urine leakage because you can’t make it to the bathroom on time). While mild overactive bladder symptoms are usually manageable, severe symptoms can be disruptive to life.

Why does overactive bladder syndrome occur?

Normally, when urine is present in the urinary bladder, and you reach bladder capacity, nerve signals to the brain trigger the urge to urinate. When you are urinating, nerve signals cause the bladder muscles to contract (squeeze) while the bladder neck, urinary sphincter, and pelvic floor muscles start to relax, allowing urine to flow out.

Overactive bladder occurs when the signals between the brain and the bladder are not working properly. This causes the bladder to empty even when it’s not full. OAB can also cause the bladder muscles to be hyper-active causing bladder muscles to contract even when there is only a small amount of urine in the bladder. These involuntary contractions of the bladder muscles cause overactive bladder symptoms such as urinary urgency and urge urinary incontinence or urgency incontinence.

What causes overactive bladder?

Some of the conditions that can contribute to overactive bladder include:

Hormonal changes in menopausal women.
Lower urinary tract infections (symptoms similar to OAB symptoms).
Tumors or stones in the bladder.
Diabetes.
Neurological disorders that can affect bladder function, such as stroke or multiple sclerosis.
Conditions that cause urinary obstruction, such as constipation, enlarged prostate gland, or prior surgery for urinary incontinence.

What are the risk factors for an overactive bladder?

The following can increase your risk overactive bladder:

Certain medications, such as diuretics (water pills) that cause your body to make more urine and your bladder to fill rapidly, causing leakage.
Caffeine or alcohol intake.
Declining cognitive function with age that can make it difficult to respond to signals from the brain to urinate.
Mobility problems, which can result in difficulty getting to the bathroom on time.
Incomplete bladder emptying due to prior history of pelvic or spinal cord injury, pelvic trauma.

How do doctors diagnose OAB?

Doctors can diagnose an overactive bladder based on your history, physical examination, urine tests (urinalysis), neurological exam, bladder function tests with urodynamic testing to determine the bladder’s ability to hold and store urine, bladder scan to measure the remaining amount of urine after urinating, and cystoscopy to determine if there are any bladder abnormalities that can cause OAB. In some cases, a biopsy can be used for further testing.

What is the first-line treatment for overactive bladder?

The first-line treatments for reducing OAB symptoms are anticholinergic medications, behavioral strategies, and alternative treatments such as pelvic floor exercises and acupuncture to improve bladder control. Even though anticholinergic drugs are very effective at controlling the symptoms of an overactive bladder, lifestyle interventions also play a crucial role in OAB treatment, in addition to one major advantage, which is their lack of adverse effects.

Non-pharmacological therapies

Pelvic floor exercises

Pelvic floor exercises, also called Kegel exercises, these exercises help to strengthen the urinary sphincter and pelvic floor muscles, thereby stopping the involuntary bladder muscle contractions that cause an overactive bladder. A healthcare professional can instruct you on how to properly do Kegel exercises. Doing pelvic floor physical therapy regularly may cause you to experience incontinence and other OAB symptoms less frequently.

Biofeedback

This is a type of therapy in which electrical sensors are used to measure certain parameters, such as heart rate, breathing pattern, muscle response, etc. The biofeedback instructor teaches you to make subtle changes to strengthen your pelvic muscles for improved bladder control when you develop urgency.

Scheduled trips to the toilet

Urinating on schedule, for example, every 2-4 hours, helps you empty your bladder and prevents the urge to urinate and other symptoms from developing.

Bladder training

This is an OAB treatment in which you delay voiding when you develop the urge to urinate. You start with small delays, such as 15-30 minutes, and gradually increase to 3-4 hours. Bladder training works well in conjunction with pelvic floor exercises so that you are able to contract (squeeze) your pelvic floor muscles and increase bladder capacity gradually to successfully delay urination.

Absorbent pads

If an overactive bladder is affecting your quality of life, you can consider wearing absorbent pads or garments to prevent accidents. These products are available in various sizes and absorbency levels. They can help you reduce inconvenient and embarrassing incidents while you are receiving treatments for OAB.

Intermittent urinary catheterization

If you have trouble emptying your bladder, you may benefit from intermittent catheterization. Your doctor can tell you if this approach is appropriate for you.

Acupuncture

Research suggests that there are potential benefits from using acupuncture for the treatment of overactive bladder. This involves placing very fine needles in specific parts of the body.

Herbal remedies

No herbal remedies have been proven to help with the symptoms of overactive bladder.

What can a urologist do for treating overactive bladder?

If the above behavioral interventions and lifestyle changes do not give you relief, your primary care physician or urologist may prescribe the following OAB drugs:

Vaginal estrogen therapy in postmenopausal women to support and strengthen the tissues in the urethral and vaginal areas.
Antimuscarinics (anticholinergic drugs) that relax the bladder muscle, for example, tolterodine (Detrol, Detrol LA), oxybutynin (Ditropan XL tablet, Oxytrol skin patch, or Gelnique gel), darifenacin (Enablex), trospium (Sanctura XR), and solifenacin (Vesicare), fesoterodine (Toviaz).
Antispasmodics that improve bladder control and reduce urine leakage, for example, fesoterodine (Toviaz).
Beta-3 adrenergic agonists that prevent urgent or frequent urination, for example, mirabegron (Myrbetriq).

These drugs can cause side effects such as dry eyes, dry mouth, and constipation. While increasing your fluid intake may exacerbate OAB, you can use eyedrops to keep your eyes moist, suck on sugar-free candy or gum to manage dry mouth, and eat a fiber-rich diet or use stool softeners to avoid constipation. Talk to your doctor if you experience bothersome side effects that do not go away. The extended-release forms of these medications may cause fewer side effects than their immediate counterparts. Keep in mind that these medications may not be the right choice if you have urinary retention, glaucoma, and certain gastrointestinal disorders.

Botox injections

OnabotulinumtoxinA (brand name Botox) injections can be used to relax the bladder muscles and prevent them from contracting. This treatment may be recommended for severe urge urinary incontinence. The effects of the injections are temporary, and repeat treatments are needed every 4-6 months. Possible side effects include urinary retention and the need for self-catheterization.

Sacral nerve stimulation (InterStim therapy)

This is a minimally invasive neuromodulation therapy in which a thin wire is placed close to the sacral nerves near your tailbone as they make their way to your bladder. A temporary wire is placed first, and a hand-held device is connected to the wire, which delivers electrical pulses to your bladder. If the results are positive, a permanent electrode is put in place for sacral neuromodulation (to regulate nerve impulses with periodic electrical stimulation) to improve OAB symptoms.

Percutaneous tibial nerve stimulation (PTNS)

In this procedure, a thin needle is placed near your ankle, which delivers electrical pulses to the tibial nerve in the leg, which transmits the electrical stimulation to the spine and nerves that control your bladder. The initial series of PTNS treatments is given once weekly for 12 weeks, followed by maintenance treatments every 3-4 weeks to keep symptoms of overactive bladder under control.

Surgical procedures

Your urologist may recommend surgery as a last resort to control urination and treat OAB if you have severe symptoms that do not respond to other treatments. Surgical procedures may include:

Surgery to increase bladder capacity by using pieces of the bowel to replace parts of the bladder. After this procedure, you may need to perform intermittent catheterization lifelong to release urine from your bladder.
Surgical bladder removal which involves removing your natural urinary bladder and creating an opening in the skin with a bag attached to collect urine or constructing a replacement bladder.

What is a new medication for an overactive bladder?

A new beta-3 adrenergic agonist called vibegron (brand name Gemtesa) was approved by the U.S. Food and Drug Administration (FDA) in April 2021 for the treatment of OAB in adults. Mirabegron (Myrbetriq) is another beta-3 adrenergic that has been available for about 10 years. This is a once-daily 75-mg oral tablet that relaxes the bladder muscle and increases the bladder’s ability to store urine.

How to manage overactive bladder naturally?

An effective treatment plan for overactive bladder includes lifestyle changes such as:

Maintaining a healthy weight and losing weight if you are overweight or obese.
Drinking enough water (check with your doctor how much fluid is appropriate - too much fluid can worsen OAB symptoms, and too little fluid can lead to concentrated urine and bladder irritation).
Limiting intake of foods and drinks that can irritate the bladder, such as alcohol, coffee, tea, carbonated drinks, citrus fruit juices, spicy foods, tomatoes, and chocolate.

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