Treatment for OAB
Treatment for OAB may include one or more of the following:
- Bladder retraining
- Medication (e.g., oral medicines, transdermal medicines)
- Sacral nerve stimulation
Bladder Training with Timed Voiding to Treat OAB
This treatment may be used for urge and overflow incontinence. The patient keeps a voiding diary of all episodes of urination and leaking, and the physician analyzes the chart and identifies the pattern of urination. The patient uses this timetable to plan when to empty the bladder to avoid accidental leakage. In bladder training, biofeedback and Kegel exercise help the patient resist the sensation of urgency, postpone urination, and urinate according to the timetable.
Medications used to treat overactive bladder include antimuscarinics (e.g., oxybutynin chloride [Ditropan®], tolterodine [Detrusitol®, Detrol LA®]) and newer drugs, such as trospium chloride (Sanctura®), derifenacin (Enablex®), solifenacin (Vesicare®), fesoterodine fumarate (Toviaz), and the beta-3 adrenergic agonist mirabegron (Myrbetriq®). These medications relax the smooth muscle of the bladder, reducing detrusor contraction and subsequent wetting accidents, often within 2 weeks. They are taken orally, usually once a day, for overactive bladder.
Side effectsincluding dry mouth, constipation, headache, blurred vision, dry eyes, hypertension, drowsiness, urinary retention, and othersdepend on which medication is prescribed and occur in approximately 20 percent of those who use these medications. Oral OAB medications should be used with caution in patients with certain types of kidney, liver, stomach, and urinary problems. Due to an increased risk for narrow-angle glaucoma, an ophthalmologist should be consulted before using OAB medications. Women who are pregnant should not take these medicines without consulting a physician.
Toviaz is available in extended-release tablets. The usual dosage of the drug is 4 mg, which can be increased to 8 mg if necessary. Mirabegron (Myrbetriq) was approved by the FDA in 2012 to treat OAB in adults. In clinical trials, this drugwhich is available as an extended-release tablet taken once a day in strengths of 25 mg, 50 mg and 100 mgreduced wetting accidents and frequency of urination. At the 50 mg dose, mirabegron also improved the storage capacity of the bladder. Mirabegron is not recommended for patients with uncontrolled high blood pressure or severe liver or kidney disease.
The oxybutynin transdermal system (Oxytrol®) is a thin, flexible, clear patch that is applied to the skin of the abdomen or hip, twice weekly, to treat overactive bladder. This treatment delivers oxybutynin continuously through the skin into the bloodstream and relieves symptoms for up to 4 daysallowing twice a week dosing. The first over-the-counter (OTC) form of this medicationOxytrol for Womenwas approved by the FDA in January 2013 for use in women over the age of 18. At this time, Oxytrol is available for men by prescription only.
In January 2009, oxybutynin chloride gel (Gelnique) received FDA approval to treat overactive bladder. This gel is applied once daily to the skin of the thigh, abdomen, or shoulder and delivers a consistent dose of oxybutynin through the skin for 24 hours. Side effects of Gelnique include adverse skin reactions, dry mouth, and urinary tract infection (UTI).
Botox to Treat OAB
In January 2013, the FDA approved onabotulinumtoxin A (Botox) to treat adults with overactive bladder who do not experience adequate results with medication. In this treatment, a series of Botox injections are administered directly into the bladder using cystoscopy. Botox can help relax the bladder and increase its storage capacity, reducing OAB symptoms.
People who receive this treatment should talk to their health care provider about taking antibiotics before, during and after, to help prevent urinary tract infection (UTI). Side effects include painful urination, urinary retention (incomplete emptying of the bladder), and UTI.
Sacral Nerve Stimulation to Treat OAB(also called sacral nerve neuromodulation [SNM])
InterStim® therapy is a reversible treatment for people with urge incontinence caused by overactive bladder who do not respond to behavioral treatments or medication. InterStim is an implanted neurostimulation system that sends mild electrical pulses to the sacral nerve, the nerve near the tailbone that influences bladder control muscles. Stimulation of this nerve may relieve the symptoms related to urge incontinence.
Prior to implantation, the effectiveness of the therapy is tested on an outpatient basis with an external InterStim device. For a period of 3 to 5 days, the patient records voiding patterns that occur with stimulation. The record is compared to recorded voiding patterns without stimulation. The comparison demonstrates whether the device effectively reduces symptoms. If the test is successful, the patient may choose to have the device implanted.
The procedure usually is performed using local anesthesia and intravenous (IV) sedation. A lead (special wire with electrical contacts) is placed near the sacral nerve and is passed under the skin to a neurostimulator, which is about the size of a stopwatch. The neurostimulator is placed under the skin in the upper buttock.
Adjustments can be made at the doctor's office with a programming device that sends a radio signal through the skin to the neurostimulator. Another programming device is given to the patient to further adjust the level of stimulation, if necessary. The system can be turned off at any time.
Possible adverse effects include the following:
- Change in bowel function
- Lead movement
- Pain at implant sites
- Unpleasant stimulation or sensation
Surgery to Treat OAB
Surgical augmentation of the bladder is reserved for people who do not benefit from bladder retraining or medication.
Those who cannot take medication due to medical conditions or intolerance may find incontinence management devices helpful.