Having an overactive bladder can be a debilitating condition, with symptoms that can range from frequent urination to urinary incontinence. However, overactive bladder treatment is available to help relieve symptoms. Treatment can include behavioral approaches, neuromodulation therapies, and medications. Depending on the cause, overactive bladder can be idiopathic, or may be associated with other medical conditions. The most effective treatments are personalized to meet the needs of each patient. A combination of behavioral measures and medications is often more effective than either alone.
The Vanderbilt University Evidence-Based Practice Center conducted a systematic review of studies on OAB. It searched the PubMed database and EMBASE for studies addressing OAB. They excluded studies that had fewer than 50 participants or were not relevant. They also searched CINAHL for relevant studies. They also screened studies that were published in English. They included studies with a randomized, double-blind design and were conducted in at least one center.
The first type of treatment is behavioral approaches, which aim to change the patient’s environment and behavior. These techniques include pelvic floor muscle training and Kegel exercises. These methods change the way patients hold their urine and postpone the urge to void. These methods can be combined with biofeedback to help patients learn how to better control their pelvic floor muscles.
The second type of treatment is neuromodulation, which involves the use of a wire, called an Interstim, that is placed in the lower back or buttocks. The Interstim wire sends an impulse to the bladder nerves. This treatment is offered to patients who have failed nonsurgical approaches. It is a two-step procedure that is performed in the office. The first step involves a small electrode that is placed near the ankle. The second step involves a battery-powered stimulator that sends the impulse through the leg nerve to the innervation of the bladder. It is a very effective treatment for OAB.
In order to develop optimal clinical practices for the treatment of OAB, the American Urological Association Education and Research Inc. (AUA) established a panel in 2009. Members of the panel include urologists, researchers, and other clinicians with specific expertise in this disorder. They were selected by the panel chair, and they received no remuneration for their work.
The final guideline was submitted to the Practice Guidelines Committee of the AUA. The panel also reviewed comments from 31 peer reviewers. It was then revised as needed, and the final version was submitted to the AUA Board of Directors.
Behavioral treatments for OAB include pelvic floor muscle training and Kegel training. These methods help patients learn to control their bladder muscles and postpone the urge to void. The most effective programs have multiple components, including bladder retraining, behavioral training, and pelvic floor muscle training. In addition to behavioral treatments, some patients may also be prescribed medication, such as onabotulinumtoxinA (OnabotulinumtoxinA), Darifenacin, and fesoterodine. They are effective treatments for OAB and usually provide good symptom relief.
Surgical interventions should be reserved for patients with idiopathic overactive bladder or other nonneurogenic bladder pathologies. Those patients who have had success with nonsurgical therapies may need to be referred to a specialist. The specialist will ask for a voiding diary, symptom questionnaires, and urodynamic testing to rule out other bladder pathologies. The specialist may also order a urethral dysfunction test, which can be performed by inserting a thin, flexible telescope through the urethra to assess the walls of the urethra.