Overactive Bladder Treatments
Agents that relax the detrusor or prevent a bladder contraction are effective for OAB and urge incontinence. Acetylcholine is a chemical released from nerves supplying the bladder that acts at muscarinic receptors to trigger a bladder muscle contraction, thereby producing urination. The detrusor expresses muscarinic (acetylcholine binding) M3 and M2 receptor subtypes. Antimuscarinics are used to treat OAB and urge incontinence and they include: darifenacin, hysoscyamine, oxybutynin, solefenacin, tolterodine and trospium. Although these pharmacologic agents are used as first line treatment options, side effects limit long term compliance.
In addition to drug therapies for OAB and urinary incontinence, behavioral regimens have been shown to reduce incontinence and urinary frequency. These regimens range from simple maneuvers such as timed or prompted urination and fluid management to biofeedback. Pelvic muscle exercises (Kegel exercises) are beneficial in appeasing urge incontinence, and can be done alone or in combination with antimuscarinic drugs. Also, patients may want to change certain aspects of their diets (e.g., decreasing caffeine or alcohol intake), lose weight and stop smoking.
Additional options exist when drugs and behavioral therapies fail to improve symptoms in patients with OAB and urge incontinence. Electrical stimulation of nerves or regions of the skin, vagina or rectum innervated by the lower spinal cord can reduce OAB and urge incontinence. Percutaneous tibial nerve stimulation weekly for several weeks has been reported to show encouraging results. The two stage sacral nerve stimulation technique using the InterStim neuromodulation device has been reported to be effective in many patients refractory to medical therapy. A new emerging option for the treatment of refractory cases of OAB is called biological neuromodulation. Early reports with the use of Botulinum Toxin injected directly to the bladder wall are very encouraging. It is now the subject of further research scrutiny.
Surgery to enlarge the bladder - called augmentation cystoplasty - can be considered when the bladder is extremely small or generates high pressure. This is major surgery with potential complications and should be attempted as a last resort. Other surgeries such as neurolysis to cut the nerves supplying the bladder are rarely performed. In some women with OAB and urinary incontinence who also exhibit vaginal prolapse (e.g., cystocele, enterocele) and stress urinary incontinence, correction of these conditions can improve the overactive bladder.
Information provided by the American Urological Association.