With overactive bladder (OAB), a person may need to use the bathroom often or experience urine leakage. Yet various treatments can help manage the condition.

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In this Behind the Counter, Dr. Joseph Brito delves into the different treatment options for OAB, including medications, behavioral therapy, lifestyle changes, and even botulinum toxin (Botox).

A person may purchase oxybutynin (Ditropan, Oxytrol) over the counter as a transdermal patch. In this form, a patch containing the medication attaches to the person’s skin.

Oxybutynin, an anticholinergic medication, interferes with the ability of smooth muscle to contract. This decreases bladder muscle function and results in fewer urges to urinate.

Though companies may market several herbs and supplements for OAB symptoms, scientists have not gathered enough evidence to support their use.

In addition, some of these supplements contain proprietary ingredients that the Food and Drug Administration (FDA) has not evaluated.

People susceptible to urinary tract infections (UTIs) often use cranberry to prevent recurrence. In one 2021 study, people with OAB symptoms reported improvements after taking dried cranberry powder for 24 weeks.

However, researchers need to conduct more studies to better understand this connection.

OAB medications broadly fall into two categories based on the way they work: antimuscarinic or anticholinergic agents and beta-3 agonists.

Medications in the antimuscarinic group include:

  • oxybutynin (Ditropan, Oxytrol)
  • solifenacin (VESIcare)
  • tolterodine (Detrol)
  • trospium (Sanctura)

Side effects include:

  • dry mouth
  • constipation
  • sleepiness
  • dizziness

A large study from 2020 suggests people who take these medications may also have a higher risk of dementia than those taking beta-3 agonists.

Mirabegron (Myrbetriq) and vibegron (Gemtesa) are two available beta-3 agonists for OAB. For mirabegron, potential side effects include high blood pressure, headache, increased heart rate, and UTI. Vibegron, a newer agent, appears to have fewer side effects.

Behavioral therapy can include:

  • dietary modification
  • pelvic floor muscle training
  • bladder management strategies

Bladder training involves making a diary of voiding (urinating) episodes and volumes, then slowly increasing the time between voids. This may also involve waiting a bit to void when a person feels the urge.

Timing fluid intake can help as well. For instance, a person can avoid drinking large volumes if going for a drive or before bed. Some individuals try to urinate on a schedule (every couple of hours) to avoid urgency episodes.

In addition, pelvic floor physical therapists can work with individuals on pelvic muscle toning, as well as relaxation techniques to minimize incontinence episodes.

A lot of OAB management comes down to lifestyle.

Certain foods and drinks can worsen symptoms, such as coffee, alcohol, spicy foods, and chocolate. Cutting back on these items or avoiding them altogether can make a big difference for some people.

Smoking, having obesity, and drinking carbonated beverages can also worsen symptoms. Weight loss and smoking cessation may help OAB symptoms and benefit overall health.

A 2016 study suggests that sleep apnea can increase OAB symptoms and that by treating sleep apnea with a CPAP device, bladder symptoms can improve.

Pelvic floor exercises can help strengthen and condition the pelvic musculature. Some people with OAB may experience urge-related incontinence, leaking small or sometimes large volumes of urine when the urge to urinate comes on strong and they do not have time to make it to the bathroom.

Increasing pelvic muscle strength can lead to an increase in the tone of a person’s urethral sphincters (two muscles that control the release of urine through the urethra). This may provide more protection against leakage.

On the other hand, relaxation techniques can help ensure people empty their bladders completely when urinating. Functional capacity of the bladder decreases if a person carries extra urine around in their bladder, which can then decrease the time it takes for the bladder to feel full.

Botox comes from the bacteria Clostridium botulinum, which makes several different neurotoxins. For the bladder, doctors use onabotulinatoxinA.

As the authors of a 2020 research review explain, it works by blocking acetylcholine release at the nerve ganglion level, which prevents bladder muscle contraction.

During a simple office-based or operating room procedure, a healthcare professional inserts a cystoscope (a thin tube with a light and camera on the end) into the urethra. They then inject Botox into the bladder wall in a grid-like fashion.

However, the effects of the toxin wear off over the course of 3–6 months. According to a 2017 meta-analysis, studies have shown that this method leads to significant reductions in incontinence episodes, urgency, and frequency.

Alternatives to medications include:

  • Botox injection, as described above
  • peripheral tibial nerve stimulation (PTNS)
  • sacral neuromodulation

PTNS stems from the same principles as acupuncture. Initial treatment protocol usually involves 12 weekly sessions for 30 minutes each, sometimes followed by maintenance treatments.

Sacral neuromodulation involves a two-step operation to implant a device into a person’s upper buttock area. This device sends electrical signals to electrodes placed at the S3 nerve roots. Though doctors have widely adopted the procedure for its efficacy, they don’t know exactly how it works, according to a 2016 review.

In extreme cases, doctors may consider making the bladder larger, known as augmentation, or (rarely) complete bladder removal.

Overactive bladder is not a disease but a collection of symptoms, so it is not “curable.” That said, the majority of people with OAB can manage their symptoms and see improvement.

A person’s doctor can work with them to identify and modify any underlying factors triggering their symptoms.

People should also work with a doctor to distinguish OAB from other processes that require a cure, such as cystitis (UTI) or even bladder cancer. Individuals with bothersome symptoms that do not improve should speak with their physician or a urologist to start an appropriate treatment plan.

Dr. Joseph Brito is a Healthline advisor, urologist at Yale Medicine, and assistant professor of urology at the Yale School of Medicine. He completed medical school at George Washington University in Washington, D.C., and residency at Brown University in Providence, RI, followed by a clinical fellowship in urologic oncology at Yale. He practices primarily in New London, CT.