Healthcare professionals may suggest bladder training and lifestyle approaches as the first-line treatment for older adults with overactive bladder (OAB). If symptoms persist, treatment may involve medications.
OAB refers to a group of urinary symptoms that include a frequent or urgent need to urinate and urinary incontinence. The condition may also affect a person’s quality of life, as it can interfere with mental well-being, sleep quality, and daily activities.
Older age is a risk factor for OAB, and the symptoms may become more severe with age.
Healthcare professionals may first suggest nonpharmacological treatment for OAB in older adults. If a person’s symptoms do not improve, treatment can include medications such as antimuscarinic agents. However, these may cause unpleasant side effects in older people.
This article looks at different types of treatments for OAB in older adults. It also discusses tips for caregivers of older adults with OAB.
Bladder training is typically the first-line treatment for older adults with OAB. It involves using methods like pelvic floor exercises or crossing the legs to delay urination when the urge to urinate occurs.
A person usually aims to delay urination for 5 to 15 minutes at the start, and gradually increases this span. The practice trains the bladder to hold a higher volume of urine for longer stretches of time, which may eventually reduce the severity of OAB symptoms.
Another method of bladder training includes timed voiding, in which a person urinates according to a
Lifestyle approaches may improve OAB symptoms and overall health and well-being.
A health professional may recommend the following:
- minimizing or avoiding bladder-irritating substances, such as:
- maintaining a moderate weight
- eating a healthy diet
- drinking six to eight glasses of water a day, stopping two hours before bedtime
- stopping smoking
- getting enough physical activity
Incontinence products may help improve the quality of life for older adults with OAB. However, they are not usually a sustainable or long-term solution.
The United Kingdom’s National Health Service (NHS) notes that these products may be most beneficial for people awaiting assessment before treatment for OAB. They include:
If a person’s symptoms do not improve or resolve with nonpharmacological treatment, a doctor may prescribe medication.
Antimuscarinics, also known as anticholinergics, are one of the main types of OAB medication. They block the action of a specific neurotransmitter, which prevents involuntary muscle movements in the body. They also inhibit the frequent urge to urinate.
Some types of antimuscarinics for OAB include:
- darifenacin (Enablex)
- oxybutynin (Ditropan XL)
- tolterodine (Detrol)
- solifenacin (Vesicare)
- fesoterodine (Toviaz)
A doctor will not typically prescribe antimuscarinics to older adults as a first-line treatment, as they may cause severe side effects. Research from 2020 notes that these medications may cause or accelerate cognitive decline in older people, so healthcare professionals typically recommend other medications.
Common adverse effects include constipation, urinary retention, and dry mouth.
In people ages 65 years and older, adverse effects include:
- an increased risk of falls
- drowsiness
- confusion
- memory and learning impairments
- general cognitive decline
- a decline in physical function
- an increased risk of dementia
The NHS notes that other medications to help with OAB include:
- mirabegron (Myrbetriq) and vibegron (Gemtesa), which help the bladder muscles relax
- duloxetine (Cymbalta), which is an antidepressant that may also help increase muscle tone in the urethra
- desmopressin (Nocdurna), which reduces urine production in the kidneys and may help treat nocturia, the frequent urge to urinate during the night
If first-line treatment and medications do not improve or resolve the symptoms, a doctor may suggest a procedure or surgery. These include:
- Botulinum toxin (Botox) injections: A doctor may inject Botox into the bladder walls to relax the bladder, which may improve OAB symptoms.
- Percutaneous sacral nerve stimulation: During the procedure, a doctor inserts a device into one of the buttocks. The NHS notes that the device uses electrical signals to stimulate the sacral nerve in the back, which helps prevent the muscle surrounding the bladder from contracting too often.
- Posterior tibial nerve stimulation: In this procedure, a doctor inserts a needle into the ankle and uses an electric signal to stimulate the tibial nerve in the leg. This may help control the urge to urinate.
- Augmentation cystoplasty: In rare instances, a doctor may recommend an augmentation cystoplasty. In this procedure, a surgeon enlarges the bladder by adding intestinal tissue to the bladder wall. A person may permanently require a catheter to urinate after the surgery.
- Urinary diversion: In a urinary diversion procedure, a doctor redirects the tubes that connect the kidneys and bladder to the outside of the body. The urine then flows from the kidneys into a bag, rather than into the bladder.
- Indwelling catheterization: A doctor may insert a catheter that remains in place permanently. Overflowing urine flows through the catheter into a bag outside the body.
Heathcare professionals may first recommend nerve stimulation procedures or Botox. They will only recommend surgical procedures for severe OAB.
The following tips may help caregivers assist practically and help protect the dignity of older adults with OAB:
- offering patient and compassionate responses if urinary incontinence occurs
- accompanying them to the doctor to learn about their treatment options
- reminding older adults with cognitive issues to take their medication and use the toilet
- helping with hygiene and incontinence products, if necessary
- helping to manage their diet and fluid intake
- encouraging bladder training exercises and other behavioral and physical therapies
- helping them set and maintain a urination schedule
- helping them access medical care when necessary
Bladder training and lifestyle approaches are usually the first-line treatments for OAB in older adults. If their symptoms do not respond, a doctor may suggest medication.
Medications that a doctor would typically prescribe to treat OAB may cause severe adverse effects in older adults. These include cognitive decline and an increased risk of falls. For this reason, nonpharmacologic treatments are preferable.
If a person’s symptoms do not improve with other types of treatment, they may require a procedure or surgery. These include Botox injections into the bladder wall, urinary diversion, and bladder nerve stimulation.
A healthcare professional can help work out which treatments may work best on an individual basis.