These can help with lifestyle tweaks alone aren’t enough.
First things first: If you suspect you have symptoms of overactive bladder, you should know that treatment likely won’t start with medication. Your first line of defense will be lifestyle tweaks for better bladder health, and your doctor can help you learn and implement them.
For many people with OAB, behavior modifications like doing Kegel exercises properly, avoiding bladder-irritating foods, or adjusting your water intake are enough to improve symptoms. However, some patients may continue to struggle with like urgency and incontinence despite the tweaks—and that’s where medications enter the conversation.
“If [patients] have engaged the behavior modifications to the best extent possible, and they’ve gone to the physical therapist, and they’ve engaged in stabilizing exercises and pelvic floor exercises, and they’re still having significant problems … it might be time to consider medications,” says Lauri Romanzi, MD, a urogynecologist in New York City.
The Types of Medications for Overactive Bladder
The most common OAB meds fall into three categories, according to Dr. Romanzi: tricyclic antidepressants, anticholinergic agents, and beta agonists.
Tricyclic antidepressants are one of the original medication options for OAB. They act on the central nervous system and the lower urinary tract to decrease spasms in the bladder. “By stabilizing the chemical balance in the brain, it calms down the overactive bladder,” says Dr. Romanzi.
Anticholinergic agents are a category of medications that “work directly on cholinergic receptors in the bladder that are activated when your bladder in urinating,” says Dr. Romanzi. These receptors are responsible for the urge of having to urinate; without them, you’d just have a full bladder, without the perceptible urge.
Beta-3 agonists work through the sympathetic nerves to relax the smooth muscle tissue in the bladder. This is the newest treatment option for OAB, and there is only one type so far—mirabegron—which received approval by the Food and Drug Administration in 2012.
Finding the Right Medication for OAB
The best medication for OAB depends on your symptoms, medical history, age, and toleration of side effects.
“You’re almost always balancing the side effects of the medication against the patient’s overall health,” says Dr. Romanzi. Doctors will typically start with the lowest dose, which can help limit side effects, and then increase the dosage if necessary.
Although many people with OAB can treat the symptoms on their own with lifestyle modifications, severe OAB often requires medication, or more. “Severe overactive bladder that doesn’t respond to medication usually needs botox or neuromodulation bladder pacemaker,” says Dr. Romanzi. Learn more about botox for OAB here.
Of course, OAB tends to be progressive, so seeking treatment early can help you avoid these more extreme treatments. Here are tips to talk to your doctor about overactive bladder.
Dr. Romanzi is a urogynecologist and reconstructive pelvic surgeon based in New York City.
00:00:00,255 --> 00:00:03,442
00:00:03,442 --> 00:00:08,042
If they've engaged the behavior
modifications to the best extent possible,
00:00:08,042 --> 00:00:11,039
and they've gone to
the physical therapists, and
00:00:11,039 --> 00:00:16,126
they've engaged in stabilizing exercises
and pelvic floor exercises, and they're
00:00:16,126 --> 00:00:21,720
still having significant problems that are
causing big quality of life difficulties.
00:00:21,720 --> 00:00:24,158
It might be time to consider medications.
00:00:24,158 --> 00:00:27,738
00:00:27,738 --> 00:00:32,272
There are three categories of medications
that can be use to treat overactive
00:00:32,272 --> 00:00:32,988
00:00:32,988 --> 00:00:38,140
The oldest are certain antidepressant
medications can significantly improve
00:00:38,140 --> 00:00:44,730
overactive bladder symptoms by stabilizing
the chemical balance in the brain.
00:00:44,730 --> 00:00:47,560
It calms down the overactive bladder.
00:00:47,560 --> 00:00:51,890
The second are the anticholinergic group.
00:00:51,890 --> 00:00:53,260
These are far more common.
00:00:53,260 --> 00:00:55,400
There are seven or eight different kinds.
00:00:55,400 --> 00:01:01,360
The anticholinergics work directly on
cholinergic receptors in the bladder.
00:01:01,360 --> 00:01:04,990
That are activated when
your bladder is urinating.
00:01:04,990 --> 00:01:08,060
The sensation of urinating
would not happen
00:01:08,060 --> 00:01:10,900
if you didn't have these
00:01:10,900 --> 00:01:13,800
Your bladder would just sit there
being full and nothing would happen.
00:01:15,100 --> 00:01:19,330
There's a newer third class called beta
agonist drugs that relax the smooth
00:01:19,330 --> 00:01:23,550
muscle of the bladder through a different
receptor called the beta receptors.
00:01:23,550 --> 00:01:28,860
It's similar to the way asthma medications
work by relaxing the smooth muscle
00:01:28,860 --> 00:01:35,600
in the bronchia and the lungs, but
this one works in the bladder muscle.
00:01:35,600 --> 00:01:37,840
And right now, there's only one,
00:01:37,840 --> 00:01:39,860
we'll have other options in the future.
00:01:39,860 --> 00:01:43,490
Picking the right medication for
overactive bladder is very individual.
00:01:43,490 --> 00:01:46,380
It depends on the patient's
health profile, their age,
00:01:46,380 --> 00:01:48,790
sometimes their gender.
00:01:48,790 --> 00:01:53,530
And if they've responded, or had problems
in the past, any of the medications.
00:01:53,530 --> 00:01:57,970
You're almost always balancing the side
effects of the medication against
00:01:57,970 --> 00:02:00,340
the patient's overall health.
00:02:00,340 --> 00:02:05,030
And also, starting with
the lowest dose and titrating up.
00:02:05,030 --> 00:02:08,880
Severe overactive bladder
usually needs medication.
00:02:08,880 --> 00:02:12,750
And severe over active bladder that
doesn't respond to medication usually
00:02:12,750 --> 00:02:16,400
needs Botox or
a neuromodulation bladder pacemaker.
00:02:16,400 --> 00:02:18,143
The earlier you come in,
00:02:18,143 --> 00:02:23,213
the more likely you are to be able to
avoid those more extreme therapies.
00:02:23,213 --> 00:02:27,497
Bragg B, Hebel D, Vouri SM, Pitlick JM. Mirabegron: a beta-3 agonist for overactive bladder.
Jayarajan J, Radomski SB. Pharmacotherapy of overactive bladder in adults: a review of efficacy, tolerability, and quality of life. Res Rep Urol. 2014;6:1-16.