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.