Treatment
for Overactive Bladder
The Agency for Health Care Policy and Research’s
(AHCPR) position on treating patients for urinary incontinence
involves
a stepped strategy moving from least to more intensive or invasive
treatments. Behavioral techniques are the first choice in most cases.
Pharmacologic treatments are the next step for patients needing more
help. Surgical techniques are recommended only after first trying
behavioral and pharmacologic treatments.
Some behavioral and surgical treatments used with OAB
include:
- Pelvic floor muscle rehabilitation
- Bladder retraining
- Fluid restrictions
- Surgery
- Electrical stimulation
- Supportive measures (absorbent pads and
undergarments)
- Catheterization
When behavioral methods alone
are unsuccessful, bladder suppressant medications may be added. Although
medications
usually do not completely eliminate the symptoms of OAB, they can reduce urinary
frequency and incontinence episodes. The choice of drug is based
upon efficacy, side effects, and any comorbid conditions of the
patient.
Pharmacologic
therapies for OAB are chosen for their calming effects on the bladder
or their effects of tightening the external sphincter. Pharmacologic
agents currently used in the treatment of OAB include:
- anticholinergics/antimuscarinics
- tricyclic antidepressants
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