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How to Manage Your Overactive Bladder

Medically reviewed on Mar 29, 2018 by L. Anderson, PharmD

What Exactly is Overactive Bladder?

More than 33 million Americans suffer from overactive bladder. Overactive bladder (OAB) is a common condition that can affect up to roughly 40% of women in their lifetime. OAB can lead to urinary incontinence - the loss of bladder control, an embarrassing problem.

Those with OAB, also called urge incontinence, experience a sudden, strong urge to urinate during the day and night; they may also leak urine before getting to the restroom.

OAB results in someone needing to urinate more than the usual 7 to 8 times per 24 hours. Therefore, OAB symptoms usually consist of four symptoms:

  • an urgent need to urinate
  • a need to urinate more frequently than normal
  • waking from sleep to urinate
  • urgency incontinence (urine leakage).

OAB is not due to effects from a urinary tract infection or from a neurologic condition such as multiple sclerosis.

Is Overactive Bladder (OAB) the Same as Stress Incontinence?

No. Stress incontinence occurs when pelvic muscles, located beneath the bladder, are not strong enough. These muscles cannot handle any pressure being exerted on the bladder, and this leads to urine leaking.

Stress incontinence may occur when someone is sneezing, lifting heavy items, laughing, or coughing. Pregnancy and after childbirth is also a time when stress incontinence may be bothersome, and it may continue to be a problem long after childbirth.

Urgency incontinence is another name for overactive bladder (OAB). Stress incontinence and OAB can also occur together, known as mixed incontinence.

Other types of incontinence include overflow incontinence and functional incontinence.

How Will I Know if a Urinary Tract Infection is Causing My Symptoms?

Leaking of urine, whether a small or large amount of urine, is the main symptom of incontinence due to overactive bladder (OAB).

OAB can also lead to leakage during sleep. Urine leakage due to a urinary tract infection (UTI) is usually a short-term problem, but visit your doctor as you may need an antibiotic.

If urine leakage is accompanied by the following symptoms, you may have a UTI.

  • Pain or a burning sensation during urination; a fever
  • Pink or red urine discoloration
  • A strong urine odor or cloudy urine
  • Stomach or back pain
  • Frequent urination

How is an Overactive Bladder Diagnosed?

If you are experiencing overactive bladder (OAB) symptoms, and especially if they interfere with your normal routines like sleep, work or leisure time, see your doctor.

Leaking urine at any age is not normal. Do not feel ashamed or embarrassed to mention these symptoms to your doctor; OAB is a common condition for which many women seek treatment. You will not be the first.

What happens during my doctor visit for overactive bladder?

  • Your medical history will be reviewed
  • You may be asked to keep a voiding dairy for a few days
  • A neurologic and pelvic exam will be done
  • Your doctor may check your urine for signs of a urinary tract infection (UTI).
  • Depending upon your results, imaging tests like a CT or MRI may be needed to determine if your OAB is due to a nerve injury.

What Treatments are Suggested for OAB?

For women who suffer with overactive bladder (OAB) symptoms treatment options include:

  • Pelvic muscle exercises
  • Bladder management techniques
  • Prescription and over-the-counter medications
  • Surgery
Obesity, older age, excessive caffeine intake, smoking and lack of exercise may be OAB risk factors.

Kegel exercises which strengthen the pelvic muscles can improve symptoms, especially in stress incontinence.

Bladder retraining, such as scheduled bladder emptying, behavioral modification, and fluid management can also be useful for OAB.

What is Fluid Management for OAB?

It is important not to severely restrict fluids for overactive bladder (OAB) as this could lead to dehydration. However, most people need roughly 4 to 8 eight ounce glasses of fluid per day; more may be required with exercise, hot weather, or excessive perspiration.

It's true that cutting back on fluids may help with leakage and embarrassing moments. However, if you do not drink enough liquids, your urine may become dark and concentrated and dehydration may occur.

One option is to drink small amounts at regular intervals throughout the day, instead of a large glass all at once. If you awaken frequently at night to urinate, avoid fluids right before bed, and cut back on alcohol and caffeine.

If you take a diuretic for high blood pressure, take it in the morning rather than at night, to help prevent nighttime trips to the bathroom.

Which Medications Are Used for OAB?

Your doctor may use multiple strategies to relieve your overactive bladder (OAB) symptoms.

In addition to the exercises and behavioral modifications, many medications are available; one is even available over-the-counter.

Extended-release forms may cause less dry mouth as a side effect.

Medications include:

Tolterodine (Detrol, Detrol LA)

Detrol and Detrol LA are brand names of tolterodine, approved to treat overactive bladder (OAB) with symptoms of urinary frequency, urgency, and incontinence (urine leakage). Tolterodine acts as an antispasmodic on the bladder muscles to lessen the symptoms of OAB.

Detrol and Detrol LA are both available in cost saving generics. The extended-release formulation is given once daily, and the immediate-release is given twice-a-day.

Common side effects include constipation, dry mouth, headache, or drowsiness. If serious allergic reactions - like swelling of your lips, throat or face, difficultly breathing or swallowing, itch, or rash appear, call 911 immediately.

Tolterodine should be avoided in patients with a heart rhythm condition (arrhythmia) due to possible worsening of their condition (QT prolongation).

Oxybutynin (Ditropan, Ditropan XL, Oxytrol, Oxytrol For Women, Gelnique)

Oxybutynin is available in many different dose forms, both over-the-counter and by prescription.

Prescription Ditropan and Ditropan XL (both also available generically) are tablet formulations.

Gelnique is a prescription gel form applied to the skin (transdermal) once daily.

In 2013, the first over-the-counter (OTC) treatment for overactive bladder (OAB) in women, Oxytrol For Women, was FDA approved. Oxytrol For Women is a patch applied to the skin every four days; Oxytrol is still available with a prescription, too, but it much more costly unless your insurance covers it. Cost for a one month supply of OTC Oxytrol for Women can vary but is roughly $35 at retail outlets.

Both versions have the same formulation and same dosage strength, but the nonprescription Oxytrol for Women is only indicated for women 18 years of age or older. For any other use, including in men, a prescription is needed.

Oxytrol side effects include skin irritation, dry mouth, and constipation. Transdermal delivery of oxybutynin by gel or patch may reduce side effects.

Trospium (Sanctura, Sanctura XR)

Sanctura and Sanctura XR (extended-release form) are known generically as trospium, and both forms are available in a cost-saving generic form. The tablets are taken either once or twice a day, and should be taken on an empty stomach one hour before meals.

As with other many drugs used to treat overactive bladder (OAB), trospium can cause side effects such as:

  • constipation
  • dry mouth
  • drowsiness
  • blurred vision
  • headache.

A severe, but uncommon allergic side effect that may require emergency treatment is angioedema -- a swelling of the face, lips, tongue, and throat. Angioedema can be life-threatening. STOP the medication and call 911 if this reaction occurs.

Solifenacin (VESIcare)

VESIcare (solifenacin), first approved in 2004, is taken by mouth in tablet form once a day. Generic solifenacin has been approved by the FDA, too, but may not yet be available in pharmacies.

Like all of the oral muscarinic antagonists used for overactive bladder, side effects like dry mouth, blurred vision, and drowsiness may occur.

If you have any kind of heart rhythm electrical issue, such as atrial fibrillation, you may need to avoid VESIcare due to worsening of your heart condition. It is important you do not use muscarinic antagonists like VESIcare if you have any form of gastric (stomach) retention, narrow-angle glaucoma, or urine retention.

Darifenacin ER (Enablex)

Enablex (darifenacin), an extended-release tablet given once a day, was approved in 2004. A generic is on the market, too.

Due to the common anticholinergic side effects that occur with this drug class, constipation may be severe, so check with your doctor if this problem arises. If you have liver disease you may need a lower dose of Enablex; if you have severe liver disease you should not use Enablex.

In addition, Enablex undergoes breakdown in the liver and can lead to multiple drug interactions, so always have your doctor or pharmacist check for interactions.

Mirabegron (Myrbetriq)

The use of overactive bladder (OAB) medications can be a problem for patients who are sensitive to side effects like dry mouth, constipation, and blurred vision.

Myrbetriq (mirabegron) by Astellas Pharma is an oral, extended-released tablet FDA-approved in 2012.

Myrbetriq works by a new mechanism of action to stimulate beta-3 receptors, causing bladder muscle relaxation and improved bladder storage.

Myrbetriq side effects include high blood pressure and the risk for urinary retention in patients receiving other antimuscarinic agents for OAB or with bladder outlet obstruction. Myrbetriq can also result in serious drug interactions, so have your pharmacist run a drug interaction check.

OnabotulinumtoxinA (Botox)

Botox (onabotulinumtoxinA) is approved to treat overactive bladder (OAB) when typical anticholinergic agents do not work well, cannot be taken, or if side effects interfere with therapy. It is also used for overactivity associated with a Neurologic Condition. It takes roughly 2 weeks for symptoms to subside.

One Botox dose, which requires injection into the bladder muscle via a special procedure, lasts for up to 6 months.

In treating OAB, the most common side effects are urinary tract infection, painful or difficult urination, and a temporary inability to fully empty the bladder.

In clinical trials, about 6 out of every 100 patients were unable to fully empty their bladder following Botox treatment. If this happens, you may have to temporarily use a disposable self-catheter to drain urine. Talk to your doctor about this possibility, and other Botox side effects.

How long does a Botox injection last? In studies, on average, patients who received a second injection, received it in 169 days (roughly 24 weeks). A reinjection should not occur any sooner than 12 weeks from the prior bladder injection.

Fesoterodine (Toviaz)

Toviaz (fesoterodine) by Pfizer is a muscarinic antagonist (anticholinergic) agent used for overactive bladder (OAB). Toviaz is available in 4 and 8 milligram (mg) extended-release tablets taken once-a-day.

If you have an allergy to tolterodine (Detrol, Detrol LA), you should not take Toviaz as it is chemically-related.

Patients who take certain drugs such as ketoconazole, itraconazole, and clarithromycin should not use the 8 mg dose due to a specific drug interaction with an enzyme system called cytochrome P450 3A4. The dosage of fesoterodine should not exceed 4 mg/day when used with potent CYP450 3A4 inhibitors.

Common side effects with Toviaz include dry mouth, constipation, blurred vision, dizziness, drowsiness, and decreased sweating.

Generics for Toviaz are not expected until 2019 or later.

Desmopressin acetate (Noctiva)

In March 2017, the FDA approved first treatment for frequent urination at night due to overproduction of urine.

Serenity's Noctiva (desmopressin acetate) is for adults who wake up at least twice per night to urinate due to a condition known as nocturnal polyuria (overproduction of urine during the night). It's classified as a vasopressin analog, in nasal spray form, and is used once daily 30 minutes before going to bed.

Noctiva, an anti-diuretic, reduces urine production. In two, 12-week studies looking at its effectiveness, patients treated with Noctiva had at least one fewer night-time urination.

Common side effects included:

  • nasal discomfort or congestion
  • sneezing
  • high blood pressure
  • back pain
  • nose bleeds
  • bronchitis
  • dizziness

Noctiva contains a boxed warning for low sodium levels in the blood (hyponatremia), which if severe, can be life-threatening.

Many Americans Struggle With Incontinence

There is a wide array of overactive bladder (OAB) treatments, and an FDA report discusses overactive bladder (OAB) and it's implication on health.

OAB can have a negative impact on social, family and work routines. Experts state that patients need to take the first step to seek advice from their doctor to determine whether their symptoms are due to OAB (or another condition) and which treatment is the best. Be sure to discuss any possible side effects and cost of prescribed medications.

If you have OAB, know that you are not alone. OAB is common in older women (about 50%), but roughly 25% of older men suffer from its effects, too.

If you suffer from symptoms of OAB, consider talking to your healthcare provider about treatment options.

Also, you might enjoy joining the Drugs.com Overactive Bladder Support Group to ask questions, keep up with research, and voice your opinion and experience with medications.

Finished: How to Manage Your Overactive Bladder

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Sources

  • Urology Care Foundation. American Urological Foundation. What is Overactive Bladder (OAB)? Accessed March 29, 2018 at https://www.urologyhealth.org/urologic-conditions/overactive-bladder-(oab)
  • FDA Approves Noctiva (desmopressin acetate) Nasal Spray for Nocturia in Adults. Drugs.com. Accessed March 29, 2018 at https://www.drugs.com/newdrugs/fda-approves-noctiva-desmopressin-acetate-nasal-nocturia-adults-4495.html
  • Lukacz E, et al. Patient education: Urinary incontinence in women (Beyond the Basics). Updated Dec. 12, 2017. Accessed March 29, 2018 at https://www.uptodate.com/contents/urinary-incontinence-in-women-beyond-the-basics
  • Urology Care Foundation. American Urological Foundation. What is urinary incontinence? Accessed March 29, 2018 at http://www.urologyhealth.org/urologic-conditions/urinary-incontinence
  • Overactive Bladder a Common Problem, FDA Says. Drugs.com. Accessed March 29, 2018 at https://www.drugs.com/news/overactive-bladder-common-problem-fda-says-55305.html
  • Diagnosis and Treatment of Overactive Bladder (Non-Neurogenic) in Adults: AUA/SUFU Guideline. Accessed March 29, 2018 at http://www.auanet.org/guidelines/overactive-bladder-(oab)-(aua/sufu-guideline-2012-amended-2014)

Further information

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