Overactive bladder causes urinary urgency, increased frequency, and urgency urinary incontinence. When an initial course of behavioral management has been completed without adequate symptom control, a defined next-line pharmacological approach is indicated.
First-line management includes bladder training, timed voiding, urgency suppression techniques, fluid management, avoidance of bladder irritants (such as caffeine and alcohol), pelvic floor muscle training, and select non-invasive therapies. Escalation to pharmacotherapy is warranted when these measures fail to produce meaningful improvement in urinary urgency, frequency, or urgency urinary incontinence.
This protocol employs oral pharmacotherapy to address urinary urgency, frequency, and urgency urinary incontinence. The specific medication class and formulation considerations — including guidance on preferred formulation type — are detailed in the full regimen.
The clinical target is meaningful improvement in urinary urgency, frequency, and/or urgency urinary incontinence. Response and tolerability are reassessed within 4–8 weeks of initiating pharmacotherapy.
DOI: 10.1097/JU.0000000000003985
Clinicians should offer antimuscarinic medications or beta-3 agonists to patients with OAB to improve urinary urgency, frequency, and/or urgency urinary incontinence.
ER formulations for antimuscarinic medications are superior to immediate release formulations for decreasing side effects and should be used preferentially.
The Panel recommends that patients should be assessed within 4 – 8 weeks after initiating OAB pharmacotherapy for efficacy of the treatment as well as the onset of side effects.
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