Which treatments really work for overactive bladder?

Although it doesn't come up often in conversation, overactive bladder is a common problem for women. 17% of women experience overactive bladder symptoms, which is a sudden urge to urinate. Some women have difficulty stopping urinating and even loss of urine (incontinence). What can women do to treat this problem? Perhaps the most common treatments are a class of drugs called "antimuscarinic medications" such as Oxybutynin. An estimated 8.1 million women in the US take these medications for overactive bladder. But what if the medications don't work? Or if you don't want to take a drug? Are there other treatment options? A new systematic review analyzed 99 studies on alternative treatments for overactive bladder. Here's what they learned.

First, why not just use antimuscarinic medications? In short- they are not perfect, and they don't help everyone. Many women experience bothersome side effects from the drugs, are unsatisfied with the results, and find it difficult to keep taking them every day. Side effects can include dry mouth, blurry vision, constipation, confusion, and dizziness. Newer research shows that these drugs often only reduce the number of episodes of urgent urination by 2 per day. If you're rushing to the bathroom 10 times a day, 8 doesn't seem much better! New treatment alternatives include various forms of physical therapy, behavioral therapy, new medications, neuromodulation, electrical or magnetic stimulation, and even Botox.

After sifting through almost 3,000 studies on overactive bladder, Dr. Olivera and his colleagues chose the best 99 studies on alternative treatments. Here, I'll review physical therapy modalities, sacral neuromodulation, and Botox. But, to learn more, their excellent systematic review can be found here.

Physical Therapy. Physical Therapy modalities are some of the best researched treatment alternatives for overactive bladder. Four different studies showed physical therapy can improve both subjective (participants' reports of symptom severity) and objective outcomes (like muscle strenghth and amount of urine leakage), compared to not doing physical therapy. Two trials tested physical therapy head-to-head against antimuscarinic medications. One of these studies found similar results with physical therapy and the medications, and the other study found that the medication results in fewer symptoms.

A whopping six studies explored physical therapy with or without biofeedback or electrical stimulation. Biofeedback physical therapy utilizes little electrodes placed on muscles, hooked up to a computer screen. When the muscle tenses, a signal pops up on the computer screen. That way, the patient gets feedback on when a certain muscle is tensing. Electrical stimulation involves electrodes placed on the muscles that emit a gentle impulse that causes the muscle to contract. In general, these studies showed that adding biofeedback or electrical stimulation to physical therapy improves outcomes over physical therapy alone.

Sacral Neuromodulation. The sacral nerve lives under your tailbone. It has branches that help the body know when the bladder is full. Research has shown that the brains of people with overactive bladder receive abnormal signals about bladder fullness. (Hence needing to run to the bathroom all the time!) In sacral neuromodulation, an electrode sends tiny electrical stimulation signals to an area near the sacral nerve. This stimulation mimics the nerve firing. Experiencing this extra stimulation helps to "modulate" the abnormal signals the brain is usually receiving from the sacral nerve. 

In two studies, researchers compared sacral neuromodulation to no treatment. In one study, sacral neuromodulation resulted in improvement in symptoms like urinary urgency and incontinence, and in overall quality of life. In the other study, patients reported the same number of bathroom trips per day whether or not they received the treatment. One study compared sacral neuromodulation to antimuscarinic medications and found that sacral neuromodulation improved incontinence, leakage, bladder muscle strength, and quality of life.

Botox. Most of us think of curing wrinkles when we hear Botox. But- this muscle-paralyzing toxin is proving to be useful in treating a wide range of disorders. Injecting Botox into  key muscles in the pelvis is believed to stop aberrant muscle activity and restore order. One study showed that Botox improved urinary urgency, frequency, and quality of life compared to fake injections. A second study compared Botox to antimuscarinic medications and showed a similar reduction in incontinence. More patients who received Botox reported feeling they were cured than those using the medication.

As you can see, we are just scratching the surface on the ways to treat this very common and bothersome problem. Overall, there is no clear "winner" or "cure-all" but rather a growing list of treatment options. Each individual will likely react differently to each type of therapy, meaning it can take a while to find the "right" treatment. We want to hear from you! Have you ever tried/prescribed any of these therapies? Did they help you/ your patient?