Treatment of Overactive Bladder in Females

Initial Evaluation

A comprehensive medical history focusing on bladder symptoms, including urgency, frequency, nocturia, and incontinence, is essential for the initial evaluation of overactive bladder in females, as recommended by the American Urological Association 2, 3
Physical examination to identify contributing factors such as pelvic organ prolapse or genitourinary syndrome of menopause is a crucial part of the initial evaluation, according to the American Urological Association 2, 4
Urinalysis to exclude urinary tract infection and hematuria is a necessary diagnostic test, as suggested by the American Urological Association 2, 5
Post-void residual measurement in patients with risk factors, such as emptying symptoms, history of retention, neurologic disorders, or prior incontinence surgery, is recommended by the American Urological Association 2, 6

The American Urological Association recommends bladder training, including timed voiding and gradual extension of voiding intervals, as a first-line treatment for overactive bladder in females 1, 2
Pelvic floor muscle training to improve urge suppression techniques is a recommended behavioral therapy, according to the American Urological Association 1, 2
Fluid management, including optimizing timing and volume of fluid intake, is an essential component of behavioral therapies, as suggested by the American Urological Association 1, 3
Weight loss for obese patients, with a goal of 8% weight loss, can reduce urgency incontinence episodes by 42%, according to the American College of Physicians 1, 8

The American Urological Association recommends beta-3 adrenergic agonists, such as mirabegron, as a second-line treatment for overactive bladder in females due to their lower cognitive risk 3, 2
Antimuscarinic medications, including darifenacin, fesoterodine, oxybutynin, solifenacin, tolterodine, or trospium, are alternative second-line treatments, according to the American Urological Association 1, 6

The American Urological Association advises using antimuscarinic medications with caution in patients with narrow-angle glaucoma, impaired gastric emptying, or history of urinary retention 1, 6
Post-void residual greater than 250-300mL warrants caution when using antimuscarinic medications, as recommended by the American Urological Association 6, 5

The American Urological Association notes that most patients experience significant symptom reduction rather than complete resolution with treatment for overactive bladder in females 1, 2
Combination of behavioral and pharmacologic therapies may provide better outcomes than either alone, according to the American Urological Association 1, 3