Managing Overactive Bladder with Incontinence

Behavioral Therapies

• The American Urological Association recommends offering stress management as a recognized behavioral therapy to all patients with overactive bladder (OAB) 1
• Stress management is a recognized behavioral therapy that can help manage stress-triggered urgency episodes, and techniques such as urgency suppression, mindfulness practices, and bladder training can be effective 1
• Behavioral therapies can be layered with pharmacotherapy (beta-3 agonists or antimuscarinics) if symptoms warrant, and non-invasive therapies like pelvic floor muscle training may address both physical and psychological components 1, 2

Treatment Approaches

• The current guideline framework emphasizes shared decision-making rather than rigid stepwise progression, allowing for combination therapy approaches that combine behavioral therapies with other treatments simultaneously 1, 2
• Addressing psychological factors is part of optimizing comorbidities, which is a standard treatment category for OAB management, and considering referral to mental health services may be necessary 2

Patient Education and Expectations

• Explain that behavioral therapies require patient adherence and compliance to maintain durable effects, and discuss that stress management is a long-term strategy, not a quick fix 1
• Emphasize that multiple treatment modalities working together typically provide better outcomes than any single approach, and ensure that patients understand the importance of a comprehensive treatment plan 1