New Clinical Practice Guidelines for Overactive Bladder

The American Urological Association (AUA) issued new guidelines today for the treatment of overactive bladder. Overactive bladder (OAB) is described by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) as having to void or empty the bladder more than 8 times in a day or more than 2-3 times/night. Strong, sudden urges occur with OAB and may or may not be accompanied by urinary leakage. The first line of treatment recommended by the AUA includes behavioral therapy as well as possible combining of anti-muscarinic therapy (the only FDA-approved medication for overactive bladder.)

Behavioral therapy for bladder dysfunction is commonly instructed as part of a symptom management strategy by pelvic rehabilitation providers. Patients are instructed in normal bladder function, dietary factors that influence the bladder, bladder habits, the influence of medications on bladder function, in addition to pelvic muscle training. Behavioral therapy is one component, and a very important one at that, of the comprehensive care for the patient with bladder dysfunction.

Second line treatments discussed in the updated guideline all relate to medications and their potential uses and risks. Recommended third line treatments suggest more invasive options including tibial nerve stimulation and sacral nerve stimulation, which are both FDA-approved options. The guidelines are based on expert opinion as well as on research. As reported in prior posts about overactive bladder, more research is required to better define the symptom complex and more consistency within the research is needed in regards to definitions throughout the research.The AUA also has guidelines for other male and female urologic conditions such as urinary incontinence, erectile dysfunction, female surgeries, and interstitial cystitis/bladder pain syndrome. You can access the page with links to these documents by clicking here. To access the new AUA guidelines for overactive bladder only, please click here.

The value of seeing behavioral training listed as the number one treatment that providers should offer the patient is to be celebrated in a world when pharmacology and surgeries is the typical go-to medical suggestion. What a wonderful document to discuss with your urologists, urogynecologists, family practice providers, and fellow party-goers as we head into the Memorial Day weekend.