Behavioral Intervention versus Pharmacotherapy or Their Combinations in the Management of Overactive Bladder Dysfunction

Table 1

Impact of various interventions in OAB patients.

Intervention	Outcome	References
Weight loss	Obesity associated with OAB, moderate weight loss associated with improvement in urge UI	[28–31]
Caffeine restriction	Relationship between caffeine intake and OAB in men/women not significant: impact of caffeine on OAB may be dose dependent	[32]
Fluid restriction	Limiting fluid intake may reduce frequency/urgency in OAB, improve quality of life	[31, 33]
Bladder training	Used for patients with stress incontinence, detrusor overactivity, or mixed incontinence: lengthen the interval between voids, significant reduction in UI episodes in 3-day bladder diaries, and significant decrease in volume of urine lost	[37, 38]
Pelvic floor muscle training	Common treatment of stress UI: significant reduction of daily UI frequency, night time UI frequency, and frequency of leakage	[35, 36]
Oxybutynin (immediate release, extended release, transdermal)	Increased maximum cytometric capacity and decreased maximum detrusor pressure in patients with detrusor overactivity	[52–54, 57]
Tolterodine (immediate, extended-release forms)	Increased maximum detrusor pressure, reflex volume, and cystometric capacity but lower withdrawal rates and less incidence of dry mouth compared to oxybutynin	[65–69]
Trospium chloride	Produced significant improvement in maximum detrusor pressure, maximum cystometric capacity, and bladder volume; beneficial for patients who are elderly and/or receiving multiple medications due to its lower predilection to cross the blood-brain barrier	[72–75, 77]
Solifenacin	Effective in reducing micturition frequency, reducing the mean number of episodes of severe urgency with or without incontinence per 24 hours and improving urgency at day 3 of treatment; improves most other OAB variables	[80–84]
Darifenacin	Significantly superior to placebo for improving micturition frequency, bladder capacity, frequency of urgency, severity of urgency, and number of incontinence episodes leading to a change in clothing or pads; can be used for elderly population due to lower nervous system effects	[87–90, 93]
Behavior and drug therapies	Combination therapy produced added benefit in terms of patient satisfaction, perceived improvement and reduction of bladder symptoms; anticholinergic may work synergistically with behavioral intervention because of the different mechanisms involved	[8, 20, 21, 94–98]