Guideline-Based Approaches and Pharmacological Strategies in OAB Management


Expert panelists review the AUA/SUFU guidelines for overactive bladder (OAB) treatment, discussing first-line behavioral strategies and the transition to pharmacological treatments.

Dr Eilber: And then beyond that, if you've gone through your assessment, you've excluded the other aspects. Dr Eilber, what are some of the recommendations, at least from guideline statements from the American Urology Association and SUFU? Can you walk us through those?

Dr Eilber: So, first line, there is always behavioral modification. And in subsequent fall visits, I always go back to that also, 'cause many patients will be doing well on their initial treatment. They come back telling you their symptoms returned and that's because they went back to drinking, there are six diacocs a day. It's just human nature to kind of regress. So of course, behavior modification, if you're drinking excessive amounts of fluid, decrease those, try not to have a lot of... of bladder irritants, caffeine, carbonated drinks, and then especially people who mainly complain nocturia, they really need to limit their fluids in the evening. And then other things, there are lots of people who say, you know, I'm great for three hours, three and a half hours, I have an accident, such a simple fix, time voiding. And those are probably the most basic things.

Dr Eilber: Yeah, one thing I've found in in my practice is that as specialists, we kind of understand the bladder physiology, but to mainstream society, simple bladder function, they don't really know. So the mere fact of doing a boarding diary and just even quantitating how often they go to the restroom or even see in the volume that comes out is sort of eye-opening to people in that regard.

Dr Kennelly: Dr. Benson, do you kind of live with other things with behavioral therapy? do you employ any other techniques?

Dr. Benson: You know, again, it's watching bladder irritants and just it's those learned behaviors that are pathologic that can be problematic. And that is every time they go by the bathroom, they simply choose to, you know, use it. Or they're in certain situations where at work and they've had stress or problems and that triggers that behavioral-psychologic sort of key. So we really do work on with just basic diary. What are you doing during the day when these things are happening? And it's amazing how often there are learned behaviors that are just part of this that are promoting it. And when they think about it and take a step back, they say, Well, yeah, I guess I do understand this situation. My bladder acts very differently. You know, five minutes into church, they need to go to the bathroom. But when they leave, they can talk to their friends for two hours. And so, you know, getting people to understand those keys is critical.

And I think some of that an adjunct to this therapy is really time. Sometimes urologists, urogynecologists don't have all the time and their support staff may not. I oftentimes employ physical therapists, women's health, physical therapists, they really focus in on this.

Dr Kennelly: Have you found any of that effective in your practices?

Dr Eilber: I look for physical therapy. referrals probably happen multiple times every time I have an office day. I think for two reasons. One is, right, we don't have the time to spend. And I'm a believer in the theory that there, when you lose pelvic floor tone, you do get a little more overactive bladder. But also if you strengthen those muscles, when you get that urgency, if you're even a little bit stronger and you're able to postpone that, you're a little bit stronger. even a few seconds, that's the difference between making it to the toilet and not. And to add on to what Dr. Benson was saying earlier, I think we also underestimate teaching people like to postpone urination. It is its bad habits. Sometimes you ask someone, "Well, what happens if you don't go to the bathroom?" Well, I know something will happen, but they've actually never had an accident. They're just so worried that it could happen. So if we slowly have them. start to train their bladder at time on, I love to use the analogy of yoga. Anyone can probably do the splits. It's a matter of focusing and doing that, stretching, you know, on a, on a regular basis over a long period of time. And you can functionally stretch your bladder. It's just that we lose our functional capacity if you give it to every urge.

Dr Kennelly: Well, I don't know that I could do the splits.

Dr Eilber: I think you could. You never know. Faith in you, Dr Kennelly.

*Video transcript is AI-generated and reviewed by Urology Times® editorial staff.

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