Overactive bladder therapy reference (2026)

Overactive bladder therapy in 2026 organises around several tiers.

Behavioural and lifestyle: bladder training, fluid management, weight reduction in selected patients, pelvic floor physiotherapy. Foundational and often paired with pharmacotherapy.

Pharmacotherapy.

Antimuscarinics: oxybutynin (multiple formulations including extended release and transdermal patch), tolterodine, solifenacin, darifenacin, fesoterodine, trospium. Effective but with anticholinergic side effects (dry mouth, constipation, cognitive effects in older adults).

Beta-3 agonists: mirabegron and vibegron. Generally well-tolerated alternatives without anticholinergic burden, increasingly preferred particularly in older adults. Vibegron has growing real-world experience.

Combination: antimuscarinic plus beta-3 agonist combinations for incomplete response on either alone.

Procedural for refractory disease.

Intravesical onabotulinumtoxinA injection: highly effective for refractory urgency urinary incontinence. Repeated every 6 to 9 months.

Neuromodulation: percutaneous tibial nerve stimulation (PTNS, both office-based and implanted), sacral neuromodulation (Interstim).

Emerging tier: novel beta-3 agonist programs and other mechanism-targeted programs in late-stage trials.

The diagnostic-pathway question matters. Distinguishing overactive bladder from other causes of urgency (urinary tract infection, interstitial cystitis, pelvic floor dysfunction, neurological causes) is part of the structured workup. Specialty referral to urogynaecology or urology is the gating clinical pattern for procedural therapy.