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Treatment options for overactive bladder (OAB)

The treatment of OAB is aimed at reducing symptoms to improve patients’ overall quality of life.

Treatments for OAB include:5

  • Lifestyle interventions
  • Containment
  • Pharmacotherapy
  • Botulinum toxin type A
  • Posterior tibial nerve stimulation
  • Sacral nerve stimulation
  • Surgery

Lifestyle interventions for OAB include weight reduction, reduced caffeine intake, bladder training, modified fluid intake and pelvic floor muscle training.5

Containment approaches for OAB include temporary urinary containment products (such as absorbent pads, waterproof pants and external sheaths) and intermittent self-catheterisation.5

Anticholinergics are the most widely used treatment for OAB but can be associated with high rates of treatment discontinuation, mainly due to lack of efficacy and side effects.6–9 The beta-3 adrenergic agonist mirabegron is an option for patients who stop using anticholinergics.5 For patients in whom oral therapy is not effective, options include botulinum toxin type A, posterior tibial nerve stimulation, sacral neuromodulation and surgery.6–9

Electrical stimulation of the posterior tibial nerve delivers electrical stimuli to the sacral micturition centre. Typically, the posterior tibial nerve is stimulated with a fine, 34-G needle, inserted just above the ankle. Treatment cycles typically consist of once-weekly treatments of 30 minutes for a total of 12 weeks.9

Sacral nerve stimulation

The goal of sacral nerve stimulation is to rebalance micturition via electrical stimulation of the sacral nerve roots.10,11

Cystoplasty/urinary diversion 

Urinary diversion involves the creation of a new bladder outlet with a valve for urinary continence, which is catheterised to empty. No studies have specifically examined this technique in non-neurogenic urinary incontinence.9

Augmentation cystoplasty involves grafting a detached segment of intestine to enlarge the bladder. Associated with high risks of short-term and long-term severe complications.9

Botulinum toxin type A*

National Institute for Health and Care Excellence (NICE) recommends bladder wall injection with botulinum toxin type A as an option:5

  • For women with OAB caused by detrusor overactivity that has not responded to non-surgical management, including pharmacological treatments.
  • For women with symptoms of OAB in whom urodynamic investigation has not demonstrated detrusor overactivity, if the symptoms have not responded to non-surgical management and the woman does not wish to have other invasive treatments.

The European Association of Urology (EAU) guidelines recommend botulinum toxin type A and BOTOX® as an option for patients with urge urinary incontinence that is refractory to conservative therapy. Patients should be counselled on the limited duration of response, risk of urinary tract infections and the possible prolonged need to self-catheterise.9

OAB is a complex, multi-symptom syndrome that can be difficult to treat12

OAB: overactive bladder.

*BOTOX® is indicated for the management of bladder dysfunctions in adult patients who are not adequately managed with anticholinergics: overactive bladder with symptoms of urinary incontinence, urgency and frequency.13

©NICE [2019] Urinary incontinence and pelvic organ prolapse in women: management. Available from All rights reserved. Subject to Notice of rights

NICE guidance is prepared for the National Health Service in England. All NICE guidance is subject to regular review and may be updated or withdrawn. NICE accepts no responsibility for the use of its content in this product/publication.


  1. Allergan. Data on file. INT/0423/2016
  2. Aurora S K, Winner P et al. OnabotulinumtoxinA for treatment of chronic migraine: pooled analyses of the 56-week PREEMPT clinical program. Headache 2011;51(9):1358-1373
  3. Blumenfeld A M, Stark R J et al. Long-term study of the efficacy and safety of OnabotulinumtoxinA for the prevention of chronic migraine: COMPEL study. J Headache Pain 2018;19(1):13
  4. Allergan. Data on file. 014
  5. National Institute for Health and Care Excellence (NICE). NG123: Urinary incontinence and pelvic organ prolapse in women: management. Available at: Accessed April 2022
  6. Chapple C R, Yamanishi T and Chess-Williams R. Muscarinic receptor subtypes and management of the overactive bladder. Urology 2002;60(5):82-88
  7. Castro D, Miranda P et al. Assessment of reasons for overactive bladder treatment change. Acta Urol Esp 2011;35:73–9
  8. Benner J S, Nichol M et al. Patient-reported reasons for discontinuing overactive bladder medication. BJU Int 2010;105:1276–82
  9. EAU Guidelines on Urinary Incontinence in Adults. Available from:  Accessed April 2022
  10. Oerlemans DJAJ, van Kerrebrock PEV. Sacral nerve stimulation for neuromodulation of the lower urinary tract. Neururol Urodyn 2008;27:28–33 
  11. Sanford M T and Suskind A M. Neuromodulation in neurogenic bladder. Transl Abdrol Urol 2016;5:117-126
  12. Starkman J S, Smith C P and Staskin D R. Surgical options for drug-refractory overactive bladder patients. Reviews in Urology 2010;12(2-3):e97
  13. BOTOX® Summary of Product Characteristics. Available at: Accessed April 2022

Please refer to the BOTOX® Summary of Product Characteristics for further information on adverse events, contraindications and special warnings and precautions for use.


Adverse events should be reported. Reporting forms and information can be found at

Adverse events should also be reported to AbbVie on [email protected] 


Date of preparation: April 2022. UK-BUO-220010.