Ryan Stewart, DO
Fellowship-Trained Urogynecologist
Urogynecology & Reconstructive Pelvic Surgery
Green Bay, Wisconsin
✓ Medically reviewed May 15, 2026

How is overactive bladder treated?

There are several ways to treat OAB, and treatment doesn’t have to follow a rigid order. I work with each patient to find the right fit based on your symptoms, your priorities, and how your body responds. Behavioral strategies are a good foundation, and we build from there.

Behavioral therapy

These approaches work well, have no side effects, and can be started right away. They also stay useful no matter what other treatments you add later.

Bladder training — you schedule bathroom visits and slowly stretch the time between them. The goal is to retrain your bladder to hold more urine comfortably.
Fluid management — spreading your intake evenly through the day (about 6 to 8 cups), and cutting back on evening fluids.
Dietary changes — reducing caffeine, alcohol, carbonation, and other things that can irritate the bladder.
Pelvic floor therapy — this goes beyond basic Kegels. A pelvic floor therapist works on strength, coordination, relaxation, endurance, and the muscles around your hips, core, and thighs. We have in-office pelvic floor physical therapists who can guide you through this.
Urge suppression — when a strong urge hits, you stop, take a deep breath, and do a quick pelvic floor contraction. You wait for the wave to pass before walking to the bathroom.

Behavioral therapy is the foundation of OAB treatment. Even patients who go on to need medication or a procedure keep using these strategies.

Medications

If behavioral therapy alone isn’t enough, medication is one option. There are two main types.

Anticholinergics (oxybutynin, tolterodine, solifenacin) — these block nerve signals that cause involuntary bladder contractions. They can cause dry mouth, constipation, and in older adults, there are concerns about long-term effects on memory and thinking. Fewer than half of patients stay on these medications past six months, often because of side effects.
Beta-3 agonists (mirabegron, vibegron) — these relax the bladder muscle through a different pathway and tend to have fewer side effects. They don’t carry the same cognitive concerns as anticholinergics. Blood pressure should be monitored while taking them.

Medications usually take 2 to 4 weeks to reach full effect. You can keep doing behavioral strategies at the same time.

Procedures for OAB

When medications aren’t the right fit or aren’t giving you enough relief, there are other options. You don’t have to try medications first if they aren’t a good match for you, though insurance sometimes requires it.

Botox injections — onabotulinumtoxinA is injected into your bladder muscle during a short office visit using a small camera. Effects last about 6 to 9 months, then the injection can be repeated. About 27% of women have complete resolution of leaking. The main risks are urinary tract infections (about 33%) and temporary trouble emptying your bladder (about 5%).
Sacral neuromodulation — a small device is placed near your tailbone. It sends gentle signals to the nerves that control your bladder. You get a test period first to see if it works before committing to the permanent device. The battery lasts 10 to 15 years with newer rechargeable models. It does not carry the UTI risk that Botox does.
Tibial nerve stimulation — a thin needle near your ankle delivers mild electrical pulses that travel to the nerves controlling your bladder. Sessions are done in the office, once a week for 12 weeks, then about once a month to maintain the effect. It has very few side effects.

Research shows that Botox and sacral neuromodulation are similarly effective over two years, so the choice often comes down to what matters most to you. Some people prefer a quick office procedure they repeat every several months. Others prefer a device that works continuously. We talk through these trade-offs together.

References

Lightner DJ, Gomelsky A, Souter L, Vasavada SP. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline amendment 2019. J Urol. 2019;202(3):558-563. doi:10.1097/JU.0000000000000309
Visco AG, Brubaker L, Richter HE, et al. Anticholinergic therapy vs. onabotulinumtoxinA for urgency urinary incontinence. N Engl J Med. 2012;367(19):1803-1813. doi:10.1056/NEJMoa1208872
Amundsen CL, Komesu YM, Chermansky C, et al. Two-year outcomes of sacral neuromodulation versus onabotulinumtoxinA for refractory urgency urinary incontinence: a randomized trial. Eur Urol. 2018;74(1):66-73. doi:10.1016/j.eururo.2018.02.011
Peters KM, Carrico DJ, Perez-Marrero RA, et al. Randomized trial of percutaneous tibial nerve stimulation versus sham efficacy in the treatment of overactive bladder syndrome: results from the SUmiT trial. J Urol. 2010;183(4):1438-1443. doi:10.1016/j.juro.2009.12.036
Peters KM, Carrico DJ, Wooldridge LS, Miller CJ, MacDiarmid SA. Percutaneous tibial nerve stimulation for the long-term treatment of overactive bladder: 3-year results of the STEP study. J Urol. 2013;190(4):1394-1399. doi:10.1016/j.juro.2012.11.175
ACOG Committee on Practice Bulletins—Gynecology, American Urogynecologic Society. Urinary incontinence in women (ACOG Practice Bulletin No. 155). Obstet Gynecol. 2015;126(5):e66-e81. doi:10.1097/AOG.0000000000001148
Sanses TVD, Zillioux J, High RA, et al. Evidence-informed, interdisciplinary, multidimensional action plan to advance overactive bladder research and treatment initiatives. Urogynecology. 2023;29(1):3-15. doi:10.1097/SPV.0000000000001274
Lukacz ES, Santiago-Lastra Y, Albo ME, Brubaker L. Urinary incontinence in women: a review. JAMA. 2017;318(16):1592-1604. doi:10.1001/jama.2017.12137
AUGS Guidelines Committee, Thomas TN, Walters MD. Clinical consensus statement: association of anticholinergic medication use and cognition in women with overactive bladder. Female Pelvic Med Reconstr Surg. 2021;27(2):e249-e261. doi:10.1097/SPV.0000000000001008

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Frequently Asked Questions

What is the first treatment usually recommended for OAB?

Behavioral therapy is usually a good starting point. This includes bladder training, fluid management, dietary changes, and pelvic floor therapy. These approaches have no side effects, and you can continue them alongside any other treatment.

Are OAB medications safe long-term?

Newer beta-3 agonists (like mirabegron and vibegron) have fewer side effects than older anticholinergics. With anticholinergics, long-term use has been linked to cognitive concerns in older adults. Your doctor can help you weigh the risks and benefits.

How do I know which treatment is right for me?

The best treatment depends on your symptoms, other medical conditions, and what matters most to you. A urogynecologist can walk you through your options so you can make a decision together.