Fellowship-Trained Urogynecologist
Urogynecology & Reconstructive Pelvic Surgery
Green Bay, Wisconsin
✓ Medically reviewed March 2026
How Is Overactive Bladder Treated?
OAB treatment follows a step-wise approach, starting with the simplest, lowest-risk options and adding more advanced therapies as needed. Most women find significant relief, often with first-line treatments alone.
First Line: Behavioral Therapy
These approaches are effective, have no side effects, and can be started immediately:
- Bladder training — using scheduled bathroom visits and gradually increasing the time between them. This retrains your bladder to hold more urine comfortably
- Fluid management — moderating intake (6-8 cups daily), spreading it evenly, reducing evening fluids
- Dietary changes — reducing caffeine, alcohol, carbonation, and other bladder irritants
- Pelvic floor exercises — learning to contract pelvic floor muscles to suppress urgency waves
- Urge suppression techniques — stopping when urgency hits, breathing deeply, doing quick pelvic floor contractions until the urge passes
Behavioral therapy is the foundation of OAB treatment. Even patients who eventually need medication or procedures benefit from these strategies. I find that many women underestimate how effective these changes can be.
Second Line: Medications
When behavioral therapy alone isn’t enough:
- Anticholinergics (oxybutynin, tolterodine, solifenacin) — block nerve signals that cause involuntary bladder contractions
- Beta-3 agonists (mirabegron, vibegron) — relax the bladder muscle through a different mechanism, often with fewer side effects
Medications typically take 2-4 weeks to reach full effect and can be combined with ongoing behavioral strategies.
Third Line: Advanced Therapies
For women who don’t get adequate relief from behavioral therapy and medications:
- Botox injections — botulinum toxin injected into the bladder muscle during a brief office procedure. Effects last 6-9 months, then can be repeated
- Sacral neuromodulation — a small device implanted near the tailbone that modulates nerve signals controlling the bladder. Tested with a trial period before permanent placement
- Tibial nerve stimulation — gentle electrical stimulation of the tibial nerve (at the ankle), performed in the office weekly for 12 weeks, then monthly for maintenance
I walk patients through each option, explaining what to expect and what the evidence shows. The decision is always shared — your preferences and lifestyle matter just as much as the clinical data.
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