1.Preferred treatment
①Behavioral therapy
Recommendation: It can be combined with other forms of treatment.
1. Lifestyle guidance: By guiding patients to make lifestyle changes, such as losing weight, controlling fluid intake, reducing caffeine or alcohol intake, etc., patients’ symptoms can be improved.
2. Bladder training
Method I: Delay urination, prolong the interval between urination and gradually make each urination volume greater than 300ml.
I. Treatment principle: relearn and master the skill of controlling urination; interrupt the vicious circle of mental factors; reduce the sensitivity of the bladder.
II. Contraindications: low compliant bladder with end-of-filling forceps pressure greater than 40cmH20 .
Ⅲ Requirement: Practical implementation of the treatment as planned
Ⅳ Cooperative measures: adequate ideation; voiding diary; others.
Method II: Timed voiding
I. Objective: To reduce the number of urinary incontinence and improve the quality of life.
ll. Indications: Severe incontinence that is difficult to control.
III Contraindications: With severe urinary frequency.
Pelvic floor muscle training
Biofeedback therapy
Other behavioral therapy/improvement of sleep, etc.
②Pharmacological treatment
The following medications are commonly used in China M receptor blockers: Tolterodine and Solifenacin are commonly used in China.
These drugs inhibit the contraction of the detrusor muscle during the storage phase by antagonizing M receptors and have a highly selective effect on the bladder, which ensures efficacy while minimizing side effects.
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A. Tolterodine: Tolterodine is a highly selective M receptor blocker for the bladder, capable of blocking both M2 and M3 receptors. It has a higher affinity for the bladder than the salivary glands. Commonly used dose is 2~4mg/day, divided into immediate-release and extended-release type.
B. Solifenacin: Solifenacin has higher affinity for M3 receptor subtype and higher selectivity for bladder than salivary gland, with a half-life of about 50 hours. Doses of 5-10 mg/day are used and can be adjusted according to the condition.
M-blockers have some side effects, such as dry mouth, constipation, dry eyes, blurred vision, and urinary retention. Because the incidence of dry mouth caused by extended-release drugs is lower than that of immediate-release drugs, extended-release agents should be considered first. M-blockers should not be used in patients with closed-angle glaucoma.
Other M-blockers include Oxybutynin and Propiverine.
The M-blockers include Oxybutynin and Propiverine. Other options include sedative and anxiolytic agents, calcium channel blockers, prostaglandin synthesis inhibitors, and herbal preparations, but credible trial reports are lacking.
(iii) Indications for changing the preferred treatment
? Treatment is ineffective;
? Patients are unable to adhere to treatment or request a change in treatment;
? Intolerable side effects occur or are likely to occur;
? Significant decrease in urine flow rate or most significant increase in remaining urine during treatment.
2.Optional treatment
(1) Type A botulinum toxin remote urinary muscle injection: Those who are not effective in M receptor antagonist treatment or cannot tolerate the side effects of M receptor antagonist can be treated with type A botulinum toxin forced urinary muscle injection.
(ii) Bladder infusion of capsaicin or heparin: decreases bladder sensory afferents after infusion and can be tried for severe bladder sensory hypersensitivity.
③Neuromodulation: Transvaginal, anal, and transcutaneous electrical neuromodulation therapy as well as magnetic stimulation are effective in some patients. Sacral neuromodulation, which is effective in patients with recalcitrant OAB, is more expensive.
④Surgery
The indications for surgery should be strictly controlled. Indications for surgery: should be strictly controlled and only for those with severe hypo-compliant bladder, bladder with too small a safe volume and endangering the function of the upper urinary tract or with a serious impact on the quality of life, who have failed with other treatments.
? Surgical methods: There are bladder enlargement and urinary diversion.
⑤ Electro-acupuncture treatment: Some data show that acupuncture helps to relieve symptoms.