I used Mirabegron for OAB, but no relief. Can Botox help me?

Question

Hello doctor,

I am 54 and struggling with an overactive bladder for almost a year. I get sudden urges and need to urinate 10 to 12 times daily, including three to four times at night. My urine test and ultrasound were normal, and my HbA1c is 5.8.

I was prescribed Mirabegron 50 mg, but it has not helped much. So my concerns are -

Should I try anticholinergic medicines instead, or are they risky for side effects like dry mouth and constipation?
Also, do pelvic floor exercises and bladder training actually make a big difference, or are they less effective in older adults?
Would Botox injections into the bladder be a better long-term option?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

Overactive bladder can be very disruptive, and it is good that your basic tests were normal and that diabetes is well controlled.

Since Mirabegron 50 mg has not given you much relief, anticholinergic medicines such as Oxybutynin, Tolterodine, or Solifenacin are reasonable alternatives or sometimes used in combination with Mirabegron, but they do carry side effects like dry mouth, constipation, and, in some cases, cognitive effects, particularly in older adults.

Pelvic floor muscle training and bladder training are very effective across age groups. When done consistently with guidance from a pelvic floor therapist, they can significantly reduce urgency and frequency, often improving outcomes even when medications are needed.

Botox injections into the bladder wall are indeed an effective long-term option for patients who do not respond to medications, providing several months of relief at a time. Still, they do carry a small risk of urinary retention and require repeat procedures.

The best approach is usually stepwise optimizing behavioral strategies, trying medication adjustments or combinations, and considering Botox if conservative measures do not provide sufficient relief.

I hope this helps. Feel free to reach out to me at any time. I am always here to help.

Thank you and take care.

Regards.