What is the first line of treatment in the patient care pathway for treatment of OAB according to guidelines?

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Starting care for overactive bladder focuses on noninvasive, behaviorally oriented strategies. The goal is to reduce urgency and frequency with minimal risk. Pelvic floor muscle training (Kegels) strengthens the muscles that help control the bladder and can lessen detrusor overactivity. Bladder training and timed voiding teach patients to void on a schedule and respond to urgency more effectively. Diet and fluid management—such as reducing caffeine and other bladder irritants and moderating overall fluid intake—can lessen bladder irritability and urge symptoms. Pelvic floor physical therapy, with or without biofeedback, helps patients learn and reinforce correct pelvic floor muscle use. Because these approaches are low risk and beneficial for many patients, guidelines advocate starting with conservative measures before moving to medications or procedures. If symptoms persist after an adequate trial, pharmacologic options like antimuscarinic agents or beta-3 agonists are considered, with neuromodulation or surgical interventions reserved for more refractory cases.