Medical and Surgical Treatments

Drugs

When lifestyle changes don't help enough, your health care provider may ask you to try a prescription drug. You may take the drug alone or along with behavioral therapy.

There are several prescription drugs available to relax the bladder muscle. These drugs can help stop your bladder from contracting when it isn't full. You take some of these medicines by mouth. With other drugs you may use a gel or adhesive patch to deliver the drug through the skin.

Your health care provider should follow you closely to look for changes in your symptoms and any problems while you are taking the medicine. Common side effects include dry mouth and eyes, constipation, and blurred vision.

To get the best results, your health care provider may ask you to take different doses of the drug. Your health care provider may also give you a different drug to try.

Injections

If lifestyle changes and prescription drugs don't work for you, or the drug side effects are too serious, more advanced therapies may be the right choice. You will most likely be referred to a specialist who treats patients with incontinence and OAB, such as a urologist. After reviewing your problem, the specialist may recommend injections. With this treatment, botulinum toxin, better known as Botox®, is injected into your bladder muscle.

Small doses of this drug can paralyze muscles. When injected into the bladder muscle, this drug may help keep it from contracting too often. Over time, this treatment wears off in some people. It may need to be repeated in 6 months or a year. The specialist should follow you closely to watch for side effects, including urinary retention (not emptying your bladder completely). If you do have problems emptying your bladder completely after injections, you may need to use a catheter (a thin, hollow tube) to empty your bladder, at least for a short time.

Stimulating Nerves (Neuromodulation Therapy)

Another treatment when drugs or lifestyle changes don't work is neuromodulation therapy. Neuromodulation therapy is the name given to a group of treatments that deliver electrical pulses to nerves to change how they work. There are 2 types of neuromodulation therapy:

Sacral neuromodulation (SNS)

A device can be placed under your skin to deliver mild electrical pulses to the nerves that control bladder function
A device can be placed under your skin to deliver mild
electrical pulses to the nerves that control bladder function
National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health

This therapy works by stimulating the sacral nerve (near the base of the spine). This nerve carries signals between the spinal cord and the bladder. In OAB, these nerve signals don't work the right way. SNS uses a "bladder pacemaker" to interrupt these signals, which can improve OAB symptoms.

During the placement of a "bladder pacemaker," a surgeon makes a small cut and places a thin wire close to the sacral nerves. The device is then tested to see how well it works for you. In a second procedure, the surgeon connects the wire to a small battery operated device placed under the skin. This device delivers electrical impulses to the bladder to stop the signals that can cause OAB.

Percutaneous tibial nerve stimulation (PTNS)

Percutaneous tibial nerve stimulation (PTNS)
Percutaneous tibial nerve stimulation (PTNS)
(c)2012 The University of Texas M.D. Anderson Cancer

This therapy stimulates the tibial nerve. For this type of neuromodulation you will not have to have surgery. PTNS is performed during an office visit that takes about 30 minutes. Your health care provider places a needle electrode near your ankle. It sends electrical pulses to the tibial nerve which runs along your knee to the sacral nerves. The electrical pulses help block the nerve signals that aren't working correctly. Often, patients receive 12 weekly treatments, depending on how well they are doing.

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