When lifestyle changes aren’t enough, the next step may be to take medicine. Your health care provider can tell you about special drugs for OAB.
There are several drug types that can relax the bladder muscle. These drugs, like anti-muscarinics and beta-3 agonists, can help stop your bladder from squeezing when it’s not full. Some are taken as pills, by mouth. Others are gels or a sticky transdermal patch to give you the drug through your skin.
Anti-muscarinics and betta-3 adrenoceptor agonists can relax the bladder muscle and increase the amount of urine your bladder can hold and empty. Combination drugs, like using both anti-muscarinics and - betta-3 adrenoceptor agonists together may help control OAB when one option alone isn’t working.
Your health care provider will want to know if the medicine works for you. They will check to see if you get relief or if the drug causes problems, known as side effects. Some people get dry mouth and dry eyes, constipation, or blurred vision. If one drug you try doesn't work, your health care provider may ask you to take different amounts, give you a different one to try, or have you try two types together. Lifestyle changes and medicine at the same time help many people.
Bladder Botox Treatment
If lifestyle changes and medicine aren’t working, injections may be offered. A trained urologist for men and women, or a female pelvic medicine & reconstructive surgeon (FPMRS) can help with this. They may offer Bladder Botox Treatment.
Botox works for the bladder by relaxing the muscle of the bladder wall to reduce urinary urgency and urge incontinence. It can help the bladder muscles from squeezing too much. To put botulinum toxin into the bladder, your doctor will use a cystoscope passed into the bladder so the doctor can see inside the bladder. Then, the doctor will inject tiny amounts of botulinum toxin into the bladder muscle. This procedure is performed in the office with local anesthesia. The effects of Botox last up to six months. Repeat treatments will be necessary when OAB symptoms return.
Your health care provider will want to know if the botulinum toxin treatment works for you. They will check to see if you get relief, or if you aren’t holding in too much urine. If urine is not releasing well, you may need to use a catheter temporarily.
Percutaneous tibial nerve stimulation (PTNS)
Drawing of an electrical stimulator for bladder nerves
Another treatment for people who need extra help is nerve stimulation, also called neuromodulation therapy. This type of treatment sends electrical pulses to nerves that share the same path for the bladder. In OAB, the nerve signals between your bladder and brain do not communicate correctly. These electrical pulses help the brain and the nerves to the bladder communicate so the bladder can function properly and improve OAB symptoms.
There are two types:
Percutaneous tibial nerve stimulation (PTNS). PTNS (peripheral)is a way to correct the nerves in your bladder. PTNS is done by placing a small electrode in your lower leg near your ankle. It sends pulses to the tibial nerve. The tibial nerve runs along your knee to nerves in your lower back. The pulses help control the signals that aren’t working right. Often, patients receive 12 treatments, depending on how it’s working.
Sacral neuromodulation (SNS). SNS (central) changes how the sacral nerve works. This nerve carries signals between the spinal cord and the bladder. Its job is to help hold and release urine. In OAB, these nerve signals aren’t doing what they should. SNS uses a bladder pacemaker to control these signals to stop OAB symptoms. SNS is a two-step surgical process. The first step is to implant an electrical wire under the skin in your lower back. This wire is first connected to a handheld pacemaker to send pulses to the sacral nerve. You and your doctor will test whether or not this pacemaker can help you. If it helps, the second step is to implant a permanent pacemaker that can regulate the nerve rhythm.
Bladder Reconstruction/Urinary Diversion Surgery
Surgery is only used in very rare and serious cases. There are two types of surgery available. Augmentation cystoplasty enlarges the bladder. Urinary diversion re-routs the flow of urine. There are many risks to these surgeries, so it is offered only when no other option can help.