Six Overactive Bladder Treatment Options When Oral Medication Is Not Working

Unfortunately, there is not a one-treatment-fixes-all answer to overactive bladder, but there are multiple options, some you can do, some we can do.

Woman looking at the ocean considering her treatment options for overactive bladder
Overactive bladder (OAB) affects 33 million Americans, but this number could be much larger because many people living with OAB do not ask for help. OAB is a problem with bladder function that causes the sudden need to urinate and can lead to the involuntary loss of urine.

It can affect both men and women but is more common in women, with about 40 percent of women affected by it at some time. These symptoms do not need to upset anyone’s life.

Oral medication is a common treatment for overactive bladder. These include oxybutynin (brand names Ditropan, Ditropan XL or Urotrol), tolterodine (Detrol) and fesoterodine (Toviaz). But most people do not stick with the pills long term. Around 75 percent of patients who start these prescription medications stop taking them within a year.

Some patients mention they stop taking the pills because they feel the medication is ineffective or has bad side effects, including dry eyes, dry mouth and constipation.

Overactive bladder medication is only one treatment option for the suffering. If medication is not working for you, come talk with one of the doctors at Urology Associates. We have many other options for you to explore, listed below.

When a patient is showing signs of overactive bladder, we start with an initial evaluation where one of our doctors will ask about urgency, frequency and retention as well as rule out infections, diabetes, prolapse and obstruction. Then we will discuss many lifestyle changes mentioned below, focusing on physical therapy.

If the patient has not seen an improvement with physical therapy or medication, we will perform a urodynamic studies to see how well the bladder, urethra and sphincter hold and release urine. These tests will give us a clearer picture to determine the best treatment option.

We have solutions: Patients should see noticeable symptoms improvement (50 percent or better) in a period of 1-3 months without significant side effects. We provide a range of treatment options to find the best option for each of our patients.

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Lifestyle changes

Lifestyle changes, also known as behavioral therapy, are often the first step when looking to manage overactive bladder. If you did not try any lifestyle changes before you started taking medication, they could be good options. Lifestyle changes can include the following.

  • Limiting drinks and food that irritate your bladder.
  • Maintaining a healthy weight.
  • Trying to empty your bladder twice each time you go to the bathroom, by taking a 30-second break and trying again.
  • Delaying going to the bathroom and training your bladder to be able to wait longer between trips to the toilet.
  • Scheduling when you will use the restroom.
  • Don’t forget to do your Kegels, which will build up the bladder muscles.
  • Pelvic floor physical therapy is also an early option to strengthen the muscles.
  • Practicing quick flicks when you need to go to the bathroom. These are quick squeezes that contract and relax the muscles in your bladder, sending a message to the nervous system to stop squeezing the bladder muscles.

Pessary

Only an option for women, a vaginal pessary is a small, removable device that is inserted into the vagina to reduce OAB symptoms caused by bladder prolapse.

There are many different shapes and sizes; a doctor can go over the differences to find the pessary that best fits each patient’s lifestyle. If fitted correctly, the woman will not feel when the pessary is in place.

Botox for your bladder

Another possible treatment option for OAB is injections of Botox into the bladder muscle. Similar to when Botox is used to smooth wrinkles, when injected into the bladder it reduces the frequency of the muscle contracting. This treatment needs to be repeated two or three times a year, depending on when a patient notices that the effects are wearing off.

Stimulating nerves

Stimulating the bladder nerves, or neuromodulation therapy, delivers electrical pulses to the nerves to change how they work. There are two types of nerve stimulation treatments, InterStim and percutaneous tibial nerve stimulation.

Both treatment options target the sacral nerve located at the bottom of the spine that regulates and controls the pelvic floor and bladder muscles.

InterStim Therapy

InterStim Therapy uses an implantable device to send mild electrical pulses to the sacral nerve. The device is controlled with a separate handheld control. Prior to implantation of the device, we have a trial period to confirm the nerve stimulation works for the patient.

After that 1-3 week trial period and if there is an improvement, an in-office procedure will be completed to permanently implant the device in the upper part of the buttock. I like to call this device the pacemaker for your bladder.

Percutaneous tibial nerve stimulation

Percutaneous tibial nerve stimulation (PTNS) is a nonsurgical treatment that is completed with multiple office visits. PTNS provides an electrical stimulation through the tibial nerve, located on the inner ankle, which passes to the sacral nerve.

The therapy consists of 12 treatments administered once a week. After the initial 12-week treatment session, there may need to be occasional treatments to maintain the muscle control. It can take a month or more of the 30-minute treatments before a patient will see initial improvements.

Surgery

Surgery to treat OAB is only for those who have tried other alternative treatments without seeing an improvement. If surgery is needed, the goal is to reduce the pressure on the bladder and improve the bladder’s ability to store urine.

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