Overactive bladder syndrome is usually managed with simple changes to diet and lifestyle, pelvic floor exercises, bladder training and prescribed medicines. However, in a small number of cases, if symptoms fail to improve, your doctor may recommend other treatments. These may include nerve stimulation, botulinum toxin A injections or surgery. Your doctor will explain the potential benefits and risks of each particular procedure.
Sacral nerve stimulation12
During sacral nerve stimulation surgery, a small device is implanted under the skin that uses mild electrical impulses to stimulate the sacral nerves of the lower back, correcting the misfiring signals between the brain and the nerves that control bladder function. The stimulation doesn't cause pain and may improve or successfully treat urge incontinence and overactive bladder syndrome in people who haven't had success with medications or lifestyle changes.
Tibial nerve stimulation12
A less invasive alternative to sacral nerve stimulation is tibial nerve stimulation. This procedure involves placing a needle through the skin near the ankle to reach the tibial nerve. The electrical stimulation flows through the needle and travels along the tibial nerve to the spine, where it connects with the nerves that control the bladder. The 30-minute procedure is usually performed once a week for 12 weeks, with many patients experiencing an improvement in their OAB symptoms by week six. Those patients who respond to treatment may need to have occasional treatments (about once every three weeks) to sustain improvements.
Injections: Botulinum toxin A13
Injections involve injecting botulinum toxin A directly into the bladder muscle, causing it to relax and increase its ability to hold more urine before you feel the need to empty your bladder; this means fewer episodes of urgency and urge incontinence. The effect usually lasts for up to six months.
Surgical treatment is usually reserved for people with severe symptoms who do not respond to other treatments, or whose OAB is a result of a blockage such as a stone, tumour or another bladder obstruction.
Bladder augmentation (cystoplasty) uses a patch of your own tissue to make your bladder bigger. This enables the bladder to store more urine.8
Another surgical procedure called urinary diversion reroutes the tubes that lead from the kidneys to the bladder (ureters) so that the bladder is bypassed and the tubes lead directly to the outside of the body through the abdominal wall. As a result, urine does not flow into the bladder but is collected in a bag worn on the abdomen (ostomy bag). This procedure is only done after all other treatment options have failed.8
One step at a time
Finding an effective remedy for your overactive bladder or urge incontinence may take time, with several steps along the way. If lifestyle changes and medications haven't worked for you, talk to your doctor about what other treatments might be available to find the right solution for you.