OAB Treatments & Management
Pelvic Floor Physical Therapy
Pelvic floor physical therapy is a treatment for problems related to the pelvic floor. This specialized therapy includes exercises that can help relieve symptoms including Overactive Bladder and Urge Incontinence.
Medications
If behavioral and lifestyle changes do not improve treatment, medications can help improve symptoms.
Anticholinergic Medication: These medications control bladder spasms
Beta-3 adrenergic Medication: Activates a receptor in the bladder muscle that helps relax the muscle to help the bladder fill and store urine
Percutaneous Nerve Stimulation (PTNS)
PTNS
This is a low-risk, non-surgical treatment option for patients who present with urinary urgency, frequency, urge incontinence, or urinary retention as well as fecal incontinence. When behavior modification and/or pharmacotherapy did not adequately relieve symptoms, this treatment was found to decrease incidence of overactive bladder or retention symptoms. PTNS is a form of neuromodulation which can be used with, or as an alternative to other treatments such as fluid modification, bladder retraining, and anticholinergic medication.
During PTNS treatment, the patient’s foot is comfortably elevated and supported. Also, during treatment a slim acupuncture needle electrode is placed near the nerve at the ankle known as the tibial nerve. A device is connected to the electrode and sends mild electrical pulses to the tibial nerve. These impulses travel to the sacral nerve plexus, the group of nerves at the base of the spine responsible for bladder function.
By stimulating these nerves through gentle electrical impulses (called neuromodulation), bladder activity can be changed.
Because this change happens gradually, patients receive a series of 12-weekly, 30-minute treatments. After the 12 treatments, when the patient’s response to therapy is
assessed, occasional treatments may be needed to sustain symptom improvement.
Bladder Botox
Botulinum Toxin Injections
Botox (Onabotulinumtoxin A) is an effective treatment for OAB and urgency incontinence. This relaxes the bladder muscle and may assist in preventing the bladder from spasming. This allows for more urine to be stored in the bladder. This is an outpatient procedure that is typically performed in an office setting. Under a local anesthetic, your doctor will use a tiny camera to look inside your bladder and will then inject botox into the bladder muscle.
What to know:
The onset of treatment may take 1-2 weeks to improve your symptoms. Bladder Botox is not permanent. It may last for 4-12 months. Repeat injections are necessary to maintain therapeutic effect. A small number of women may experience side effects including urinary tract infections or difficulty emptying their bladder.
Sacral Nerve Stimulation
Sacral Nerve Stimulator (SNS)
This is an implantable system (similar to a heart pacemaker) that is surgically implanted in the buttocks and sends mild electrical impulses to the sacral nerves. This can assist for urinary or fecal incontinence symptoms.
First a trial called a Percutaneous Nerve Evaluation (PNE) is performed in the office setting under local anesthesia to determine who is a good candidate for SNS. If the trial (lasting ~1 week) is successful, then surgery is planned in the operating room.
If you notice significant improvement and decide to proceed, the doctor places the stimulating wire in the permanent device in your lower back through a minor outpatient procedure. It can be helpful for both leakage of stool and chronic constipation in patients who have failed other options.