New Treatments for Overactive Bladder
Medications for OAB
Several different medications have been approved to relieve the symptoms of urinary frequency and urgency. They include oxybutynin (Ditropan, Oxytrol, Gelnique), tolterodine (Detrol), solifenacin (Vesicare), fesoterodine fumarate (Toviaz), trospium (Sanctura), and darifenacin (Enablex). Oxytrol is available in a pill by prescription and in the form of the skin patch over the counter for women.
These drugs help prevent the uncontrollable muscle contractions that can lead to overactive bladder and leaking. However, they can cause side effects, including dry mouth, blurred vision, constipation, and urinary retention. Extended-release versions of these drugs may help reduce side effects.
Percutaneous Tibial Nerve Stimulation
If your overactive bladder hasn't improved with lifestyle changes and medicines and you don't want to have surgery, percutaneous tibial nerve stimulation (PTNS) is an option. During this technique, the doctor inserts a fine-needle electrode into the nerve just above your ankle. A mild electrical impulse is passed along the needle to nerves of the spine that control bladder function.
"It's a fairly simple procedure, done in the office," says Ross Rames, MD, associate professor of urology at the Medical University of South Carolina. Rames works with the university's Bladder and Pelvic Health Center. "Often, we'll see improvement within the first couple of weeks after the patient starts PTNS treatments." With PTNS, you'll need a series of 12 treatments, scheduled about a week apart. You may need more than one treatment to keep seeing results.
Sacral Nerve Stimulation Therapy
Sacral nerve stimulation is a treatment in which mild electrical impulses are sent to the sacral nerves near the lower back. A device -- implanted in the upper buttocks under the skin -- is used to provide electrical pulses that influence bladder function. The procedure to implant the device does involve surgery, but it is minimally invasive, and reversible.
Botulinum Toxin Injections for OAB
You might be wondering, "Botox? Like movie stars use on their forehead?" Yes, the same substance that dermatologists use to smooth out wrinkles can also be used to relax an overactive bladder.
To treat incontinence, doctors inject botulinum toxin into the bladder muscle. This is done with a needle that is inserted via a long tube called a cystoscope that goes up into the bladder. "The goal is to reduce the over-activity of the bladder muscle so that the patient has better control, but still allow enough muscle contraction to empty the bladder," Rames says. The effects generally last for about 9 months. So far there don't seem to be any major side effects from botulinum toxin, although it's only recommended if your symptoms aren't controlled with behavioral therapies, medications, or a combination of both.