New Treatments for OAB

Most people with an overactive bladder don't tell their doctor, says Charles Rardin, MD, but those who do usually find relief. "While overactive bladder is very common, we never consider it normal," he says. He's a urogynecologist at Brown University and Women & Infants Hospital of Rhode Island.

Current ways of dealing with the condition already help many people, and researchers around the country are studying new treatments for OAB.

Daily Pills

For many years, a class of drugs called anticholinergics -- including darifenacin (Enablex), solifenacin (Vesicare), and tolterodine (Detrol) -- was the go-to for bladder control. These drugs block the extra signals that tell your bladder to squeeze. That unwanted squeezing is what makes you feel like you have to go all the time.

The medicines work well, but some people have a hard time with the side effects, which include constipation and dry mouth.

A newer drug called mirabegron (Myrbetriq) works differently. It helps your bladder hold more so you don't have to go as often. It doesn't cause the same side effects as anticholinergics, and it may work better for some people. But you could get high blood pressure, which your doctor should watch for.

Now that we aren't limited to just one type of drug, "it opens up the world of medicines for overactive bladder," says Lisa Hawes, MD, a urologist at Chesapeake Urology Associates.

In-Office Procedures

When pills don't make OAB better, your doctor might suggest a different approach.

Percutaneous tibial nerve stimulation (PTNS) is a modern take on ancient Chinese acupuncture. This procedure requires the least amount of poking around inside your body and has the lowest chance of complications. But it will take more of your time than the other ones.

The doctor inserts a tiny needle attached to an electrode into the skin by your inner ankle. The electrode sends a pulse to the nerves at the base of your spine that control your bladder. Over time, the nerve stimulation eases your need to pee. The treatment takes 12 weeks, with a 30-minute session in your doctor's office each week. After that, you'll get booster sessions every month or two as needed.

Continued

"It's 100% life-changing," says Melissa Arentz, who lived with overactive bladder for 15 years before she tried PTNS. "I'm thrilled with it!"

For her, the weekly sessions didn't seem like a bother. "To me, it's relaxing. And that's time I'm not taking to run to the bathroom later," says the 39-year-old Baltimore resident.

Sacral neuromodulation permanently stimulates those nerves at the base of your spine. The doctor puts a device under your skin. Rardin describes it as "in the upper outer buttock, where the jeans pocket goes." The implant keeps sending a pulse to the nerves, which you can control with a separate handheld device.

For the first year after treatment, you'll need follow-up visits every 3 months. The next year, you'll go every 6 months. After that, your doctor will check the implant's battery once a year and replace it when needed.

Botox injections are another strategy. Yes, the botulinum toxin that dermatologists use to relax lines and wrinkles in the face can also freeze the "squeeze" of your bladder that makes you run to the restroom.

Your doctor will put a thin tube with a tiny camera on its end into your urethra. They'll use that to inject Botox in several places inside your bladder. "It works beautifully" for uncontrolled bladder spasm, Hawes says. The effects of Botox last for about 6-9 months.

On the Horizon

New therapies are being tested. For example, some scientists think that changing the bacteria that live in the urinary tract could make a difference for older women. They're looking at estrogen as a way to do that.

Others researchers are trying to improve current treatments. One study is trying to find out if filling the bladder with water to stretch it out before injecting Botox works better than Botox injections alone.

But, Rardin says, "None of these treatments should downplay the importance of Kegel exercises, diet, bladder retraining, and other lifestyle changes in the treatment of overactive bladder."

WebMD Feature Reviewed by Minesh Khatri, MD on November 02, 2017

Sources

SOURCES:

Charles Rardin, MD, professor of obstetrics and gynecology; program director, fellowship in female pelvic medicine and reconstructive surgery, Alpert Medical School of Brown University; director, minimally invasive and robotic surgical services, Women & Infants' Hospital of Rhode Island, Providence.

Mayo Clinic: "Bladder control: Medications for urinary problems."

Therapeutic Advances in Urology: "Mirabegron: a review of recent data and its prospects in the management of overactive bladder."

Lisa Hawes, MD, urologist, Chesapeake Urology Associates.

The Simon Foundation for Continence: "Percutaneous Tibial Nerve Stimulation (PTNS)."

Research and Reports in Urology: "Effectiveness of percutaneous tibial nerve stimulation in the treatment of overactive bladder syndrome."

University of Utah Health Care: "InterStim Therapy for Bladder Control."

Medscape: "Botox Ok for Some Patients With OAB, but Not All."

ClinicalTrials.gov: "The Estrogen Impact on Overactive Bladder Syndrome: Female Pelvic Floor Microbiomes and Antimicrobial Peptides," "Evaluation of Botulinum Toxin A Alone Versus Botulinum Toxin A With Hydrodistension for Treatment of Overactive Bladder (HydrA)."

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