You did everything right. You took charge and saw your doctor about your bladder symptoms. You were diagnosed as having overactive bladder (OAB). So, following your doctor’s directions, you modified your diet and the amount and timing of what you drank. You dutifully did your Kegel exercises. But it wasn’t enough. Then, you received a prescription for a drug to control your symptoms. Maybe it worked. Maybe it didn’t. Maybe the side effects were too much. So you try another drug and maybe another. In the end, maybe you find a drug that works for you. But what if you don’t?
While drugs can be an easy and effective way to control OAB symptoms, a large number of patients aren’t able to deal with the associated side effects which may include sedation, negative cognitive effects, dry mouth, constipation and headaches. In fact, in one study of more than 23,000 patients with OAB symptoms, about 60 percent had stopped drug therapy within 90 days and over 80 percent stopped before one year.”1
Your quest for a successful OAB treatment doesn’t have to stop with drugs. Even if your doctor does not offer additional treatments beyond behavior and drug therapies, there are other effective treatments available from specialists such as urologists, urogynecologists and gynecologists. Don’t give up hope! Contact a specialist to learn more about these and other options:
Percutaneous Tibial Nerve Stimulation (PTNS): PTNS is a reversible, low-risk, non-surgical option that indirectly stimulates the nerves responsible for your bladder function. Treatment is effective in 60 – 80 percent of patients. During treatment, a slim needle electrode is placed near the nerve at your ankle known as the tibial nerve. The stimulator is connected to the electrode and sends mild electrical pulses to the tibial nerve. These impulses travel to the sacral plexus, the group of nerves at the base of the spine responsible for bladder function. PTNS therapy is delivered in a series of 12 weekly, 30-minute office visits, during which you will rest comfortably in a chair. Occasional treatments (usually once every 1-3 months) are generally needed to sustain results. The most common side effects are temporary and minor and include bleeding and mild pain at or near the stimulation site.2
Sacral Nerve Stimulation (SNS): SNS stimulates the sacral plexus using a surgically implanted device. This procedure is effective in about 60 percent of patients.3 Before committing to the permanent implant, you will go through a trial assessment period with an external device. Your doctor will numb a small area and insert a thin, flexible wire near your tailbone. The wire is taped to your skin and connected to a small external device which you’ll wear on your waistband. Complications associated with the trial assessment include movement of the wire, technical problems with the device and some temporary pain. After you show improvement with the test stimulation, you will be scheduled to have a small device implanted in your buttocks during an outpatient procedure. Complications with the implanted device may include pain at the implant site or new pain, infection or skin irritation, lead (thin wire) movement/migration, device problems, interactions with certain other devices or diagnostic equipment such as MRI, among others.4
Bladder surgery to increase bladder capacity: This is a major surgical procedure during which pieces of your bowel are used to replace portions of your bladder. One result of the procedure is that you may need to use a catheter intermittently for the rest of your life to empty your bladder. This surgery is reserved for patients with severe OAB symptoms as it is a major surgical procedure with the potential for serious side effects.
Bladder removal: This procedure is the last resort for patients with severe OAB and involves removing the bladder and surgically constructing a replacement or an opening to an external bag to collect urine. This is a major surgery associated with serious side effects.
References:
1. Perfetto, E.M., Prasan, S. & Jumadilova, Z. (2005). Treatment of overactive bladder: a model comparing extended prelease formulations of tolderodine and oxybutynin. Am J Manage Care, 11, S150-S157.
2. Visit www.urgentpcinfo.com for more information
3. Medtronic-sponsored research. InterStim Therapy Clinical Summary 2011.
4. InterStim Therapy for Urinary Control: Imagine Everyday Freedom. Rev 0110