Surgeries and Other Procedures to Treat Overactive Bladder

Lifestyle changes, behavioral methods and medications are enough to treat overactive bladder (OAB) for most people. But sometimes symptoms persist despite all of these measures. If other treatments haven't resolved your overactive bladder, your doctor may suggest an implant, procedure or surgery to help.

Pessary

For some women experiencing incontinence, a pessary - a plastic or latex ring placed into the vagina - may be a treatment choice. By pressing against the urethra, a pessary can reduce leakage. However, pessaries are more often used to treat stress incontinence (leakage that occurs when laughing, coughing, sneezing or exercising) and pelvic prolapse (condition in which pelvic organs sag because of weakened muscles and ligaments) than the urge incontinence that may be associated with OAB.

Nerve stimulation

Electrical nerve stimulation involves sending electrical impulses to nerves that control bladder function. It may decrease urinary urgency, frequency and urge incontinence, and improve the bladder's ability to empty. The three main types focus on the pelvic floor, the sacral nerves and the tibial nerves.

Pelvic floor electrical stimulation (PFES) is a noninvasive technique that may be combined with biofeedback. Through adhesive electrode pads placed on the skin, a mild current stimulates the pelvic muscles and can increase the patient's awareness and control of them.

Sacral nerve stimulation is also used for overactive bladder. An external trial of sacral nerve stimulation involves a small external device that is hooked to your belt, with a wire inserted into the skin in your lower back or upper buttock. If the external trial helps overactive bladder, a surgeon can permanently implant a device beneath the skin. Possible risks include infection, pain at the surgical site and altered bowel function.

Tibial nerve stimulation is a minimally invasive procedure that requires several short office visits. The doctor inserts a thin needle into the skin over the tibial nerve in your ankle. A microcomputer then sends painless impulses up this nerve to the hyperactive nerves of the bladder.

Other available forms of electrical stimulation involve varying degrees of risk.

Bladder surgery

Surgery is rarely used for overactive bladder but may be recommended by a doctor in severe cases. Bladder augmentation surgery involves reducing bladder contractions by removing some smooth muscle, or expanding an inadequate bladder with intestinal tissue. Potential risks include continued or increased incontinence, kidney damage and bladder problems such as stones or possibly even cancer.

You may have heard about the "sling" operation that improves bladder control by lifting the neck of the bladder or the urethra. However, this treats only stress incontinence, not the urge incontinence that may be associated with OAB, according to the National Institutes of Health.

Intravesical Injection of Botox

Although it is not FDA approved, an intravesical injection of Botox can be used for patients who do not respond to other conservative measures. It is used by urologists treating patients with more complex incontinence.

Like other treatments for OAB, procedures have their risks. Talk to your doctor about your options, and be sure you understand and consider all the factors involved before undergoing a procedure.

Reviewed by: David O. Sussman, D.O., FACOS

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