Learn More About Advanced Therapies for OAB

Treatments for Overactive Bladder (OAB) typically begin with first-line therapies (behavioral therapies) that include dietary changes, bladder training and pelvic (Kegel) exercises. Medications (second-line therapy) may be added for patients with bothersome symptoms who wish for additional help or have not seen improvement with first-line therapies. Refractory OAB refers to those patients who have failed to see satisfactory improvement with behavioral therapies and medications. Medications are often tried for 4-8 weeks before concluding that they are ineffective, though this time can be shorter if the drug is stopped for severe side effects. OAB is considered refractory even if only one medication was used. However, with two different classes of OAB medications available, most experts would recommend a trial of more than one medication before concluding a patient has refractory OAB.

When someone has refractory OAB, they may want to consider an advanced (also called third-line) therapy for Overactive Bladder. Third-line therapies for OAB tend to be more invasive or time-consuming than medications or behavioral therapies. So, additional thought is given to how bothersome symptoms are to the patient when considering advanced therapies. It is possible for a patient who was bothered enough by their symptoms to try a medication may not feel that it is appropriate to try a more invasive therapy. Advanced therapies may be more effective than previous therapies but they also carry unique risks that should be weighed against how much the symptoms are affecting the quality of life. More severe symptoms often lead patients to conclude that advanced therapies provide value for the costs they bring.

There are a number of reasons why someone with refractory Overactive Bladder (OAB) may want to see a specialist about advanced therapies. Perhaps most important among these is that a bladder health expert is able to perform a more complete evaluation. It is usually not appropriate to perform an extensive workup in the early stages of OAB treatment. However, once more advanced therapies are considered, it is often useful to obtain a more careful examination which may include more advanced tests. This evaluation is often best conducted by a specialist in the field of pelvic health. This can confirm that Overactive Bladder is truly the cause of the symptoms.

Working with a specialist may also provide more options for therapy. Advanced therapies include treatments such as botulinum toxin injections, sacral neuromodulation, posterior tibial neuromodulation and even potential new therapies as part of a clinical trial. An expert in bladder health is more likely to be able to offer all of these options and have more experience in providing the therapy.

Three main categories of third-line (or advanced) therapies are currently FDA-approved for treatment of refractory OAB, though new developments are being advanced which may increase the options in the near-future. Botulinum toxin (Botox) can be administered into the lining of the bladder though a small scope. Sacral neuromodulation treatment is delivered using an implantable device which stimulates the bladder nerve to control symptoms. Peripheral tibial nerve stimulation (also called percutaneous tibial neuromodulation) is a less-invasive therapy that uses a tiny needle inserted near the ankle to stimulate a branch of the nerve to the bladder. Currently PTNS is administered in a provider’s office, though there are devices being tested that would eliminate the need for frequent office visits for treatment.

Each of these therapies has unique advantages and disadvantages that may appeal to individual patients or may be more appropriate in certain situations. It is helpful to meet with a provider capable of providing all of these therapies so that you can choose the therapy most appropriate for you. Choose a specific third-line therapy guide below to explore more details of each advanced therapy.