What to Do If Your Overactive Bladder Medication Isn’t Working
If your overactive bladder medication isn’t working, don’t give up. Find out what other treatments you can explore.
If your doctor has prescribed medication for your overactive bladder, chances are good that you’ve either already stopped taking it or you will soon. As many as 78 percent of the patients who start these medications stop taking them within a year.
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But medication is only one part of the treatment equation for overactive bladder. If your first (or even your fourth or fifth) medication isn’t working for you, there are still other treatments to explore.
Why do so many patients stop taking their medication for overactive bladder?
“There’s a combination of inefficacy and intolerability,” says urologist Courtenay Moore, MD.
Some patients find that they simply don’t yield the results they were hoping for. Others have trouble tolerating side effects, which include dry mouth, dry eyes and constipation.
Unfortunately, patients often don’t realize that there are several other options, Dr. Moore says.
If medications aren’t working for you, talk to your doctor or a urologist about other approaches. They range from injections to implants, and each approach has pros and cons. Here are three of the most common alternatives:
1. Onabotulinum toxinA
Botox® (onabotulinum toxinA) is well-known for smoothing wrinkles, but onabotulinum toxinA injections can also benefit your bladder. Injecting the drug directly into bladder muscles helps to calm the bladder and prevent urinary urgency and related leakage.
The big advantages are that injections are only required two or three times a year, and side effects like dry mouth and constipation aren’t an issue.
However, there are other possible side effects, Dr. Moore notes. About 6 percent of patients have a hard time urinating and require intermittent catheterization. And, about 20 percent develop urinary tract infections.
RELATED: Incontinence? Botox for Your Bladder
2. Sacral neuromodulation
This treatment uses a device that works like a pacemaker for your bladder.
In the first stage of this approach, a doctor sedates the patient and inserts a lead into the patient’s back to stimulate bladder nerve roots. “You do a two-week test stimulation,” explains Dr. Moore. “And if you have 50 percent improvement in your symptoms then you go on to implantation.”
A doctor implants the device under the skin. It helps regulate the bladder with a mild electrical current that stimulates the sacral nerve (sacral nerves control bladder, bowel and rectal function). The device has a long-lasting battery (five to seven years), and rechargeable batteries are in development.
However, the device also has limitations: Patients can’t have spinal magnetic resonance imaging (MRI) scans because of the device’s metal parts, and the device isn’t effective in treating incontinence that relates to neurological disorders.
3. Percutaneous (PTNS) tibial nerve stimulation
PTNS is a type of neuromodulation that doesn’t involve an implant. Instead, PTNS uses a needle placed on the ankle bone to stimulate the nerve root and regulate bladder function.
Patients typically see reduced symptoms for three to four months after the treatment, but there is a significant time commitment: It takes an hour of treatment each week for 12 weeks.
Dr. Moore says researchers are testing PTNS home kits, which could make this treatment more convenient for people with busy schedules.
Dr. Moore says there are a number of reasons why people with overactive bladder problems don’t explore all treatment options.
“Most of the time, it’s two or three years before people are diagnosed or even have treatment,” she says. Then, after patients try multiple medications without success, they may lose hope for an effective treatment and give up.
But there’s no reason to prolong treatment that’s not working, she says.
She suggests talking to a urologist after your first failed attempt at treatment with medication. “The main point is that if you’re having bothersome symptoms, talk to your doctor about them,” she says.