Pharmacotherapy (medications) include:

• Oxybutynin (Ditropan, Gelnique, or Oxytrol)
• Tolterodine (Detrol),
• Solifenacin (VESIcare)
• Trospium (Sanctura)
• Mirabegron (Myrbetriq)
• Fesoterodine (Toviaz)
• Darifenacin (Enablex)

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Interstim which is also known as Sacral Neuromodulation can be helpful for patients as well.

Sacral Neuromodulation is a proven treatment option for bladder control and bowel control. More than 150,000 patients worldwide have received Sacral Neuromodulation for bladder control and bowel control.

Sacral Neuromodulation is delivered via the Interstim system. This implantable system sends electrical pulses to an area near the sacral nerve to modulate the neural activity that influences the behavior of the pelvic floor, lower urinary tract, urinary and anal sphincters, and colon. Unlike oral medications that target the muscular component of bladder control, Sacral Neuromodulation offers control of symptoms through direct modulation of the nerve activity.

A distinct advantage of Sacral Neuromodulation is that it is tested for potential success prior to moving on to long-term therapy. The evaluation gives patients and physicians an opportunity to find out in as few as 3 to 7 days whether adequate symptom reduction is achieved. In this way, you are not committed if it does not work or if you do not like it!

Videos (click to open and play):

Bladder Overactivity, Sacral Neuromodulation and Interstim YouTube

Percutaneous Nerve Evaluation PNE also known as Interstim Trial YouTube

Stage Two Interstim Procedure YouTube

Risks: Possible Adverse Events or Risks include:

• pain at implant sites
• new pain
• lead migration
• infection
• technical or device problems
• adverse change in bowel or voiding function, and
• undesirable stimulation or sensations.

Any of these may require additional surgery or cause return of symptoms.

Who should not receive Interstim Therapy:

• Those who need regular MRIs (head and neck are OK)
• Those who cannot or are unwilling to control the device by remote control
• Those who are regularly exposed to a magnetic field
• Those who receive regular Diathermy treatments
• Those with urinary blockage

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Interstim System

Basic Interstim Evaluation Animation (68.4 MB, no sound)

Full Interstim Implant (19.9 MB, no sound)

What Can I Expect After an Interstim Procedure? YouTube

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Botox is a prescription medicine that is injected into the bladder muscle and used to treat overactive bladder symptoms such as a strong need to urinate with leaking or wetting accidents (urge urinary incontinence), a strong need to urinate right away (urgency), and urinating often (frequency) in adults 18 years and older when another type of medicine (anticholinergic) does not work well enough or cannot be taken. Botox can begin to reduce daily leakage episodes after just 2 weeks. One Botox treatment for OAB can last up to 6 months.

Botox treatment works by calming the nerves that trigger the overactive bladder muscle. In your body, certain chemicals travel from nerve cells to muscle cells to make your bladder contract so that you can urinate. With OAB, these muscles contract uncontrollably, creating leakage, the strong sudden need to go, and going too often.

Botox is injected into the bladder muscle and works on the nerves to help block the signals that trigger OAB which helps:

• Reduce daily leakage episodes.
• Treat the strong need to urinate right away.
• Reduce the number of times that you need to empty your bladder daily.

Important Safety Information: In clinical trials, 36 of the 552 patients had to self-catheterize for urinary retention following treatment with Botox compared to 2 of the 542 patients treated with placebo. Patients with diabetes mellitus treated with Botox were more likely to develop urinary retention than nondiabetics.

Who Should Not Use Botox:

Do not take Botox for the treatment of urinary incontinence if you: have a urinary tract infection (UTI) or cannot empty your bladder on your own and are not routinely catheterizing. Due to the risk of urinary retention (not being able to empty the bladder), only patients who are willing and able to initiate catheterization post-treatment, if required, should be considered for treatment.

Side Effects

The most common side effects after a Botox treatment were:

• Problems swallowing, speaking, or breathing
• Spread of toxin effects
• Urinary tract infection (18% vs 6% with placebo)
• Painful or difficult urination (9% vs 7% placebo)
• Urinary Retention - Inability to fully empty your bladder, which may require the temporary use of a self-catheter (6% vs 0% placebo)

Risks

Tell your doctor about all your muscle or nerve conditions such as amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease), myasthenia gravis, or Lambert-Eaton syndrome, as you may be at increased risk of serious side effects including severe dysphagia (difficulty swallowing) and respiratory compromise (difficulty breathing) from typical doses of Botox.

Serious and/or immediate allergic reactions have been reported. These reactions include itching, rash, red itchy welts, wheezing, asthma symptoms, or dizziness or feeling faint. Tell your doctor or get medical help right away if you experience any such symptoms; further injection of Botox should be discontinued.

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How Does Botox Work? (2.2 MB, Allergan Corporation)

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Posterior Tibial Nerve Stimulation (which is also known at PTNS or Urgent PC) is a non-drug, non-surgical option. Therapy consists of twelve 30-minute weekly sessions in our office, followed by a refresher treatment about once a month to maintain improvements. During treatment you will sit with your foot elevated. This allows the clinician to stimulate the tibial nerve using a very thin needle temporarily placed in your ankle. This stimulation travels up the leg to the sacral nerve plexus, the group of nerves at the base of the spine responsible for bladder function. PTNS or Urgent PC therapy may be successful if other therapies have not worked for you. Many studies show up to 80% of patients get better with Urgent PC treatment. Most patients don’t experience side-effects but if they do occur they are typically temporary and include mild pain and skin inflammation at or near where the needle is placed.

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Urgent PC System	Pathway of Urgent PC System	Urgent PC System (female)	Urgent PC System (male)

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Urgent PC Animation (22.4 MB)		Urgent PC Animation with Subtitles and no sound (19.7 MB)

The following handouts can be helpful while undergoing the Posterior Tibial Nerve Stimulation procedure. Each handout focuses on a specific week within the PTNS treatment.

• Week 1: Answers to Common Questions
• Week 2: Setting Treatment Goals
• Week 3: Lifestyle Choices
• Week 4: Exercises for a Better Bladder
• Week 5: Overcoming the Urge
• Week 6: Celebrating Life Successes
• Week 7: Urgent PC PTNS Takes Times
• Week 8: Avoiding Symptom Recurrence
• Week 9: Looking for More?
• Week 10: Ongoing Therapy
• Week 11: Preparing for the Future
• Week 12: Moving Forward

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Surgical Treatments can include the following options:

• Suprapubic Tube: A Suprapubic Tube is a regular catheter that is surgically inserted through the abdominal wall into the bladder. It drains the bladder to a bag (like a regular catheter through the urethra) or it can be plugged and the bladder can be emptied on demand by unplugging the tube.

These surgeries can be associated with continued urinary tract infections, bowel issues, hernias, and the need for other surgeries (to name a few complications.)

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A catheter bag	A leg catheter system	A Foley catheter

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Suprapubic Catheter diagram	Suprapubic Catheter diagram on male	Suprapubic Catheter diagram on female	Suprapubic Catheter diagram on female external

• Augmentation Cystoplasty is an invasive operation that uses a portion of bowel to change the shape or size of the bladder to aid in bladder storage and emptying.
  
  

• Urinary Diversion includes any surgical technique that diverts or changes the way urine is stored in and eliminated from the body. This usually involves use of a segment of bowel. The bladder can be closed off of the urethra and a small tube can be created using bowel or other tissue to open to the outside of the abdomen. The patient can then use a small catheter to empty the bladder through that tube. These surgeries are very invasive and require several days in the hospital for recovery.