If medication fails to achieve results, you may find relief in advanced therapies Norton Healthcare offers for overactive bladder.

Story by: Crystal Hammon on December 8, 2023

Controlling your bladder is something we take for granted until we lose the ability. If you’re living with urinary incontinence, you may be surprised to learn that your condition is quite common.

“Among American adults, 42.6 million have an overactive bladder,” said Stephanie A. Flaspoehler, APRN, nurse practitioner with Norton Urogynecology Center. “That’s more people than are diagnosed with diabetes, asthma, Alzheimer’s disease or breast cancer — and the prevalence increases with age.”

Urinary incontinence is marked by frequent or urgent urination, leaking urine before you reach the bathroom, and/or urinating more than twice a night or eight times during the day.

As symptoms progress, incontinence can be functionally and socially debilitating. Out of fear or embarrassment, people start to limit activities.

“It can also negatively affect sleep patterns and often places seniors in nursing homes prematurely,” said Stephanie, who wishes more people knew that they don’t have to view this chronic condition as a normal part of aging.

At Norton Urogynecology Center, many people see lifechanging results through evidence-based diagnosis and treatment guidelines set by organizations that promote high standards of health care, such as the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction and the American Urology Association. Currently, these standards treat urinary incontinence with behavioral modifications, medication and advanced therapy — in that order.

“Behavioral modifications are simple things patients can do, such as diet changes to avoid things that aggravate bladder symptoms. These include coffee, tea, soft drinks, spicy foods, chocolate and acidic food,” Stephanie said.

Some people benefit from bladder and pelvic floor training guided by a physical therapist.

Medications are another option, but, for many reasons, they don’t suit everyone.

“A lot of patients try medications,” Stephanie said, “but they may or may not work for them, or they may have issues with cost or side effects.”

The most affordable medications, a class of drugs known as anticholinergics, are not recommended for long-term use by women over age 55 because of a link to cognitive decline, dementia and Alzheimer’s disease, according to a 2019 study published in the Journal of the American Medical Association.

Specialists usually encourage people to try at least two medications, aiming for at least a 50% improvement in self-reported symptoms. If medication fails to achieve results or you’re averse to taking medications regularly, you may find relief in three advanced therapies Norton Healthcare offers for overactive bladder.

Percutaneous tibial neuromodulation (PTNM) therapy is a noninvasive treatment that restores bladder function by gently stimulating the tibial nerve through nerve modulation.

“Patients come to a provider’s office once a week for 12 weeks for a 30-minute treatment session, followed by monthly maintenance sessions. Stephanie said. “The tibial nerve is stimulated using an acupuncture like needle near the ankle.”

PTNM is effective, covered by most insurance and has few, if any, side effects.

Botox injections to the bladder are another in-office treatment. They take no more than 30 minutes and require no sedation other than local numbing. Botox works by relaxing the bladder muscles, giving the patient more time to get to the bathroom when they have the urge. Within a week, most patients see improvements that last between four and six months. Side effects are rare.

“Less than 5% of the time, Botox can relax the bladder too much, which can prevent patients from urinating naturally,” she said. That’s easily resolved with a urinary catheter until the Botox wears off. 

Finally, there is sacral neuromodulation therapy. Unlike medication and Botox, which work with the bladder’s muscular function, this technique restores communication between the brain and pelvic floor, improving bladder function through modulating nerve activity. People who receive this therapy are prescreened by a test that lasts three to seven days to determine whether their incontinence is related to the nervous system rather than muscles.

If your condition responds to the test, you are eligible for a device that regulates bladder function. The device is implanted under light sedation or general anesthesia. Operating much like a pacemaker for the heart, the battery-operated device lasts 10 to 15 years. At that point, the batteries are replaced and the device remains in place.

“I think the important thing to know is that you don’t have to live with this condition,” Stephanie said. “If you don’t see progress with behavioral modifications or medication, that’s when this third tier of advanced treatments may be worth considering.”