Skip to Main Content


Medicines for bladder control help to treat an overactive bladder (OAB). The medicines generally work by blocking signals that may cause muscle spasms in the bladder. If you have tried conservative treatments (such as cutting back on common bladder irritants, bladder retraining, and other lifestyle changes) but are still having bothersome bladder symptoms (such as urinary frequency, urinary urgency, or urinary leakage associated with urgency), you may consider starting a medicine to help with bladder control. Talk with your doctor about how your OAB medicine is working. If your symptoms are not improving, ask about the possibility of changing medications or if you might be a candidate for other treatments.

Refractory Overactive Bladder/Advanced Therapies

If lifestyle and behavioral treatments and medicines don’t help to control your symptoms of overactive bladder (OAB), there are additional therapies available. These therapies include: botulinum injections into the bladder and nerve stimulation therapies.

Bladder Injections

The bladder may be injected with OnabotulinumtoxinA, a powerful neurotoxin. It works by helping to relax the bladder muscle. Bladder injections are usually an outpatient procedure performed in a doctor’s office.

Nerve Stimulation

Percutaneous tibial nerve stimulation (PTNS) is an outpatient office procedure in which a slim needle is temporarily inserted in your ankle near the tibial nerve and connected to a battery-powered stimulator. This is like a combination of acupuncture and a TENS unit .Each treatment lasts for approximately 30 minutes and the recommended treatment course is weekly for 12 weeks, followed by a period of tapered therapy that is typically monthly. Sacral nerve modulation (SNM) is an implantable system using a lead and battery (similar to a heart pacemaker) that sends continuous mild electrical impulses to the sacral pelvic nerves. It typically involves a test either in the office with or a one- to two-week trial with placement to confirm success prior to the full placement of the stimulator (battery). The device is reversible, and some devices are not safe for MRIs after insertion.  

●   Read more about nerve stimulation for pelvic floor disorders.