Rather than a specific condition, overactive bladder (OAB) is a collection of symptoms used to describe difficult to manage urinary issues and bladder problems, such as a frequent and sudden urge to urinate. It can be difficult to control. Urinary incontinence may also be experienced, which causes an unintentional loss of urine.
Symptoms of Overactive Bladder
The most common symptoms of OAB include:
- An urge to urinate that is difficult to control
- Urge incontinence, which is when an urgent need to urinate is experienced
- Frequent urination, which is categorized as more than eight times in a 24 hour period
- Nocturia, which is waking up to urinate more than twice overnight
Your healthcare provider may recommend various treatments for overactive bladder, such as dietary changes, behavior modifications and muscular techniques, including pelvic floor training. When these techniques are not enough to improve OAB symptoms, neuromodulation therapy may be recommended.
What Is Neuromodulation Therapy?
Neuromodulation therapy was initially created by neurosurgeon C. Norman Shealy, MD, in 1967. An implantable device was used to treat intractable chronic pain. According to the International Neuromodulation Society, “His spinal cord stimulators, which he called ‘dorsal column stimulators,’ were intended exclusively for pain relief. These early efforts were not without complications, however, due in large part to mechanical shortcomings of the new devices.”
Science has come a long way since then and neuromodulation therapy is a viable treatment for OAB. According to the International Neuromodulation Society, “Neuromodulation is technology that acts directly upon nerves. It is the alteration—or modulation—of nerve activity by delivering electrical or pharmaceutical agents directly to a target area.”
Neuromodulation therapy treats a variety of conditions such as chronic pain, urinary incontinence, Parkinson’s disease, pelvic disorders and ischemic disorders. This can include an angina and peripheral vascular disease. It can even stimulate hearing in a deaf patient and it is used in cochlear implants.
In regards to neuromodulation therapy for overactive bladder, a small device is inserted into the lower back, near the spine. This device is about the size of a pacemaker and it is meant to stimulate the sacral nerve. When working correctly, the sacral nerve carries signals between the brain, bladder and spinal cord, and it tells you when you need to urinate. With OAB, these signals are not working correctly. Neuromodulation therapy interrupts signals that may be skewed.
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Pros and Cons of Neuromodulation Therapy for Overactive Bladder
Sacral nerve stimulation (SNS) is a highly effective treatment. Most people note success with the treatment. However, the devices may stop working. Approximately 2/3 of people will note that the device stops working within five years; if this occurs, another surgery is required to replace the device or the battery.
It is also a process to be approved for the device. The provider will need to verify that the device will work before surgically implanting it. In order to do this, a “test” is performed. The test involves making a small cut in the lower back and placing a wire in this cut. The wire is attached to a battery powered stimulator, which is carried for three weeks. If the trial is successful, then permanent placement can occur.
It is also important to remember that placement of the stimulator requires a surgery. Having any surgery carries risks, such as infection and pain. Other side effects of the placement of SNS include:
- Wire movement
- Temporary electric shock feeling
- Bleeding at the implant site
Other stimulation options are available. For example, percutaneous tibial nerve stimulation (PTNS) involves insertion of a thin needle near the tibial nerve. A stimulator sends impulses through this needle to the nerve, which sends the impulses to the bladder. PTNS treatments are approximately 30 minutes long and require about 12 treatments, though more sessions may be required. There are minimal side effects, but they include:
- Tingling or mild pain
- Bruising or bleeding at the insertion site
Transcutaneous electrical nerve stimulation (TENS) helps to strengthen the muscles in the vagina. Thin wires are placed in the vagina or in the anus (for males). Electricity stimulates the muscles to make them stronger.
The Bottom Line
Neuromodulation therapies are viable treatment options for most people. Though there are risks, they are typically minimal.
In order to find out if neuromodulation therapy for overactive bladder is right for you, make sure you talk to your doctor about it. Be sure to weigh the pros and cons to see if your symptoms and OAB case meet the use of this type of therapy. Remember, there are other types of overactive bladder treatment that may be more suitable for you, so it is important to talk to your doctor before choosing a course of action.
