Other treatments for overactive bladder and urgency incontinence
If you have overactive bladder, you may be offered treatment with a substance called botulinum toxin A, which involves injections into the sides of your bladder. This treatment should be used only if drugs for overactive bladder haven't worked. Some women have difficulty urinating after this treatment so you need to be able and willing to insert a catheter yourself after the procedure if needed (you will be offered training to help you with this). A catheter is a tube that is passed through your urethra (the tube from the bladder to the outside of the body) into the bladder to empty it.
When discussing botulinum toxin A your healthcare professional should make sure you understand the procedure and its risks and benefits before you agree to it. They should also explain how the risks and benefits vary according to the dose used.
You should have a follow-up appointment 6 months after treatment. Your healthcare professional should tell you how to get an appointment sooner if symptoms return. Repeat treatments with botulinum toxin A may be needed. Botulinum toxin B should not be used.
If your first treatment with botulinum toxin A is not effective, your doctor will need to meet with other healthcare professionals to review your case.
The recommendations in the NICE guideline were based on evidence available for the licensed botulinum toxin A called BOTOX made by Allergan. Not all botulinum toxin A available in the UK is licensed. In the UK, medicines are licensed to show that they work well enough and are safe enough to be used for specific conditions and groups of people.
If you have overactive bladder, a procedure called percutaneous sacral nerve stimulation may help. It involves inserting an implant into the lower back that helps the bladder work in a more controllable way.
You should only be offered this procedure if treatment with drugs and botulinum toxin A hasn't worked and you are unable to insert a catheter yourself. Your healthcare professional should tell you:
that before you have the procedure you will need tests to check whether nerve stimulation can control your symptoms
about the risks of the procedure not working
that any implant might cause problems in the future that may need surgery
about side effects
how to make an appointment with a specialist if symptoms return.
If drug treatment for overactive bladder has not worked and you don't want treatment with botulinum toxin A or percutaneous sacral nerve stimulation, your healthcare professional may discuss a treatment called percutaneous posterior tibial nerve stimulation with you. This uses an electric current to stimulate a nerve near the ankle to change bladder function.
If other treatments are not successful, your healthcare professional may suggest surgery to treat detrusor overactivity (when the bladder muscle starts squeezing to empty out urine more than normal). He or she should carefully discuss the risks and benefits of surgery and the alternative treatments with you before you make a decision. The discussion should include any plans you may have for having children in the future, because this may affect the choice of treatment. You should only be offered surgery after the healthcare team has reviewed your care and treatment options.
Before considering surgery for you should have urodynamic tests to check that you have detrusor overactivity. These are tests to find out why your bladder and urethra (the tube from the bladder to the outside of the body) are not working properly.
Your healthcare professional may suggest a procedure called augmentation cystoplasty. This involves increasing the size of the bladder by adding a piece of tissue from the intestines into the bladder wall. The procedure may cause complications and you may not be able to pass urine normally after the procedure, so it should be used only if you are able and willing to insert a catheter yourself and if other treatments have not worked.
A further procedure is urinary diversion, in which the tubes from the kidneys to the bladder (the ureters) are linked directly to the outside of your body, so the urine can be collected without flowing into the bladder. This should be offered only if other treatments have not worked or are not suitable.
If you have either of these operations, you should be offered regular check-ups for the rest of your life.