New Overactive Bladder Treatment Offers Relief Without Daily Medication

A new implantable device may help people with overactive bladder regain control and reduce urinary urgency. A UHealth urologist explains how it works and who may benefit.

For millions of people, the day is mapped by the nearest restroom. A sudden, difficult-to-control need to urinate can interrupt work, exercise, travel and sleep. When urgency is accompanied by leakage, it can also lead to embarrassment and isolation.

Yet overactive bladder is a medical condition, not an inevitable part of life, says Ricardo I. Palmerola, M.D., a board-certified urologist and urogynecologist at UHealth—University of Miami Health System, who specializes in urogynecology and reconstructive pelvic surgery.

“This is not a normal part of aging, it is not something you just have to live with, and it is very treatable,” Dr. Palmerola says.

During November, Bladder Health Awareness Month, Dr. Palmerola encourages people bothered by urgency, frequent urination, nighttime bathroom trips or leakage to talk with a health care professional, particularly when symptoms limit daily activities.

Overactive bladder: what patients should know

Overactive bladder is a group of symptoms centered on urinary urgency. The bladder squeezes when it shouldn’t, creating a sudden, intense need to urinate that can be difficult to control. People may urinate frequently during the day, wake repeatedly at night or experience leakage before reaching a restroom.

Symptoms can affect adults of different ages but become more common with age. Large population studies show a similar overall prevalence in men and women, roughly 16% in both groups.

At UHealth’s Desai Sethi Urology Institute, specialists evaluate patients for other conditions that can mimic or worsen overactive bladder, including urinary tract infections, bladder stones, incomplete emptying, medications that affect urination, pelvic organ prolapse in women and an enlarged prostate in men. An evaluation may include a medical history, physical examination, urine testing and, when appropriate, additional bladder-function testing.

Can patients prevent overactive bladder from worsening?

Some risk factors can be modified, Dr. Palmerola says. Managing diabetes, quitting smoking and maintaining a healthy weight can support bladder health. Fluid habits also matter: Drinking too much and consuming bladder irritants such as excess caffeine or alcohol can worsen urgency and frequency. Certain substances, including ketamine and cocaine, can be particularly harmful to the bladder.

Other factors cannot be changed, including prior vaginal deliveries. In postmenopausal women, genitourinary syndrome of menopause, which involves changes in the lower urinary tract related to low estrogen, can contribute to symptoms and may be treated separately with low-dose vaginal estrogen. In men, treating urinary obstruction when present may help alleviate symptoms.

What are the treatment options?

Treatment is tailored to each patient’s symptoms, goals and health history. It typically begins with behavioral changes, including:

• Reducing bladder irritants such as caffeine and alcohol.
• Keeping a voiding diary to track bathroom trips and fluid intake.
• Identifying overlooked fluid sources, like soups and smoothies.
• Learning urge-suppression techniques, timed voiding and pelvic-floor muscle exercises.

Some patients benefit from pelvic-floor physical therapy. Physicians may also prescribe medication, including antimuscarinic drugs or newer beta-3 agonists, which often have fewer side effects.

The goal, Dr. Palmerola says, is not simply to reduce bathroom trips or leakage but to restore quality of life.

For patients who need additional treatment, minimally invasive options include percutaneous tibial nerve stimulation (PTNS), sacral neuromodulation, implantable tibial neuromodulation and Botox injections in the bladder.

What is implantable tibial neuromodulation?

For appropriate patients, implantable tibial neuromodulation, or ITNM, is a newer treatment option available at UHealth.

A small, implanted device delivers electrical stimulation near the tibial nerve at the ankle. The nerve connects with the same network involved in bladder control, allowing stimulation to affect signals among the bladder, spinal cord and brain.

Tibial nerve stimulation is already an established treatment for overactive bladder. Percutaneous tibial nerve stimulation generally requires a series of 12 weekly office visits and ongoing monthly maintenance appointments. Implantable systems are designed to provide therapy without that recurring schedule.

Research on implantable tibial nerve stimulation has reported improvements in urgency urinary incontinence and quality of life, although outcomes vary and long-term evidence continues to develop. A urologist can discuss expected benefits, potential risks and device-specific considerations with patients.

“We recommend ITNM for patients with bothersome symptoms who have either tried and failed other therapies, or who wish to mitigate medication side effects,” Dr. Palmerola says. ”At this point, it is showing significant promise in patients who otherwise would have gone untreated.”  

Who may be a candidate?

Patients considering implantable tibial neuromodulation may be looking for an alternative to another daily medication, particularly if they already take several medications, Dr. Palmerola says.

The device is implanted just above the ankle using local anesthesia and a small incision.

“This new treatment is much less invasive. Patients are able to stay awake for the implant and receive local anesthesia,” Dr. Palmerola says. “The device is implanted just above the ankle with a couple stitches to heal. Afterward, some patients get instant relief, but within days, for most of these patients, the urgency should be alleviated. And urinary frequency should follow suit.”

Bringing research into patient care

The addition of ITNM reflects the Desai Sethi Urology Institute’s focus on combining specialty care, education and research to expand treatment options for people with urologic conditions.

UHealth faculty study lower urinary tract dysfunction and neuromodulation and evaluate how emerging technologies may fit into personalized care. That academic setting can help turn questions arising in the clinic into research and new findings into patient care.

“In our division there are several fellowship trained physicians, offering the latest and greatest therapies within reason,” Dr. Palmerola says. “We are trying to be at the forefront of overactive bladder care and management both locally and nationally, so this speaks to the University’s foothold in the space.”

Written by Jannette Neuwahl Tannen. Medically reviewed by Ricardo I. Palmerola, M.D.

Tags: frequent urination treatment, implantable tibial neuromodulation, overactive bladder symptoms, tibial nerve stimulation for overactive bladder, urinary urgency treatment