Overactive bladder (OAB): Can drug therapies and surgical options be the answer?

Written by: Mr Ranjan Thilagarajah
Edited by: Jay Staniland

In our three part series about the condition overactive bladder, we finally take a look at the drug therapy and surgical options available to the sufferer of an overactive bladder, a condition leaving you with a frequent desire to pee, with little or no control, and at times involving urinary incontinence.


Drug therapy to help with an overactive bladder


When lifestyle changes and behavioural therapies have not succeeded in easing the symptoms of an overactive bladder, your consultant urologist will next prescribe anti-cholinergic or anti-muscarinic drugs.

These drugs are designed to help strengthen the sphincter muscles around the bladder, helping to reduce the desire to go to the toilet. These treatments are successful in achieving an improvement in the symptoms in 70% of patients.

The downside of the drugs is that they have a lot of side-effects including a dry mouth, blurred vision, constipation and fatigue, and so can not always be tolerated by the patient.


Invasive therapies for overactive bladder


If the drug therapies are not successful, or can not be tolerated by the patient, the next stage is to see a specialist to try an invasive/surgical technique to find a solution to the problem of an overactive bladder.


  • Botox – Botulinum toxin is injected into the muscle of the bladder, which reduces the amount that the muscle can contract, relieving the urgency and frequency to pee in 70% of patients. Unfortunately, the effects begin to wear off after six to nine months, and repeat treatments are necessary. Due to the effect of restricting the bladder muscles, 20% of women using this treatment have found a difficulty emptying their bladder at all for several months following treatment. It may be necessary for patients to self-catheterise following the treatment.
  • Sacral nerve stimulation – One of the reasons the bladder doesn’t work properly is that disrupted nerve signals are being sent between the bladder and the bladder muscles. A solution to this is to disrupt the unwanted nerve signals. This is done by electrical stimulation to certain nerve transmitters, via electrodes in the patient’s back.
  • Augmentation cytoplasty – This is a procedure that is usually a last option in cases of an overactive bladder. The capacity of the bladder is increased using segments of bowel, leaving the mucous membrane in place reduce muscle contraction and improve bladder function. Following this surgical option, patients may need to use a catheter, which can lead to urinary infections.
  • Urinary diversion – A procedure used in rare cases, in those cases where augmentation cytoplasty is not possible. In this procedure, a diversion is made using a small section of bowel to redirect urine to an external pouch.

If you are concerned about an overactive bladder, and want to know what options are available to you, make an appointment with a specialist.

Mr Ranjan Thilagarajah

By Mr Ranjan Thilagarajah

Mr Ranjan Thilagarajah is an expert consultant urological surgeon, specialising in prostate cancer diagnosis and robotic da Vinci surgery. Practising from his private clinic at Springfield Hospital, he is also honorary consultant urological surgeon at Royal Marsden Hospital and other prestigious hospitals. Alongside his clinical work, Mr Thilagarajah devotes time to teaching future generations, working as a senior lecturer at Anglia Ruskin University, and has contributed to numerous medical articles in peer-reviewed journals and is the receiver of a level 8 clinical excellence award.

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