Surgery for Overactive Bladder: When Is It Necessary?

These options can be life-changing, but not all people with OAB need them.

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The majority of the time, overactive bladder (OAB) can be managed with lifestyle tweaks or medications for OAB. For example, kegels and bladder training may be enough for many people with OAB to regain their continence and prevent urgency or leaks.

However, some people with OAB may need more treatment. “If a patient has tried medications and they’re not working, there are some surgical options for overactive bladder,” says Lauri Romanzi, MD, urogynecologist in New York City. The surgeries available to treat OAB include a botulinum toxin injection and a neuromodulation pacemaker.

Botulinum toxin is injected into different points in the bladder using a small fiber optic tube. “Once [the medication] in, as with any part of the body, it relaxes the muscle, and this can help reduce overactive bladder symptoms,” says Dr. Romanzi. (Learn more about botulinum toxin injection for OAB here.)

Neuromodulation pacemaker (or bladder pacemaker) is a small implant that attaches to the hip area to control your void reflex using a remote control. “It’s turning out to be a very good rescue therapy for patients with severe overactive bladder who have poor to minimal responses to anything else,” says Dr. Romanzi.

Having surgery for OAB is considered an extreme option that comes with pros and cons; in general, it’s considered beneficial only for those with severe OAB symptoms that are disrupting their quality of life and that have not improved with behavioral modifications.

However, the earlier you begin treatment for OAB, the better you’ll respond to behavioral modifications for OAB—and the less likely you’ll need surgery. “You’re not helping yourself by waiting; you’re simply making yourself resistant to more and more therapeutic options,” says Dr. Romanzi.