Treatments Options

How are Overactive Bladder and Faecal Incontinence treated?

A variety of treatments are available, including behaviour modification, pelvic muscle strengthening, medication, minimally invasive procedures, and neuromodulation.

OAB Treatment suitable for OAB
FI Treatment suitable for FI

First-line Therapy

Behavioural ChangesOABFI

Behavioural and lifestyle changes are the first line of treatment of OAB and FI. The specialist will recommend changes to the patient’s daily routine to reduce the severity of the urgency. Some strategies include:

  • Scheduled Toileting: The patient may be prompted to use the bathroom every 2-4 hours.
  • Toilet Training: Involves scheduled toileting in which the length of time between bathroom visits is gradually increased.
  • Pelvic Muscle Rehabilitation: Pelvic floor muscles hold the bladder, bowel, and uterus in place. They also control the contraction and release of the urinary and anal sphincters – the valves that control the passage of urine and faecal matter. Pelvic floor exercises, commonly referred to as Kegel exercises, strengthen the pelvic floor muscles and may improve bladder and bowel control, reducing the episodes of incontinence. Depending on the severity of the symptoms, Kegel exercises may be combined with:
    • Pelvic muscle stimulation: Mild electrical stimulation to help automate the process of performing Kegel exercises. Stimulation is generally applied using a home-use device.
    • Biofeedback: A process using visual or auditory signals to assist targeting the right muscle during exercise.
For patients with persistent symptoms, medication is usually the next treatment option or it may be recommended simultaneously2.
MedicationOABFI

Bladder contractions occur during the activation of muscarinic receptors by a neurotransmitter called acetylcholine. Anticholinergic medication deactivate muscarinic receptors and, therefore, block the bladder contractions that cause it to overact. The medication commonly prescribed to treat OAB includes anticholinergics, antimuscarinics or β3 agonists.

To control bowel movement, anti-diarrhoeal medicines or bulk laxatives to relax the bowel may be prescribed.

Hormone therapy, such as estrogen creams, may also be effective in helping to improve pelvic floor muscle function.

Advantages
  • Non-invasive
  • May be effective at treating symptoms of OAB
Disadvantages
  • Anti-cholinergic medications may not be well tolerated by some patients

Second-line Therapy

Bladder Wall InjectionsOAB

Botulinum toxin A, also known a Botox, is a prescription medicine that is injected into the bladder wall. Botox acts by interfering with the neural transmission of the targeted tissue, blocking the release of acetylcholine, and causing muscle paralysis.

The treatment is not permanent and repeat treatments will be required every 3-6 months to control symptoms in the long term3.

The patient may experience difficulty urinating after this treatment and, in some cases, the bladder may need to be emptied using a urethral catheter4.

Bladder wall injections are generally performed as a day-surgery at a hospital and, therefore, will require a general anaesthetic and hospitalisation.

Advantages
  • Clinically effective in wide range of patients suffering from OAB
  • Simple surgical procedure
Disadvantages
  • Surgically invasive in-patient or out-patient procedure required for bladder wall injection
  • Re-treatment is required every 6-12 months, requiring further surgical intervention
  • Patient may have to self-catheterise in order to urinate
NeuromodulationOABFI
Bladder function is regulated by a group of nerves at the base of the spine called the sacral nerve plexus. By stimulating these nerves through gentle electrical impulses (neuromodulation), OAB symptoms can be treated. Neuromodulation can treat OAB and FI simultaneously. Sacral nerve neuromodulation is administered as either PTNS, an ongoing clinic-based procedure, or using an SNS implant, a medical device surgically implanted.

Percutaneous Tibial Nerve Stimulation (PTNS)

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PTNS is a clinic-based, non-drug, non-surgical treatment for voiding dysfunctions.

PTNS involves inserting a fine needle into the tibial nerve just above the ankle. A mild electric current is passed through the needle and carried up the leg to the sacral nerve plexus.

Placing the needle electrode during PTNS feels similar to administering an acupuncture needle. The treatment does not carry any of the surgical risks associated with treatments such as bladder wall injections or implantation with a SNS device, which require hospital admission and administration of general anaesthesia.

Advantages
  • Minimally invasive
  • Well tolerated with minimal side-effects
  • Clinical studies show it is effective in a wide range of patients suffering from OAB
Disadvantages
  • Requires initial on-going monthly treatments with possible subsequent maintenance therapy
  • Not all OAB patients are suitable or will respond to treatment
Clinical evidence shows that up to 80% of adult patients suffering from OAB respond to treatment5, regardless of gender or age in adults6, while studies show that more than 60% of patients respond to FI treatment with PTNS7.

Find out more about PTNS


Sacral Nerve Stimulation (SNS)

SNS entails surgically implanting a neurostimulator in the body with leads attached to the sacral nerve plexus. Stimulation of the sacral nerve plexus acts to modulate bladder or bowel activity. The device is then programmed to achieve optimal bladder and bowel control.

Whilst SNS aims to provide a permanent, long-term solution for OAB and FI symptoms, the device is surgically implanted and, therefore, carries the clinical risks associated with surgical procedures. SNS implants may also need to be adjusted, or have the batteries replaced at certain intervals, requiring further surgical interventions.

Advantages
  • Long-term treatment solution to OAB
  • Clinical studies show it is effective in a wide range of patients suffering from OAB
Disadvantages
  • Requires surgical implantation and ongoing surgical interventions for battery replacement and lead adjustment
  • Not all OAB patients are suitable or will respond to treatment

Third-line Therapy

Bulking AgentsFI

Implanting a soft-tissue bulking agent is a minimally invasive and simple surgical procedure to treat faecal incontinence8. It involves injecting a material into the muscles around the anus (anal sphincter) with the aim of bulking the sides of the sphincter and, therefore, closing it. The procedure is generally performed under general anaesthesia as a day surgery.

Implanting a bulking agent is used to treat passive faecal incontinence due to a weak or disrupted internal anal sphincter. Treating faecal incontinence due to nerve damage may show better results with neuromodulation.

Advantages
  • Minimally invasive surgical procedure
  • Studies demonstrate clinical improvements in FI for certain patient groups
Disadvantages
  • Not suitable for all patients, your clinician will need to determine whether you are a suitable candidate
  • Long-term, re-treatment may be required
  • Surgical intervention required for implantation of bulking agent
Best Supportive CareOABFI
Best supportive care refers to alternative methods to manage Overactive Bladder and Faecal Incontinence when all other options have failed. A specialist is the best person to provide advice on management options.