Third line treatments

For those who do not receive adequate relief from overactive bladder with behavioral and medical therapy, there are three third line treatments. You will usually need to see a specialist to receive these.

Bladder Botox (Onabotulinum toxin A)
Botox works by paralyzing muscle. Injections of Botox directly into the bladder wall treats overactive bladder symptoms by preventing the muscles from contracting. This is done by introducing a small camera, called a cystoscope, through the urethra and into the bladder. A tiny needle is then used to inject the bladder with the Botox. The major side effect from bladder Botox is urinary retention, the inability to completely empty the bladder. Some people may need to self catheterize their bladder due to urinary retention for several months until the Botox wear off. Another common side effect is urinary tract infection.  

(Image adopted from http://icord.org/studies/2015/09/botox-for-overactive-bladder-and-prevention-of-autonomic-dysreflexia-following-spinal-cord-injury )
 

Percutaneous tibial nerve stimulation (PTNS)
In PTNS, a small needle electrode is inserted near the ankle. In a process called neuromodulation, electrical signals are sent up your leg to the nerves in your pelvis that control the bladder. Each session last 30 minutes and is performed weekly for initially 12 weeks, then at longer intervals depending on your response to the therapy. 
 

Sacral nerve stimulation
This is a form of neuromodulation in which a nerve stimulator is implanted and generates signals to the pelvis to decrease bladder activity. The implant is effective for up to 10 years.