Name: Other Treatments for Bladder Conditions
Creator: COB Foundation
Published: 2018-12-13T00:00:00.000Z

When lifestyle changes and oral medications aren’t enough to manage bladder symptoms, other treatment options exist. These range from minimally invasive procedures like Botox injections to surgical interventions for specific structural problems. This article covers the main alternatives to tablets, what each involves, and who they might suit.

I should say upfront: most of these treatments are second-line options. You’ll typically have tried behavioural approaches and at least one or two medications before being offered anything discussed here. That’s not arbitrary gatekeeping—it reflects genuine clinical evidence that simpler interventions work for many people, and more invasive options carry additional risks that only make sense when simpler approaches have failed.

Botulinum Toxin (Botox) Injections

Botox has become an established treatment for overactive bladder that doesn’t respond adequately to medication. The same botulinum toxin used cosmetically can calm an overactive bladder muscle when injected directly into the bladder wall.

How It Works

During a cystoscopy (a procedure where a thin camera is passed through the urethra into the bladder), the urologist injects small amounts of botulinum toxin at multiple points in the bladder muscle. The toxin blocks the nerve signals that trigger unwanted bladder contractions, reducing urgency and incontinence episodes.

The procedure takes about 20-30 minutes and can be done under local anaesthetic, though some centres offer sedation. Most people go home the same day. You might notice some blood in your urine for a day or two afterwards, which is normal.

What to Expect

Results typically become apparent within two weeks. Clinical trials show that around 60% of patients achieve at least a 50% reduction in incontinence episodes 1. Some people do even better; others see more modest improvement or don’t respond at all.

The effects aren’t permanent. Most people find symptoms returning after six to nine months as the toxin wears off. If it works for you, repeat injections are needed to maintain the benefit. The good news is that repeat treatments generally remain effective—the bladder doesn’t become resistant to Botox in the way it might to some medications.

The Risks Worth Knowing About

The main concern with bladder Botox is urinary retention, meaning difficulty emptying the bladder completely. This happens in roughly 5-10% of patients 2. If the bladder muscle becomes too relaxed, you may need to learn clean intermittent self-catheterisation (more on that below) to empty your bladder until the effect wears off.

Before offering Botox, your specialist will discuss this possibility and may want to confirm you’d be willing and able to self-catheterise if necessary. This isn’t meant to scare you off. For most people, self-catheterisation is manageable and temporary. But it’s important to go in with realistic expectations.

Urinary tract infections are also more common following Botox treatment, occurring in roughly 10-20% of cases. Staying well hydrated and emptying your bladder completely helps reduce this risk.

Electrical Stimulation Treatments

Several treatments use electrical stimulation to regulate bladder function. The basic idea is that stimulating certain nerves can calm an overactive bladder or strengthen a weak one. These range from simple home devices to surgically implanted systems.

Percutaneous Tibial Nerve Stimulation (PTNS)

PTNS (sometimes marketed as Urgent PC) involves inserting a fine needle near the ankle and delivering a mild electrical current. The tibial nerve at this location shares a pathway with the nerves controlling the bladder. Stimulating it appears to modulate bladder signals, though the exact mechanism isn’t fully understood.

A typical treatment course involves 12 weekly sessions, each lasting about 30 minutes. You sit in a chair while a healthcare professional places the needle and adjusts the stimulation. It shouldn’t be painful—most people feel a slight tingling or pulsing sensation in the foot or toes.

Studies report that 60-80% of patients experience improvement, though the effect is often more modest than with Botox 3. PTNS tends to suit people looking for a less invasive option who are willing to commit to regular treatment sessions. After the initial course, maintenance sessions (usually monthly) are needed to sustain benefits.

PTNS has few side effects. Occasional minor bruising at the needle site is about it for most people.

Sacral Nerve Stimulation (SNS)

Sacral neuromodulation (brand name InterStim) takes electrical stimulation further with a permanently implanted device. It works like a pacemaker for the bladder, delivering continuous low-level stimulation to the sacral nerves that control bladder function.

The process happens in two stages. First, you undergo a trial period (usually two to four weeks) with a temporary external stimulator. This lets you and your doctor assess whether you respond before committing to permanent implantation. If the trial shows significant symptom improvement (usually defined as at least 50% reduction), you can then have the permanent device surgically implanted.

SNS can be highly effective for the right patients. It’s used for both overactive bladder and urinary retention when other treatments have failed. However, it involves surgery, general anaesthetic, and an implanted device that may eventually need battery replacement or adjustment. It’s generally reserved for refractory cases after simpler options have been exhausted.

Pelvic Floor Electrical Stimulation

For stress incontinence and weak pelvic floor muscles, electrical stimulation devices can help strengthen the muscles more effectively than exercises alone. Small probes inserted vaginally or rectally deliver electrical pulses that cause the pelvic floor muscles to contract.

This is essentially passive exercise—the device does the work while you sit there. It can be useful for people who struggle to activate their pelvic floor muscles voluntarily, or as a supplement to manual exercises. Some physiotherapists use these devices during consultations; home units are also available.

The evidence for pelvic floor stimulation is mixed. Some studies show benefit, particularly when combined with active exercises, but it’s not clearly superior to motivated, well-performed Kegel exercises done consistently 4.

Biofeedback

Biofeedback uses measuring devices to help you become more aware of bodily functions that normally happen outside conscious awareness. For bladder conditions, it’s mainly used to improve pelvic floor exercise technique.

How It Works in Practice

During a biofeedback session, sensors detect electrical activity in your pelvic floor muscles. This information displays on a screen, showing you in real time when you’re contracting correctly and how strongly. It’s essentially instant feedback on your Kegel technique.

Many people doing pelvic floor exercises are actually doing them wrong—bearing down instead of lifting up, holding their breath, or activating the wrong muscles entirely. Biofeedback catches these errors immediately. You can see on screen when you’re getting it right and adjust accordingly.

Who Benefits

Biofeedback works well if you’ve been doing pelvic floor exercises without improvement and want to confirm you’re doing them correctly. It also helps people who have difficulty sensing their pelvic floor muscles at all, which is common after childbirth, surgery, or with neurological conditions.

Biofeedback isn’t a treatment in itself; it’s a teaching tool. Once you’ve learned proper technique, you shouldn’t need ongoing sessions. The skills transfer to home practice.

Physiotherapists specialising in pelvic health commonly offer biofeedback as part of their assessment and training. Some NHS continence services provide it; privately, expect to pay for each session.

Intravesical Treatments

Intravesical therapy means delivering medication directly into the bladder via a catheter, bypassing the digestive system entirely. This approach is mainly used for interstitial cystitis/painful bladder syndrome and certain types of incontinence.

What Gets Instilled

Several substances may be instilled into the bladder depending on the condition:

Dimethyl sulfoxide (DMSO) has been used for decades for interstitial cystitis. It’s thought to have anti-inflammatory and muscle-relaxing properties. Treatment typically involves weekly or fortnightly installations for several weeks.

Hyaluronic acid and chondroitin sulphate (brand names include Cystistat, iAluRil, Gepan) are glycosaminoglycans that may help replenish the bladder’s protective lining in people with IC/PBS. Evidence is mixed, but some patients report meaningful relief.

Botulinum toxin for bladder injections is technically an intravesical treatment, though it’s injected into the muscle rather than simply instilled.

Local anaesthetics (lidocaine) mixed with other agents may be used for painful bladder conditions or to help with urgency.

What the Procedure Involves

A thin catheter is passed through the urethra into the bladder. The treatment solution is instilled, and you’re asked to hold it for 20-60 minutes before voiding. The procedure itself takes only a few minutes; the waiting is the main time commitment.

Some people find catheter insertion uncomfortable, but it shouldn’t be painful. Using plenty of anaesthetic gel helps. The main risk is urinary tract infection, which is minimised by using sterile technique.

For more detailed information on specific intravesical medications, see our article on intravesical medications.

Catheters and Self-Catheterisation

When the bladder won’t empty properly (whether due to obstruction, nerve damage, or muscle weakness), catheters may be needed to drain urine. This isn’t a treatment for overactive bladder but rather for urinary retention and incomplete emptying.

Clean Intermittent Self-Catheterisation (CISC)

CISC involves passing a thin, single-use catheter through the urethra to drain the bladder, then removing it. Most people learn to do this themselves at home, inserting a catheter several times daily.

It sounds daunting, but most people master the technique within a week or two. Modern catheters come pre-lubricated and are much easier to use than older designs. The procedure takes about five minutes once you’re practiced.

CISC is often preferable to having an indwelling catheter because it reduces infection risk and preserves more normal bladder function between catheterisations. People with neurogenic bladder, post-surgical retention, or retention following Botox treatment commonly use this technique.

Indwelling Catheters

When self-catheterisation isn’t practical, an indwelling catheter (one that stays in place) may be needed. Urethral catheters pass through the urethra and are held in the bladder by a small inflated balloon. Suprapubic catheters are surgically placed through the abdominal wall directly into the bladder.

Indwelling catheters carry higher infection risk than intermittent catheterisation and require ongoing care. They’re generally used when other options aren’t feasible, such as for people with severe mobility issues or advanced illness.

Catheter Complications

All catheter use carries infection risk. Catheter-associated urinary tract infections are among the most common healthcare-associated infections. Good hygiene, adequate fluid intake, and regular catheter changes (for indwelling types) help minimise this risk.

Long-term catheter use can also cause bladder stones, urethral damage, and bladder shrinkage. These risks are another reason intermittent catheterisation is preferred over indwelling catheters when possible.

A pessary is a removable device inserted into the vagina to support pelvic organs. They’re used primarily for pelvic organ prolapse but can also help with stress incontinence by supporting the bladder neck.

How They Work

Pessaries come in various shapes (rings, dishes, cubes, and others), each suited to different prolapse types and anatomies. The device sits in the vagina and physically supports the bladder, uterus, or rectum in a more normal position.

For women with cystocele (bladder prolapse), a well-fitted pessary can reduce the bulging sensation and improve bladder emptying. Some pessaries with additional knobs or ridges (called incontinence pessaries) specifically support the urethra to reduce stress leakage.

Fitting and Maintenance

Pessaries need to be fitted by a healthcare professional. Finding the right type and size often takes a few attempts—what works perfectly for one woman may be uncomfortable or ineffective for another.

Once fitted, most pessaries can be left in place for extended periods, removed for cleaning every few weeks or months. Some women prefer to remove them nightly or before intercourse. Your healthcare provider will advise on the appropriate routine for your specific pessary.

Who They Suit

Pessaries offer a non-surgical option for prolapse management. They work well for women who want to avoid or postpone surgery, those with health conditions that make surgery risky, and women planning future pregnancies. (Pregnancy and birth can worsen prolapse that’s been surgically repaired.)

Pessaries aren’t for everyone. Some women find them uncomfortable or difficult to manage. Vaginal discharge and occasional irritation are common. Regular follow-up is needed to check the vaginal tissues remain healthy.

Surgical Options

Surgery is generally the last resort for bladder conditions, reserved for specific structural problems or when all other treatments have failed.

Surgery for Cystocele (Bladder Prolapse)

Surgical repair of bladder prolapse involves making an incision in the vaginal wall and tightening the tissues between the vagina and bladder. The aim is to create better support, pushing the bladder back into a more normal position.

Recovery typically takes four to six weeks. During this time, heavy lifting and straining must be avoided to let the repair heal. Most women stay in hospital for one to three days after the procedure.

Success rates vary depending on the severity of prolapse and surgical technique. Recurrence is possible, particularly if underlying risk factors (chronic coughing, heavy lifting, constipation) aren’t addressed.

Some repairs use surgical mesh to reinforce the tissue. Mesh complications have received significant media attention in recent years, and its use has become more restricted. If mesh is being considered, discuss the risks and benefits thoroughly with your surgeon.

Surgery for Enlarged Prostate

In men, benign prostatic hyperplasia (enlarged prostate) often causes lower urinary tract symptoms that overlap with overactive bladder. When medication doesn’t adequately control these symptoms, surgery to reduce prostate size may be recommended.

Transurethral resection of the prostate (TURP) remains the most common procedure. An instrument passed through the urethra removes excess prostate tissue, widening the channel through which urine flows. It’s effective but carries risks including retrograde ejaculation (semen going backward into the bladder instead of out) in most men, and temporary urinary symptoms during recovery.

Newer techniques including laser prostatectomy, prostatic urethral lift (UroLift), and water vapour therapy (Rezūm) offer alternatives with different risk profiles. Your urologist can advise which approach suits your specific situation.

Stress Incontinence Surgery

For women with stress incontinence that hasn’t responded to pelvic floor exercises, surgical options include:

Mid-urethral slings place a strip of synthetic mesh or tissue under the urethra to provide support. These have been highly successful for many women but, like vaginal mesh for prolapse, have faced scrutiny over complications in some cases.

Colposuspension stitches the vaginal wall to ligaments behind the pubic bone, supporting the bladder neck. It’s an older technique now less commonly performed but still used in certain situations.

Bulking agents injected around the urethra can help thicken tissues and improve closure. Effects are often temporary, requiring repeat injections.

Any surgical decision requires careful discussion of individual risks and benefits. The choice depends on your specific anatomy, whether you’ve had previous surgeries, and your tolerance for different types of complications.

Making Treatment Decisions

With so many options, deciding which treatment to pursue can feel overwhelming. A few principles help:

Start conservative. Lifestyle modifications, pelvic floor exercises, and bladder training have no surgical risks and work for many people. Give them a proper trial before escalating.

Be realistic about expectations. Even advanced treatments rarely eliminate symptoms completely. Success usually means noticeable improvement rather than cure.

Consider your circumstances. A treatment requiring weekly clinic visits might not suit someone with work or caring commitments. An implanted device might not suit someone who needs regular MRI scans for another condition.

Get specialist input. If first-line treatments haven’t worked, referral to a urologist or urogynaecologist gives you access to the full range of options and expertise in matching treatments to individual circumstances.

The COB Foundation provides information and support for people navigating bladder condition treatments. Our articles on OAB treatments and medication for OAB cover related topics in more detail.