Overactive Bladder

Overactive bladder (OAB) is the name for a group of bladder symptoms that includes urinary frequency, urgency, and urinary leakage. Some patients with OAB also experience frequent nighttime urination. As many as 30% of older men and 40% of older women suffer from OAB symptoms, but the condition can also occur in younger people.  OAB may occur as a result of damage to the bladder from an enlarged prostate, neurologic disease, diabetes, pelvic surgery and radiation. OAB significantly impacts work, social life, exercise, and sleep.

In some cases, lifestyle changes such as limiting caffeine and fluids, double voiding, and timed urination can improve OAB symptoms. Pelvic exercises in the form of bladder re-training or biofeedback may improve some mild OAB symptoms. Patients are often offered medication as initial treatment for OAB. Two classes of oral medications can improve bladder capacity and unwanted bladder contractions. While these medications may help some patients, side effects or cost can limit usefulness.

For patients who suffer ongoing OAB symptoms,
we can provide advanced treatments
to offer hope and restoration.

Dr. Thompson has significant experience treating complex urinary conditions.  Due to the expertise and skill she provides, many patients with significant OAB symptoms regain urinary confidence.

Urinary dysfunction and OAB are often complex and multifactorial. For this reason, we may consider additional testing to further understand the anatomy and the function of your condition. You may be asked to keep a voiding diary to help demonstrate your fluid intake and urination. Diagnostic testing can be beneficial in helping us pursue a treatment that is tailored to your situation. Testing may include laboratory evaluation of a urine sample, a bladder scan (an ultrasound that shows how much urine is left behind in the bladder after urination), cystoscopy (examining your bladder with a small camera that is inserted into the urine channel), and/or urodynamics (a test to assess the bladder function using small catheters).  Once we have a more complete picture of your urinary condition, we may offer advanced treatment for OAB such as percutaneous tibial nerve stimulation (PTNS), intravesical Botox injections, or a bladder pacemaker. The OAB treatment algorithm that we use reflects the recommendations of the American Urologic Association.


Tibial nerve stimulation is an OAB treatment that attempts to correct communication between the bladder and the brain, thereby improving urinary control. PTNS is performed by placing a small electrode into your tibial nerve near the ankle and sending electrical pulses to this nerve. Because this nerve directly influences bladder function, the pulses help to reestablish normal signals to your bladder. Patients typically undergo 12 weekly treatments and require monthly maintenance treatments if initial treatments are successful. While this therapy may be limited in efficacy and convenience for some patients, it is safe and well-tolerated.

Bladder Botox

Bladder Botox is a procedure that has been shown to improve many OAB symptoms.  Botox works by relaxing the muscle of the bladder wall so that the bladder can expand and hold more urine. Botox may also diminish spasms that cause bladder urgency, frequency, or leakage. During a bladder Botox treatment, a scope is passed into the bladder, and the Botox medication is injected into wall of the bladder. The procedure is performed in Dr. Thompson’s office using local anesthesia.  Risks may include urinary bladder infection, incomplete bladder emptying, and temporary muscle weakness. Botox often lasts six to nine months and repeat injections help maintain success of the treatment.

Botox Patient Animation Video

Bladder Pacemakers

Sacral neuromodulation (SNM) or the bladder pacemaker is a form of nerve stimulation that helps reconnect signals between the bladder and the brain.  Some patients with OAB have abnormal signals that cause urgency and leakage, and neuromodulation attempts to correct nerve signaling. The procedure is typically performed in two steps.  Initially, a temporary lead is placed near the bladder nerve in your lower back and attached to an external battery for one week. If patients experience benefit from the trial pacemaker, they are offered placement of a permanent lead. Using light sedation and x-ray guidance, the permanent lead is then implanted in the lower back and connected to a battery that is placed under the skin. Some risks include infection, pain over the generator site, and potential generator failure after years of use. Most patients experience either significant benefit or lifetime relief of OAB symptoms.

Having cared for thousands of patients with overactive bladder, Dr. Thompson offers her extensive experience in the latest therapies to improve urinary confidence and well-being.