Innovative Solutions for Overactive Bladder: Neuromodulation Devices

This episode explores various neuromodulation devices designed to help women manage overactive bladder. I talk about the symptoms of overactive bladder and the common treatments such as pelvic floor exercises, behavioral changes, and medications. The episode features clips from interviews with leaders in the field discussing devices like Vivali, Zyda Control Sock, Revi, Ecoin, and sacral nerve stimulators. Each device has its unique approach and benefits, ranging from non-invasive wearables to implantable stimulators, offering patients multiple options for managing their symptoms. The episode aims to provide an overview of these technologies to help listeners make informed decisions about their treatment options. 

Timeline:

00:28 Introduction to Overactive Bladder 

01:46 Exploring Vivally: A Wearable Solution 

08:31 ZIDA Device: Simplifying Bladder Control 

14:59 Revi: Implantable Tibial Nerve Stimulator 

20:14 E Coin: Long-Term Implantable Solution 

27:39 Sacral Nerve Stimulation: A Long-Standing Solution 

34:25 Conclusion and Further Resources

Transcript

Hi there. I've been thinking about all the women that I've seen who have overactive bladder, so are struggling with issues like going to the bathroom all the time, going to the bathroom a lot at night, leaking before you can get there, having that extreme urge symptom. So overactive bladder is so common and so bothersome for so many women.

And some women have tried pelvic floor muscle strengthening, behavioral changes, and some medications. And, and maybe at the point where they're looking at neuromodulation, so stimulating nerves to help with urgency urinary incontinence or urinary frequency. There are lots of different ways that we do that.

And sometimes it's hard to find all of the different things that are on the market. And so on today's episode, I put together different snippets from conversations that I've had about devices that stimulate nerves to help with overactive bladder. So some of these devices stimulate your third sacral nerve, which is in your back.

Some of them stimulate your posterior tibial nerve, which is in your ankle. But they all help with overactive bladder. And I hope listening to these little snippets gives you an idea of what you might be interested in trying. So let's go ahead and let's get started. So this first clip is taken from Season 2, Episode 27, and this is about the device called Vivali.

This is from an interview that I did with Jill Schiaparelli, who was the CEO at the time of the company, um, and we talk all about things Vivali. Vivali is a wearable device that you use at home that stimulates your posterior tibial nerve, which is on your ankle. So, you know, when we stimulate the tibial nerve, right, there are different ways that we can do it.

We can do it with patches. We can do it with basically acupuncture needles. There's an implant that we can do. So  how is Vivaldi different?  

Well, we, we really wanted to think about, you know, as patients, what would we want efficacy, all these products that you described are effective in some way, but we're saying for this indication, we have to raise the bar on what makes a treatment ideal for the patient.

And for us, that meant we eliminated surgery. and side effects and we shifted it to the home and had it be super convenient. Our therapy is just 30 minutes as little as once a week. Can you say that 

again? 

30 minutes once a week. And I want you to think about that in perspective, the implants you're using right now on the low end are probably several hours a day to 24 hours a day, seven days a week.

And so you might wonder why we can do it so quickly. And what we've really innovated here is something called. Physiologic closed loop continuous sensing neuromodulation, and that's a lot of words, but when you think about shifting a physician prescribed product into the home, you have to make sure that the patient who's presumably not a trained medical professional can get accurate neuromodulation every time by simply pushing a button.

And so what that does is it means the technology has to be very sophisticated. So what we're doing is continuously monitoring the patient's muscle contraction or EMG signal. Now, I think in sacral nerve, you might do that in the operating room once to make sure everything's placed. But We do it about 20 times a second.

Yeah, we're continuously doing that. And what that means is we're getting very effective targeted neuromodulation. And what it also means is we know for sure that that electrical signal is getting to the nerve. Anybody can come along and put a stimulator patch as you described up to your skin, anywhere on the body and say, I'm stimulating, but that's completely ineffective if it's not getting to the nerve target.

And I don't mean to get overly complex, but think about if you, um, you had a lamp  and you turn on the light switch and, you know, it wasn't going into the lamp. If the lamp wasn't plugged in, the electricity is never going to get on. The light's not going to go on. It's the same thing with neuromodulation.

You have. That the right amount of electricity is getting to that nerve for your whole treatment. And that's what closed loop neuromodulation does. The other thing it has allowed us to do is we actually calibrate or personalize the amount of electricity for every patient. Which none of the current neuromodulation products do that.

It's usually one size fits all or two or three different programs. At all. The physician actually calibrates the stimulation range for every patient in the office in a relatively quick, noninvasive. Um, technology, so when you send that patient out, they're actually getting. Stimulation personalized to them and continuously adjusted to make sure it's hitting the nerve.

So does the boot ever fit anybody incorrectly? Is there a chance that you could put the boot on and it wouldn't stimulate your nerve correctly? 

So we thought about that, right, because there's a lot of different foot sizes and ankle anatomy. And when you design any sort of medical product, you have to take all that into account.

So we've done a couple of things. We had, we did a study with 40 patients several years ago, and we located the optimal stimulation areas. And we're where most people can easily activate the tibial nerve. We then created the garment to ensure that the stimulating electrodes are not only in the right position for most people, but also that they're of the right size.

You know, we did, we did stimulation zones, if you will. We then design designed several with two sizes of the garment, which accommodate probably 90 to 95 percent of foot and ankle anatomies. And then the final thing we did is because we're doing closed loop, the system, the garment does a check. So if the patient, for example, puts it on incorrectly, or for example, wants to stimulate on the right foot, but accidentally put the garment on the left foot, the system, which is controlled by an app on the patient's phone, recognizes that and says, sends an error message.

If you're someone who has fat ankles, will it work? Absolutely. That was a big clinical question. And there's a lot of skepticism about the ability to deliver electricity through the skin where you have a lot of fat or adipose tissue or edema, which is swelling. Um, and we were able to activate the nerve in excess of 95 percent of people.

Yeah. Um, so it's, it's very reliable for most people. The other thing is the garments can be worn on the left or the right foot. So, for example, there are some contraindications if somebody has, for example, a large metallic ankle implants. Okay. Um, they probably are. And that's true for most stimulation because metal can, you know, can cause problems with the signal, but the patient can simply use the other foot.

So there's optionality here. To really make it accessible to virtually every patient who has the condition.  

That was actually going to be my next question. Is there anyone that you would say, Oh, this is not a good treatment modality for you. These people should not have this treatment. 

You know, we have not tested it in pregnant women.

I, I also want to make sure, you know, we've not tested it in people that perhaps might have cognitive issues. You know, you want to make sure somebody's able to put it on. Right. And you know, they have to be if you can put on a shoe or a sock, you're able to use this. We've also designed our app, you know, to the app standard where I don't want to insult anybody, but most apps are designed to be at a sixth grade reading level.

And that's a standard. So that's kind of what we did as well. So  very, very few people would be excluded from using this. That was our intent. 

Yeah. This next clip is taken from episode 35 from season two, and it is about the ZYDA device, which is another wearable device for overactive bladder. And it is an interview with Isaac Oppenheim, who is the CEO of the company. 

And the difference between us and them is that, you know, our 100 percent focus is helping patients and understanding patients. Our device is super simple because,  you know, I've got parents, I've got grandparents, and I know  how complicated things can get for them and taking something that's really complicated and making it really simple.

Is kind of the, the miracle of Zyta. You know, if you can put on your sock in the morning, um, and open up your car using your key fob, then you are, you are able to use the Zyta control sock. And I'm not one to get up. I'm not a medical device sales guy. I'm not the CEO of, uh, you know, a multinational company. 

Our device is just as good as everybody else. You can go get an implant. If your insurer wants to pay for that. Um, it'll do the same thing as using our soft. You want a fancy thing that has an app? There's a product, you know, there's a company out there that's got that for you. Um, but our product is simple and it's inexpensive because, you know, we come from, we make the product, you know, kind of vertically integrated.

I am there to say, hey, let's not make this something that's going to be expensive for the patient. It's an expensive product. Let's not be, you know, let's not,  let me not dilute anybody. But, um, That's how I got to this product. That's, I think, what kind of differentiates us and why I am so passionate about helping people, you know, in the course of running our clinical trials, particularly, you know, women, um,  were so affected.

I would say one of the things about overactive bladder is nobody's ever died of overactive bladder. It's not cancer. But 

I think one of the things that's so important in your story is, you know, you use the word dignify so many times and, and I think overactive letter does rob you of your dignity, right?

I mean, it's so embarrassing for, um, you know,  mature. Establish people to have have this problem. And so the fact that you have, you know, the face of your product is someone that you respect and you're looking to restore dignity. I, you know, I think that's such a, an amazing thing. And it, it also highlights that this is a big problem for men and women, right?

I mean, women are more affected, but it is definitely a big problem for men as well.  

For sure, you know, and, you know, kind of in the world of partners, you know, I know when I get out of bed, I'm a young guy, I get out of bed at night because I'm thirsty because whatever it is, it bothers my wife sleep. When I get out of bed when, you know, a husband gets out of bed 5 times, 6 times a night to go to the bathroom because they've got nocturia, you know, it's not just impacting them.

It's impacting their spouse. And the same is true. If a woman's getting out of bed 5, 6 times a night, her husband's, you know, body of sleep, their relationship is impacted. The impacts of overactive bladder are not, um, but medical  death. It's the death of a lifestyle. I can't, you know, I met a woman, um, who was  literally suicidal over the fact that her,  her, her overactive bladder had, is preventing her grandkids from coming to visit her because they say that she smells. 

That breaks my heart. Like, I can't, I can't, you know, express how, how, you know, how we have to help, you know, everybody out of this situation. And unfortunately, as you know, you and a lot of people know, the solutions that are out there today. Aren't good. Yeah, the medicines that are out available. They're not particularly great and everybody out there will tell you I have the golden ticket and there is no golden ticket.

Unfortunately, I believe that there, you know,  there is a combination solution that Zyda can really help to provide because we're not because we're honest. Yeah, we're not going to tell you. Oh, just put this sock on and you'll be cured. Take X drug y, drug vetric, or whatever it is, gem, Tessa, and your your, your OEB symptoms will be go away.

Let's talk about the, you know, what is called the clinical success rate. To be a, you know, for success, for a drug or device to say this works. It's a 50% reduction in symptoms. So that's already setting patients up for, you know, kind of  expectations of failure because I've met the patient that says, oh, I have four incontinent episodes a day and you brought me down to two.

So that's a success. No, nobody. That's not what people want. They want not to be incontinent at all. Are there ways to get there? Yeah, absolutely. Neuromodulation is an excellent tool. The Zydecontrol Sock is a wonderful tool. But yeah, there's also behavioral lifestyle lifestyle changes that you need to do.

Maybe you also need to do your pelvic floor therapy, right? 

Yeah. It usually is multifactorial. So, in your randomized controlled trial, how successful was it?  

So, I mean, we had an 80 percent success rate, um, which is, you know, I would say just as successful as everything out there on the market. Everybody's kind of in that same spectrum. 

It's more effective for incontinence and urge. Um, you know, when you look at frequency, nobody wants to get to 0. Right. Time's going to go in the bathroom a day. So we got the, the improvement there is typically about 30%. And that's where the,  the, the success, uh, threshold is there. I can say, you know, we did not have this in our study, but when I talk to patients, the most impactful thing for them is nocturia.

Nocturia, you know, getting up at night, going to the bathroom is something that, you know, really makes people's lives hard. They're tired in the morning, it disturbs their spouses, uh, or partner's sleep. And being able to get up and, uh,  go to the bath, you know, if they were getting up six times a night to get up twice a night,  that's an incredible, uh, benefit to them.

And that's really,  You know, aside from called the improvement in urgent improvement of incontinence, that's really where people get excited when I speak with them. Yeah,  

I'm going to switch gears here a little bit. And now we're going to talk about a device that stimulates the same nerve, the posterior tibial nerve, but is an implantable device.

And so this means that you undergo a surgery and we put something in the ankle that stimulates the device. This first technology is the Revi. From Blue Wind Medical, and this is from a conversation that I had with Dr. Rebecca McCreary, who's a physician who does these implants. The Revi is a little bit different because we don't implant a battery, and you have to stimulate the device at home.

Yeah, so this is an implantable device. We implant it using local anesthesia, local numbing medicine, and it's performed as an outpatient procedure. And the nice thing is, The device is a therapy that would be a long term treatment option for patients, and I think that really aligns nicely with overactive bladder being  a chronic problem that really deserves a chronic therapy.

So  it's nice that a patient doesn't have to be in my office all of the time. To receive the treatment, which would be the current model for some of the percutaneous therapies on the market. And so it really moves the needle in introducing a therapy that patients can do a little bit more on their own terms.

How long does it take to implant it?  

Maybe 20, 30 minutes, you know, some of it is, uh, just depending upon,  you know, what kind of response the patient's getting, and I really think it's important to take the time during the procedure to make sure the placement is  optimized. And so,  You know, one procedure might take a little longer than another and, um, you know, but if you  don't get the placement, right, you know, it's hard to expect the therapy to work.

Yeah. And so  

when you talk about placement, how are you checking that in the office?  

Yeah, ideally we see the nerve bundle and so we, um, are laying,  um, the device right over the actual tibial nerve, um, area, but then we're asking patients where they feel the stimulation when we turn the device on or activate it and making sure that they're getting the appropriate sensation at the right time.

Reasonable levels. Okay. So the objective information, you know, like we're seeing it and then having the patient confirmed. 

Yeah. So patients are awake while you're doing this and you're asking them where they feel the stimulation and making sure that when you turn the stimulation on, you don't have to turn it on super high.

Is that right? Okay. Yep. And then what makes this device different than the other implantable tibial stimulators?  

One nice feature of this device is that there aren't any batteries that are part of the implant. And so all of the batteries or things that would wear out over time are in the, um, low band that the patient wears on their ankle to activate the device.

So  you're not having to go through another surgery to change out a battery, you know, when it wears down. 

So it's one and done. And, and I think that's important because even if the battery lasts for a long time, I mean, you're at some point, you're going to be back, um, replacing that battery and, and that's a, that's a surgery and that's a lot for people to go through how, so when they wear this external stimulator, how often do you have to wear it? 

So in the clinical trial that we participated in and are are currently enrolling patients for patients use the device for 30 to 60 minutes a day. Now, I can certainly see,  you know, like, if a patient  has the device,  Implanted outside of the setting of a clinical trial, I could see them using it a little bit differently to, um, adjust to their, their situation, but, um, those are the parameters we're using for the clinical trial.

Yeah. So the current recommendation is to do it every day. Yes. Do they know? So if it were me, I would want to charge it the least amount possible. Okay. Right. I mean, I would want to do it as infrequently as possible. Do they know that that's the the minimum amount that you need to get the results?  

You know, I think every patient's a little bit different and the way the FDA wants these trials designed or wants to approve things is  with, um, specific parameters.

Yeah. And so I imagine for one patient, it's different than another. And, um, and it may change for individual patients over time as overactive bladder kind of waxes and wanes.  

Now we're going to talk about the equine. And this is from an interview that I did with a woman who had had the equine implanted and is from season one, episode 43.

I always love the episodes that are interviews. Yeah. with patients. The E coin is an implantable device and it has a battery, which means that you don't have to do anything. It just stimulates the nerves and hopefully works for you. But when that battery wears out, you do have to have another surgery to replace it.

So the E coin, it's about the size of a nickel, right? So it's this little here that you, you insert in the ankle and where did you have it placed? Did you have it placed in a surgery center or in the office? 

So, um, where it was, uh, the doctor's group that did it in my area, they did not allow them to do in the office, but they had a, have an outpatient surgery center.

And so I was in that outpatient surgery center. 

And what kind of anesthesia did you get? 

Just local. 

Yeah. So just lidocaine injected. And what was that like for you?  

Uh, that was fine. Uh, I, I needed them to give me a one more shot than, I don't know if she, the doctor, if she didn't hit the correct area, but they did a, Another shot.

But, um, there was people there. I mean, I was awake, which was really nice. So, um, it was funny to 

me that you think that was nice because I think some people would think it was really nice and other people would think it was terrifying, right? Just  your your personal. It 

was  for me. Um, they as you know, they do a slit.

They cut a slit and they put it. I mean, I didn't watch him doing it. But I could, they had someone talking to me the whole time and, you know, I could monitor everything for if I was in discomfort, I could tell them. So I just felt it was well controlled. 

Yeah. Do you consider yourself to be someone who has a really high pain threshold?

No. 

Okay. Just check. I hate 

pain. 

Okay. So I think that's good for people to know, right? That you don't like pain. And you felt like this was pretty easy because you basically numb it up. You wait, you clean off the area and then you're right. You make an incision in the skin and then just slip it under the skin basically.

And then you have to sew it up in three different layers. Um, and if you're moving really quickly, I mean, I would say it takes somewhere between 20 to 30 minutes. Um, which is,  you know, I mean, it can be hard to be still for that long, especially if you're a little bit uncomfortable.  

I didn't feel any uncomfortableness  and mine actually took a bit longer.

I think it was more like 40, 45 minutes. And I didn't have, like I said, they were talking to me and monitored to me, so I didn't even feel I was there that long. 

Okay, so that's good. So you felt like it was an easy procedure. And then after the procedure, you know, we, we put the implant in, but then the implant isn't turned on until everything is healed.

And that usually takes about a month. And while things are healing, you wear this compressive sock to keep it in the, um, the right place while it heals. How uncomfortable was that compressive sock for you?  

So at the beginning, it was fine. Uh, but when I went in, uh, For four weeks, because I did keep it on 24 hours, seven days a week like they requested.

I guess I had some rubbing on the top of my foot that I didn't realize  in one spot.  

Yeah. And so then after that, you just had to keep the sock off and it healed. 

Yeah,  

that, that's been the thing that, um, you know, some of my patients have found that, you know, the procedure itself wasn't bad, but then keeping this compressive sock on for a month was, um, the thing that irritated them the most. 

But I would also tell you that I've only done these in the summer, so I don't know if maybe, you know, that's a summertime phenomena and as it gets cooler, that's not such a big. a big deal. Um, how hard was it for you to wait that month for them to turn it on?  

Um,  it was a little disappointing. I, I didn't realize it was going to be a month.

I thought after the two weeks when they took the stitches out that I would be able to get it turned down, but you know, I was just so happy to have a, what I consider a permanent type of solution. That it was a minor thing.  

And then once they turned it on, so the device doesn't stimulate constantly, it stimulates for a period of time, every three days when it comes on, what's it feel like for you? 

I only felt it the first couple of times it came on and I just like felt little something. It wasn't as, um, so on the nerve, the PTNS, It always depended on the person how good they were on hitting the nerve with the acupuncture, you know, so sometimes it was They could really hit that nerve and you, it'd be almost painful to get the treatment.

You want to be just not quite on the nerve, right? Cause when you get the nerve, really feel that. 

Yeah. So this was much less, um, uh,  couple of times I did feel it, it was much less than even the treatment. Uh, and then after the couple of times I, I may feel it every now and then, it's different times. So I don't know if that's what I'm really feeling or not, but it's nothing painful.

Yeah. So, and it sounds like most of the time you don't even realize that it's kind of stimulating that nerve. That is, I would 

say 99. 99  percent of the time I haven't, but when they turned it on, to be fair,  they asked me if I could feel it and I couldn't. So they put it at a nominal, um, yeah, intensity.

Yeah. They kind of want it to be below the threshold, right? So you're not really feeling it that much. Do you, um, did you have to have your settings changed at all or your settings have been the same the whole time? 

Yeah. My settings are the same.  

And, um, what about your symptom relief? So, oh my gosh. 

So, uh, it has made, I have traveled. 

A  couple of times on airplane trips, long airplane trips, like from the West Coast to the East Coast and the West Coast to Texas, and it's just been wonderful  because plane travel was very difficult because of the pressure for me when you go up on the planes and really normally during the days. Time. I never think about my bladder at all, which I was constantly thinking about it before.

Yeah. This last clip is from season two, episode 12, and it is about sacral nerve stimulation. So your third sacral nerve was the first nerve that we stimulated to help treat overactive bladder. And it's been done for more than 20 years in the United States. And this episode is an interview with a woman who has had the device implanted and is also a representative for one of the companies.

So she helps treat women who have this problem as well. And she has a really interesting perspective on everything. There are two companies. That creates sacral nerve  stimulators. One is exotics and the other is Medtronic and she works for the exotics company. 

Sacral nerve stimulation is, and then I was implanted, um, when I was 44.

Okay. 

Yeah. So there are two different brands of sacral neural stimulation Medtronic, which has been on the market for longer and exotics, which is a newer version. Why did you pick exotics?  

The innovation. So that's what really we talk about as a company. It was M. R. A. Compatible. The battery lasts the one I have.

I have a rechargeable device that last at least 15 years in my body. I was 44. So instead of having to have a surgery every 5 to 7 years, I would have to have one, you know, maybe in 20 and you know, this battery, the testing we've done internally shows that this 15 year FDA approved battery could last for 20 and 30 years.

Also, the, the, the, the fussiness of the Medtronic system, you have to have a communicator and, and, uh, like a Samsung phone and you have to charge each piece and they both have different types of cords and I have a little remote and it's just a little green key fob and it communicates. Through my skin with a device with no cords or communicators.

Um, so, and, and I could have an MRI. So these were all, and I don't have a problem charging. I'm young, you know, relatively speaking, and I charge my phone every day. So, yeah, 

I think everything that you're saying is true. I think that Exonix really came around and, and, Fixed all of the things that were irritating patients about the Medtronic product, right?

It wasn't particularly user friendly. Um, and, and it just hadn't been updated in a long time. And, and now, you know, Medtronic has changed a lot of things, right? In, in order to make it As good. I mean, the battery lives are longer. There are things that are changing, but I think exotics came around and, and, you know, kind of made it a much easier, less footsie technology.

Are you intimidated by the technology as a, as a patient? Because I think a lot of people are, and, and just find this whole stimulating a nerve and electricity in my body and battery just to be a little bit terrifying.  

So now that I'm an employee, of course, I'm, you know, but thinking back to when I was going to have it implanted,  it was an interesting concept, but I knew there were, you know, we have pacemakers for the heart and we have pain stimulators and as a nurse.

I understood that, but yes, the explaining this to a patient who has no grasp on that. It can be overwhelming. Um, so I try to keep that very simple. When I explain it to patients, we're just going to stimulate a nerve in your sacrum that's responsible for the communication between your brain and your bladder.

And. It's going to clear up whatever miscommunication we have, and that's as far as I go, but I would say, yes, it was a little overwhelming, but there was a lot of information given. Dr. Kennelly will answer any question that you have. Our website is fantastic. So there's a lot of tools and resources. To help and and axonics as a company make sure our patients are informed and feel comfortable before moving forward.

I think that's true. I think that there's an awful lot of handholding and the degree of handholding really depends on the patient, right? Some people need a lot of handholding. Some people don't. So when you had the device implanted, I mean, where are you at now in terms of symptoms? Are you still getting up four times a night?

Are you peeing 20 times a day? 

22 to 26 times a day before 8 to 10 now. Okay. Depending on how many bladder ear tints I choose to put in my body on a daily basis. So I still drink at least two cups of coffee in the morning. I still like to have a cocktail, you know, with friends or on the weekends. So, and that I use that when I educate patients as well, like you still have to live your life.

Yeah, 

you want to watch that. You want to watch the bladder irritants. You want to watch your water consumption. You want to stop drinking 2 hours before bed. But if you don't, that's okay. Because being on yourself has never killed anybody. So we just, we have to live our lives and feel like we are fulfilled.

And that's what I do. So. I would say, um, maybe up to 12 times if it's a day where I have the extra coffee or the extra cocktail, but that is the, um, the exception, not the rule. So, and I don't get up at night. It's very, um, uncommon for me to get up at night up at night. I have noticed that with my, um, my cycle.

That right before I'm about to start my period and I must be like dumping fluid. I do I will get up there's a there's a night each month that I'll get up 2 or 3 times and I'm like, that's interesting. And then I realized it was. Um, yes, very cyclic. 

Yeah, I mean, that's, um, that definitely indicates right that there's a hormonal component there, right?

When your estrogen levels are lower, you're perceiving it, which will be an important thing for you to kind of  monitor as your estrogen levels change over time or not change if you choose  to address that. So is there anything that I know, I know, is there anything that it didn't fix for you? Is there anything that you think, oh my gosh, I, I wish it would've done this. 

I wish I was dry.  

Yeah, 

I still leak a little bit. Yeah. Um, but I used to saturate four large pads a day  and, um, you know, being a bedside nurse, I remember starting an IV  multiple times. And just being on myself because I needed to go and I couldn't hold it and I got stuck in the room longer than I thought I was going to, you know, those kinds of things now it's, it's drops.

It's not, it's not floods. And I would love to be completely dry. 

Yeah, 

um, and, but that's not, it's not a cure. So, in a way, as a clinical specialist, it's a great thing that I can bring to the table for my patients to say, we're going to improve your quality of life. But we, we cannot cure you from that. 

So I hope that helped provide you with an overview of the different products that are on the market that can stimulate your nerves and help with overactive bladder.

If you have more questions and I would encourage you to go back and listen to the original episodes because there's a lot more detail that is there and these were just little clips. But I think it's important for you to know that there are lots of different things that you can do. can use to treat overactive bladder and One may not be better than another but it may appeal to you more for different reasons.

You may not want a surgery You may not like the idea of doing something with a nerve in your back And so there are other options for you and it's important for you to be aware of the different things that are out there so good luck and Let's move forward