Overactive Bladder

Overview

What is overactive bladder?

Overactive bladder (OAB) is a combination of symptoms that may cause you to urinate (pee) more frequently, have uncontrollable urges to pee, experience incontinence and have to pee at night.

Who does overactive bladder affect?

Overactive bladder is most common in people 65 and older. Women may have OAB at a younger age, usually around 45.

How common is overactive bladder?

Overactive bladder is common. It affects up to 33 million adults in the U.S., including as many as 30% of men and 40% of women. However, that number may be higher because many people may feel embarrassed and won’t get help.

How does overactive bladder affect my body?

Overactive bladder symptoms can cause stress and affect your quality of life.

Does overactive bladder go away?

No, overactive bladder doesn’t go away on its own. If you don’t treat OAB, your symptoms can get worse, the muscles in your bladder that help control when you pee can become weak and your pelvic floor tissues can get thinner.

Symptoms and Causes

What are the symptoms of overactive bladder?

Overactive bladder represents a collection of symptoms. These symptoms include:

  • Urinary urgency. Urinary urgency is a sudden, uncontrollable need to pee. Once you feel the need to pee, you have a short amount of time to get to a bathroom.
  • Frequent peeing. A frequent need to pee means you have to go to the bathroom more often than usual.
  • Urge incontinence. Urge incontinence is a sudden, uncontrollable need to pee, and you may leak pee.
  • Nocturia. Nocturia is the need to get up to pee at least two times each night.

What is the main cause of overactive bladder?

Conditions or injuries that affect your detrusor muscle cause overactive bladder. Your detrusor muscle is a collection of smooth muscle fibers in the wall of your bladder. These conditions may include:

  • Abdominal trauma. Pregnancy and childbirth can stretch and weaken your pelvic muscles. Your pelvic muscles are the muscles and tissues that support the organs in your lower abdomen. Your bladder may sag out of its normal position if your pelvic muscles weaken.
  • Nerve damage. Sometimes your body sends signals to your brain and bladder to pee at the wrong time. Certain diseases and trauma can cause nerve damage, including pelvic or back surgery, herniated discs, radiation therapy, Parkinson’s disease, multiple sclerosis or a stroke.
  • Medications, alcohol and caffeine. All of these can dull your nerves, which affect signals to your brain and cause your bladder to overflow. Diuretics and caffeine may cause your bladder to fill rapidly and potentially leak.
  • Infection. An infection, such as a urinary tract infection (UTI), can irritate your bladder nerves and cause your bladder to squeeze without warning.
  • Extra weight. Having overweight can put extra pressure on your bladder, which can cause urge incontinence.
  • Estrogen deficiency after menopause. Hormonal changes may cause urge incontinence. Vaginal-only estrogen therapy can help.

Diagnosis and Tests

How is overactive bladder diagnosed?

A healthcare provider can diagnose overactive bladder by reviewing your symptoms and conducting a physical examination of the organs around your pelvis and rectum. They may ask you questions such as:

  • What are your symptoms?
  • How long have you had these symptoms?
  • Do you have a family history of overactive bladder?
  • What over-the-counter and prescription drugs do you take?
  • What kinds of fluids do you drink during the day?
  • What time of day do you drink certain fluids?
  • What do you eat during the day?

They may also refer you to a urologist. A urologist is a doctor who specializes in diseases and conditions that affect your urinary tract and reproductive system.

What tests will be done to diagnose overactive bladder?

A healthcare provider may order tests to help diagnose overactive bladder. These tests may include:

  • Urinalysis. A urinalysis (urine test) examines the visual, chemical and microscopic aspects of your pee. A provider will look for red blood cells, white blood cells and bacteria. If you have any of them in your pee sample, you may have an infection that causes OAB.
  • Urodynamic testing. Urodynamic tests measure how much pee remains in your bladder after you go to the bathroom, how much you pee, how fast you pee and how much pressure is on your bladder as it fills with pee.
  • Ultrasound. An ultrasound is a noninvasive imaging test that allows a healthcare provider to take a detailed look at your bladder.
  • Computed tomography (CT) scan. A CT scan is a noninvasive imaging test that produces 3D images of your bladder.
  • Cystoscopy. A healthcare provider will use a special instrument (cystoscope) to look inside your bladder from your urethra. The provider typically uses a numbing gel so you don’t feel pain in your urethra. In rare cases, they may use general anesthesia, so you aren’t awake, won’t move and won’t feel any pain.

Management and Treatment

How do you fix overactive bladder?

Different treatments can help fix your overactive bladder. Treatments may include changing certain behaviors, medications and nerve stimulation (neuromodulation).

What behavioral changes can I make to help fix overactive bladder?

You can make many changes to your behavior to help fix your overactive bladder. These include:

Keeping a bladder diary

A healthcare provider may ask you to keep a bladder diary for a few days. Noting what happened before you had an accident can help the provider determine the cause of your OAB. You’ll use your bladder diary to track:

  • What you drink.
  • How much you drink.
  • What you eat.
  • How often you pee.
  • When and how much pee you leak.
  • How often you feel an urgent need to pee.
  • When you were unable to reach the bathroom in time.
  • If anything caused you to pee, such as coughing, sneezing or laughing.

Monitoring your diet

Stop eating or cut back on drinks or foods that may cause bladder symptoms. These may include:

  • Tea.
  • Coffee.
  • Alcohol.
  • Caffeinated soft drinks.
  • Fruits and fruit juices.
  • Chocolate.
  • Tomatoes and tomato-based products.
  • Spicy and acidic foods and drinks.
  • Foods and drinks that contain artificial sweeteners, such as diet soft drinks and some chewing gums.

Maintaining bowel regularity

Constipation can place pressure on your bladder and affect your bladder function. You may be able to avoid constipation and reduce bladder symptoms by keeping healthy bowel habits. The following can help you maintain bowel regularity:

  • Increase your fiber intake. Incorporate foods such as beans, pasta, oatmeal, bran cereal, whole wheat bread, fresh fruit and fresh vegetables into your diet.
  • Drink two to four extra glasses of water each day.
  • Exercise regularly.

Managing your weight

Having overweight can put pressure on your bladder, which may contribute to bladder control problems. Maintaining a weight that’s healthy for you can reduce pressure on your bladder.

Stop using tobacco products

Cigarettes and other tobacco products can irritate your bladder muscle. Coughing spasms due to smoker’s cough can also cause leakage.

Bladder retraining

When you have OAB, your body conditions your bladder muscles to react a certain way. By resetting your bladder muscles, you may hold your pee better.

Bladder retraining teaches you how:

  • Resist feelings of urgency.
  • Delay going to the bathroom.
  • Pee according to a timetable instead of responding to feelings of urgency.

How do you reset an overactive bladder?

The following steps can help you reset your overactive bladder:

  • Start with your current voiding interval. Your voiding interval is how often you pee. For example, if you pee every hour on average, this is your current voiding interval. Record how often you pee in your bladder diary to determine your current voiding interval.
  • Once you’ve established your current voiding interval, try to wait a few minutes between when you feel the need to pee and when you actually go to the bathroom. Over time, slowly increase the time between when you pee. If you develop urgency between the voiding intervals, take deep, slow breaths in and out of your mouth. Imagine yourself in a peaceful setting or use another relaxation technique until the urge passes. Once the urge passes, go to the bathroom.
  • Empty your bladder regularly all day and night at first. Don’t wait until the last minute. For example, start by going to the bathroom every two hours. If you’re still dry after two hours, gradually increase the time between when you go to the bathroom. If you’re wet, decrease the time between when you go to the bathroom to once an hour. If you usually go every hour, try to increase the time between bathroom visits to one hour and 15 minutes.
  • Once you can maintain your new schedule without an accident for at least a week, try to increase your voiding interval by an extra 15 minutes. Continue until you reach a schedule that makes you feel comfortable. Try to achieve a voiding interval of between two and four hours.
  • Stick to your schedule as much as possible.

How do I control urges when resetting my bladder?

Controlling your urges is a key step in resetting your bladder. The following strategies may help:

  • Stop what you’re doing and stay put. Stand quietly or sit down, if possible. Remain as still as possible. When you’re still, it’s easier to control your urges.
  • Squeeze your pelvic floor muscles quickly several times (Kegels). Don’t fully relax in between Kegels.
  • Relax the rest of your body. Take several deep breaths to help you let go of any tension.
  • Concentrate on suppressing your urge to pee.
  • Wait until the urge goes away.
  • Walk to the bathroom at a normal pace. Don’t rush. Continue squeezing your pelvic floor muscles quickly while you walk.

Patience is important. Retraining your bladder usually takes at least six to eight weeks to see results. Talk to a healthcare provider if you have any questions or aren’t happy with your progress. They may prescribe medications for you to take while you’re resetting your bladder to help you achieve the best outcome.

Can nerve stimulation help overactive bladder?

Yes, nerve stimulation can help improve OAB. Your nerves help tell your brain that your bladder is full. By treating your nerves, you can improve your bladder control.

Nerve stimulation is a reversible treatment. Healthcare providers only recommend it if other treatments don’t work.

There are several types of nerve stimulation treatments. These include:

Sacral nerve stimulation

Sacral nerve stimulation is a therapy that electrically stimulates the nerves that control your bladder.

A healthcare provider will implant a small device called a neurotransmitter under the skin near your upper buttock (butt) area. The neurotransmitter sends mild electrical impulses through a wire near your sacral nerve. Your sacral nerve is a nerve in your lower back. The impulses help you control your bladder.

Sacral nerve stimulation can reduce the number of times you have to use the bathroom or the number of times you accidentally leak pee. It’s overall very effective. It’s also an outpatient procedure, so you can go home afterward.

Percutaneous tibial nerve stimulation

Percutaneous tibial stimulation sends small nerve impulses to a nerve branch near your ankle. It helps stimulate bladder control.

Percutaneous tibial nerve stimulation is an outpatient procedure. Many people need 12 weekly sessions and then monthly maintenance sessions afterward.

Botulinum toxin injections

Botox® is the most well-known botulinum toxin brand. A healthcare provider injects Botox into your bladder wall using a cystoscope.

This therapy is very effective, even for patients who haven’t responded well to other therapies. A small number of people may have temporary urinary retention (difficulty peeing) after a Botox injection.

Botox injections wear off over time. Most people need to repeat injections every six months.

What medications are used to treat overactive bladder?

As you’re retraining your bladder, a healthcare provider may prescribe medication. Medications can help restore normal bladder function. Commonly prescribed medications for overactive bladder include:

Anticholinergic medications

Anticholinergic medications help control muscle spasms in your bladder. A healthcare provider may prescribe:

Beta-3 adrenergic medication

Beta-3 adrenergic medications cause the detrusor muscles in your bladder to relax so your bladder can store more pee. A healthcare provider may prescribe:

How soon after treatment will I feel better?

Pelvic floor exercises and changes to your lifestyle may take six to eight weeks before you start to see results.

Many medications start to relax your bladder muscles after a few hours. But they may take up to a month to work fully.

Botox should start to work after one to two weeks.

Most people start to see improvement after six nerve stimulation treatments. However, it may take up to 12 treatments to see results.

Prevention

How can I reduce my risk of developing overactive bladder?

Lifestyle adjustments can help reduce your risk of developing an overactive bladder. These may include:

  • Maintaining a weight that’s healthy for you.
  • Drinking caffeine and alcohol in moderation.
  • Drinking the proper amount of fluids each day. Too many fluids can worsen your symptoms, while not drinking enough can irritate your bladder lining and increase the severity of your urges.
  • Exercising regularly.
  • Performing Kegels or other pelvic floor exercises.
  • Managing conditions that may cause OAB, such as diabetes or UTIs.

Outlook / Prognosis

What can I expect if I have overactive bladder?

Overactive bladder symptoms can cause considerable stress. Treatment can be challenging to manage, and symptoms may never completely disappear. But many people are satisfied with the treatment they receive and often experience a dramatic improvement in their quality of life.

Living With

How do I take care of myself?

If treatments don’t work for you, or if you’re waiting for them to take effect, incontinence products such as disposable pads or adult diapers can help you take control and improve your quality of life.

The following can help boost your comfort and confidence if you’re wearing incontinence products:

  • Change the product regularly. Changing your pads or adult diapers after a leak helps reduce odors.
  • Apply a barrier ointment or lotion. Using a barrier ointment or lotion on your skin before using incontinence products helps prevent skin irritation from regular exposure to pee.
  • Wear comfortable, loose-fitting clothes. Incontinence products can be bulky and make you feel self-conscious. Comfortable, loose-fitting clothing can help hide incontinence products, so you worry less about others noticing what you’re wearing.
  • Wear darker clothing. Darker clothing helps hide any leaks that may occur.

When should I see a healthcare provider?

See a healthcare provider if you experience any symptoms of an overactive bladder.

Age-related OAB may develop gradually and slowly worsen over time. If your symptoms develop suddenly and you have heavy leakage, your OAB may be a symptom of another condition, such as an infection or a neurological issue. It’s best to have a provider check these symptoms sooner rather than later.

What questions should I ask a healthcare provider?

  • How do you know that I have an overactive bladder?
  • What’s the cause of my overactive bladder?
  • What’s a normal number of times to pee each day?
  • How much should I drink each day?
  • What fluids should I drink?
  • What fluids should I avoid drinking?
  • What foods should I eat?
  • What foods should I avoid eating?
  • What treatments do you recommend?
  • Are there any side effects to your recommended treatment?
  • What medications do you recommend?
  • Are there any side effects to your recommended medications?
  • Are there any other lifestyle changes I can make?
  • Can you recommend a support group for people with overactive bladder?

A note from Cleveland Clinic

Overactive bladder is a common condition that causes changes in your bathroom habits, which can be embarrassing. Many people struggle to talk to a healthcare provider about their symptoms. However, providers can help answer any of your questions without judgment. They can determine the cause of your overactive bladder and work with you to develop the best treatment plan. If you have symptoms of overactive bladder, talk to a healthcare provider so you can regain control of your bathroom habits and improve your quality of life.

Last reviewed by a Cleveland Clinic medical professional on 09/13/2022.

References

  • Leron E, Weintraub AY, Mastrolia SA, et al. Overactive Bladder Syndrome: Evaluation and Management. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5903463/) Curr Urol. 2018 Mar;11(3):117-125. Accessed 9/13/2022.
  • National Association for Continence. Multiple Pages. (https://www.nafc.org/) Accessed 9/13/2022.
  • National Institute on Aging. 15 Tips to Keep Your Bladder Healthy. (https://www.nia.nih.gov/health/15-tips-keep-your-bladder-healthy) Accessed 9/13/2022.
  • National Institute of Diabetes and Digestive and Kidney Diseases. Symptoms & Causes of Bladder Control Problems (Urinary Incontinence). (https://www.niddk.nih.gov/health-information/urologic-diseases/bladder-control-problems/symptoms-causes) Accessed 9/13/2022.
  • Office on Women’s Health. Urinary Incontinence. (https://www.womenshealth.gov/a-z-topics/urinary-incontinence) Accessed 9/13/2022.
  • Przydacz M, Campeau L, Walter JE, et al. How Long Do We Have to Treat Overactive Bladder Syndrome (OAB)? A Questionnaire Survey of Canadian Urologists and Gynecologists. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6143506/) Can Urol Assoc J. 2018 May 14;12(9): E378–83. Accessed 9/13/2022.
  • Urology Care Foundation. What is Overactive Bladder (OAB)? (https://www.urologyhealth.org/urology-a-z/o/overactive-bladder-(oab%29) Accessed 9/13/2022.

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