Overactive Bladder

Overactive bladder (OAB) is a mix of symptoms that may cause you to pee more often, have strong urges to pee, leak pee (incontinence) and have to pee at night.

Symptoms of this condition can cause stress and affect your quality of life. It can be frustrating to think about the nearest bathroom all the time. But an honest talk with a healthcare provider can get you on your way to managing OAB.

OAB is common. It affects millions of adults in the U.S. It’s most common in people 65 and older, but it isn’t a normal part of aging. Women may have OAB at a younger age, usually around 45.

Symptoms of overactive bladder

Overactive bladder symptoms include:

• Urinary urgency: This 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: This is an uncontrollable, urgent need to pee. You may leak pee.
• Nocturia: This is the need to get up to pee at least two times each night.
• Urinary retention: This is the feeling of incomplete bladder emptying.

Overactive bladder causes

Conditions or injuries that affect your detrusor muscle (in your bladder wall) cause overactive bladder. These may include:

• Abdominal trauma: Pregnancy and childbirth can stretch and weaken your pelvic muscles. These muscles and tissues support the organs in your lower abdomen. Weak pelvic muscles can make your bladder sag out of its normal position.
• 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 disks, radiation therapy, Parkinson’s disease, multiple sclerosis or stroke.
• Alcohol, caffeine and certain medicines: 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 quickly.
• Infection: A urinary tract infection (UTI) can irritate your bladder nerves and make your bladder 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.

Risk factors

Risk factors for OAB include:

• Being postmenopausal
• Having a history of prostate issues
• Having a disease that affects your brain or spinal cord

How to lower your risk

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 much fluid can worsen your symptoms, while not enough fluid can make urges more severe)
• Getting regular physical activity
• Asking your healthcare provider for a different medicine (only stop taking medicine if your provider tells you to)
• Performing Kegels or other pelvic floor exercises
• Managing conditions that may cause OAB, like diabetes or UTIs

Complications of this condition

If you have an overactive bladder, it affects your daily life. In addition to physical issues, OAB can affect your emotional well-being. It can be difficult to travel or even go to social events. If you have to get up to pee during the night, it can prevent a good night’s sleep. You may also get hurt if you fall when trying to get to the bathroom in time.

How doctors diagnose overactive bladder

A healthcare provider can diagnose OAB by reviewing your symptoms and performing a physical examination of the organs around your pelvis and rectum. They may ask you about your symptoms, medications you take and fluids you drink.

A provider may ask you to keep a bladder diary for a few days. This can help them determine the cause of your OAB. You’ll use your bladder diary to track what and how much you drink, how often you pee and how often you leak.

You may get a referral to see a urologist. This is a doctor who’s an expert in diseases and conditions that affect your urinary tract and reproductive system.

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

• Urinalysis: This urine test checks your pee for an infection that causes OAB.
• Urodynamic testing: These tests measure how much pee stays in your bladder after you pee, how much and how fast you pee, and how much pressure is on your bladder as it fills.
• Pelvic ultrasound: This is a noninvasive imaging test that allows a provider to take a detailed look at your bladder.
• Computed tomography (CT) scan: A CT scan is a noninvasive imaging test that makes 3D images of your bladder.
• Cystoscopy: After numbing your urethra, a provider puts a special tool (cystoscope) through it to look inside your bladder.

How is it treated?

It’s rare for treatments to cure an overactive bladder. But different treatments can help with OAB. Overactive bladder treatments may include changing certain behaviors, taking medications and having nerve stimulation.

Behavioral changes

You can make many changes to your behavior as an OAB treatment. These include:

Monitoring what you eat and drink

Avoid or cut back on drinks or foods that may cause bladder symptoms. These may include foods or drinks with caffeine or artificial sweeteners.

Pooping regularly

Constipation can place pressure on your bladder and affect its function. You may be able to avoid constipation and reduce bladder symptoms by keeping healthy bowel habits. You can do this by eating more fiber, drinking two to four extra glasses of water each day, and being physically active.

Managing your weight

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

Avoiding tobacco products

Cigarettes and other tobacco products can irritate your bladder muscle. Coughing spasms from smoking can also cause leakage.

Training your bladder

Bladder training teaches you how to resist feelings of urgency, delay going to the bathroom and pee according to a timetable instead of responding to feelings of urgency.

Patience is important. Training your bladder usually takes at least six to eight weeks to see results.

Medications

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:

• Anticholinergics
• Beta 3 agonists
• Antispasmodics
• Alpha-adrenergic agonists

Botulinum toxin injections

A healthcare provider injects this into your bladder wall using a cystoscope. The injection keeps muscles from contracting. This therapy is very effective, even for people who haven’t responded well to other therapies. Most people need to repeat injections every six months.

Nerve stimulation

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. Healthcare providers only recommend it if other treatments don’t work.

Types of this reversible treatment include:

• Sacral nerve stimulation: This device electrically stimulates the nerves that control your bladder. It can reduce the number of times you have to pee or the number of times you leak pee.
• Percutaneous tibial nerve stimulation: This sends small nerve impulses to a nerve branch near your ankle. It helps stimulate bladder control. Many people need 12 weekly sessions, and then monthly maintenance sessions.

When should I see my healthcare provider?

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

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

You may want to ask your healthcare provider:

• What’s the cause of my overactive bladder?
• How much should I drink each day?
• What fluids should I avoid drinking?
• What treatments do you recommend?
• Are there any lifestyle changes I can make?

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.

OAB 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.

Is there anything I can do to feel better?

If you’re waiting for treatments to take effect, products like disposable pads or adult diapers can help you feel in control and catch leaks.