What Is an Overactive Bladder?
Treatment Options for Frequent Urination and Leakage
Published July 2023
If your bladder is calling you to the restroom repeatedly throughout the day and night, you may have what is called "overactive bladder" or OAB. And, you aren't alone. OAB affects approximately 33 million people in the U.S., or 10% of the population. This common condition, where the bladder contracts at the wrong time and without warning, is characterized by a frequent and sudden urge to urinate even when the bladder is not full.
Even though OAB is common and treatable, it is a condition that can take years for people to seek medical help for, says Vikas Desai, MD, a urologist at Northwestern Medicine. He explains that people can be embarrassed by the symptoms and often don't know that there are several treatment options that can help, including some you can do at home.
What causes an overactive bladder?
According to Dr. Desai, there are many possible causes of OAB, including:
- Age: OAB is more common in older adults.
- Medications: Some medications, such as decongestants and diuretics (water pills), can make OAB worse.
- Medical conditions: OAB can be a symptom of other medical conditions, such as:
- Urinary tract infections (UTIs)
- Multiple sclerosis (MS)
- Parkinson's disease
- Bladder stones
- Kidney disease
- Enlarged prostate
- Bladder cancer
- Lifestyle factors: Stress, caffeine, alcohol, smoking and having excess weight can cause OAB.
Constipation can also cause OAB. "People don't realize that constipation and overactive bladder can be related," says Dr. Desai. "The bowel sits right behind the bladder. When it's full, it can put pressure on the bladder."
The symptoms of OAB can vary from person to person, but they often include:
- Having to urinate more than eight times a day
- Having to urinate two or more times during the night
- Feeling like you have to urinate right away, even if you just went
- Leaking urine when you feel the sudden urge to go
- Feeling like you can't completely empty your bladder
If you are experiencing any of these symptoms, it is important to see your physician to get a diagnosis. While OAB does have similar symptoms to urge incontinence and the two often occur together, they are separate conditions.
There are wide range of treatment options available for OAB, including:
- Dietary changes: Eliminate caffeinated beverages, alcohol and chocolate, and minimize the use of citrus fruits and juices, spices, sugar and artificial sweeteners. In addition, avoid liquids before bedtime, eat a high-fiber diet to avoid constipation and ask your physician if you should limit the amount of water and other liquids you drink during the day.
- Bladder retraining: With this technique, you resist the urge to urinate and gradually expand the intervals between bathroom breaks. It can train your bladder muscles to hold urine for longer periods of time. You begin with short intervals, such as 15 or 30 minutes, then gradually work your way up to urinating every three to four hours.
Minimally invasive treatments
- Pelvic floor therapy: Physical therapy of the pelvic floor aims to rehabilitate the pelvic floor muscles to restore their normal function. For the best results, you should work with a specialized physical therapist who will help you learn the most effective techniques.
- Biofeedback: A technique, often used with pelvic floor muscle exercises, that includes being connected to electrical sensors that help you get information about your body and find the right pelvic muscles to squeeze.
- Nerve stimulation: Since your nerves send signals to tell your brain that your bladder is full, treating your nerves can help bladder control. There are two types of nerve stimulation procedures:
- Sacral nerve stimulation A device, implanted under the skin near the back of your hip, sends electrical impulses to the sacral nerves, which reach the bladder.
- Percutaneous tibial nerve stimulation: A small needle electrode is inserted near the ankle to send electrical impulses to the tibial nerve, which then travel to the sacral nerves to reach the bladder.
- Bladder Botox® therapy: BOTOX is injected into the bladder muscle to partially paralyze and relax it.
Medications and surgery
- Medications: There are medications that block certain nerve signals that trigger bladder contractions as well as medications that relax the bladder muscle and help it hold more urine.
- Surgery: Not often used to treat OAB, surgery can be necessary if your loss of bladder control can't be managed with any other option and is truly a debilitating condition for you. This typically occurs in cases of prior pelvic radiation.
Dr. Desai recommends starting with behavior modifications — the first line of defense. "Medications aren't always the long-term solution for many patients because behavior modifications haven't been optimized," he explains. "If you continue to smoke and drink five to six cups of coffee a day, a medication can't overcome that." He adds that surgery is rare and typically the last line of defense.
With the proper diagnosis and treatment, you can find relief from an overactive bladder and improve your quality of life.