Overactive bladder is a condition characterized by the sudden and urgent need to urinate, which can lead to incontinence. Overactive bladder can be caused by involuntary muscle contractions as well as alterations in nerve signals between the brain and the bladder, causing an urge to urinate even when the bladder is not completely full.
Overactive bladder is more common in women, especially women over 60 years of age, however it can happen at any age and can also affect men, often due to conditions like diabetes, obesity, or overweight.
Treatment of overactive bladder is managed by a urologist and may include physical therapy or medications to help restore function of the bladder muscles. Some cases may require surgery.
Main symptoms
The most common symptoms of overactive bladder are:
- Increased urgency without any signs of a UTI (urinary tract infection);
- Sudden and uncontrollable urge to urinate;
- Frequent urge to urinate, and in small amounts;
- Difficulty holding your bladder;
- Pain or discomfort with urination or over the bladder;
- Sensation of incomplete emptying.
Other symptoms may include leaking urine, nighttime incontinence, or getting up more than twice a night to pee.
Symptoms of overactive bladder often occur in combination with symptoms of stress incontinence, which can cause a person to leak urine when they cough or laugh due to pressure on the bladder. These symptoms can also be a sign of an enlarged prostate in men.
Symptom checker
Use the symptom checker below to determine whether your symptoms may be the result of overactive bladder (select all that apply):
Confirming a diagnosis
A diagnosis of overactive bladder is made by a urologist based on symptoms, medical history, and a physical exam, which may include a pelvic and rectal exam in addition to a neuro exam.
A doctor may also order a urine test to rule out a UTI as well as exams like an ultrasound of the urinary tract and urodynamics, which is a test that measures pressure in the bladder, urine flow, and muscle activity during urination.
Possible causes
Overactive bladder can be caused by a variety of health conditions, including:
- Weak pelvic floor muscles related to pregnancy or childbirth;
- Neurological disorders like paraplegia, Parkinson's disease, Alzheimer's disease, stroke, or multiple sclerosis;
- Diabetes;
- Irritation of the urinary tract, such as in the case of a UTI;
- Overweight or obesity;
- Hormonal changes, especially a decrease in estrogen due to menopause;
- Use of diuretics;
- Bladder cancer;
- Bladder stone or cysts;
- Excessive consumption of caffeinated beverages.
These conditions make it more difficult to control the muscles of the bladder. Overactive bladder affects more women than men and is more common in people over the age of 60. It can negatively impact quality of life and lead to emotional distress and avoidance of social events.
Treatment options
Treatment of overactive bladder is managed by a urologist or primary care provider and may include:
1. Kegel exercises
Kegel exercises may be recommended by your provider to help strengthen the pelvic floor muscles and urinary sphincter in order to reduce involuntary bladder contractions.
2. Pelvic floor physical therapy
Pelvic floor physical therapy may be prescribed by your doctor to strengthen the muscles of the pelvic floor, which can help improve bladder control and relieve symptoms of overactive bladder.
Pelvic floor physical therapy is done by a physical therapist and involves special exercises. Electrical stimulation or biofeedback may also be used.
3. Medications
Medications may be prescribed by your doctor to help relax the bladder and alleviate symptoms.
Anticholinergics, such as oxybutynin, tolterodine, darifenacin, or fesoterodine, or antispasmodics, such as trospium, may also be indicated to treat overactive bladder.
Treatment of overactive bladder in menopausal women may also include hormone replacement therapy (HRT) or vaginal estrogen, which comes as a cream, vaginal suppository, or vaginal ring.
4. Botox injections
Botox injections into the muscle of the bladder can help reduce involuntary muscle contractions.
This treatment may be indicated in cases of severe urinary incontinence, with effects generally lasting around 6 months, after which another injection will be needed (depending on the recommendation of your doctor).
5. Percutaneous tibial nerve stimulation
Percutaneous tibial nerve stimulation (PTNS) can be done by a doctor to reduce the activity of the detrusor muscle of the bladder. This procedure is done by placing electrodes near the ankle and stimulating the tibial nerve. This stimulus travels up to the detrusor muscle to reduce bladder contractions and help alleviate symptoms.
6. Surgery
When other treatments are not enough to control the symptoms of overactive bladder, surgery may be recommended to increase the storage capacity of the bladder. In some cases, the bladder may be removed entirely and a urostomy bag placed to collect the urine.
Prevention strategies
Overactive bladder may be prevented or managed with some simple and natural strategies, including:
- Avoiding alcohol, caffeine, and cigarettes;
- Losing weight, which helps reduce pressure from the abdomen on the bladder;
- Emptying your bladder entirely, each time you go to the bathroom;
- Performing exercises to strengthen your pelvic floor, such as Kegel exercises;
- Drinking medicinal teas with anise, rosemary, or mugwort, which have antispasmodic properties that may help relieve symptoms of overactive bladder.
Timed voiding and bladder training may also be helpful in managing symptoms. This involves going to the bathroom at regular intervals and before you feel the urge to urinate. You can start by going to the bathroom every hour and increasing the interval over time as you are comfortable, eventually going 3 to 6 hours between trips to the bathroom.
Managing anxiety is another important part of preventing incontinence episodes, as anxiety makes it more difficult to control your bladder and can make it feel like your bladder is always full.