Condition Basics
What is overactive bladder?
With overactive bladder, you have many strong, sudden urges to urinate during the day and night. You can get these urges even when you have only a little bit of urine in your bladder. You may not be able to hold your urine until you get to the toilet. This can lead to urine leakage, called incontinence.
Even without incontinence, overactive bladder can make it hard to do the things you enjoy. The need to drop everything and race to the toilet can disrupt your life. And if you leak, even if it's only a little bit, it can be embarrassing.
Overactive bladder can cause other problems too. Hurrying to the toilet can lead to falls and broken bones. Overactive bladder can also cause sleeping problems, depression, and urinary tract infections.
Many people are too shy to talk about their bladder problems. But overactive bladder can get better with treatment. Don't be afraid to talk with your doctor about how to control your overactive bladder.
What causes it?
Overactive bladder may be caused by bladder problems, a spinal cord injury, or pelvic surgery. But in many cases, doctors don't know what causes it.
Some medicines can cause overactive bladder. Talk with your doctor about the medicines you're taking to find out if they could affect your bladder. But don't stop taking your medicine without talking to your doctor first.
What are the symptoms?
The main symptoms of overactive bladder are:
- An urgent need to urinate.
- The need to urinate often.
- Waking up to urinate 2 or more times a night.
- The need to urinate even if you have just gone to the toilet.
- Taking many trips to the toilet only to urinate just a little bit each time.
- Leaking urine when you have the urge to urinate.
You may have some or all of these symptoms.
How is it diagnosed?
Your doctor will ask you about your past health. You'll have a physical exam and be asked about any symptoms. Depending on your symptoms, you may have a pelvic exam. Or if your symptoms could be caused by prostate problems, you may have a rectal exam.
You'll be asked what kinds of fluids you drink and how much. Your doctor will also want to know how often you urinate, how much, and if you leak. It may help to write down these things in a bladder diary for 3 or 4 days before you see your doctor.
You'll also be asked about any medicines you take.
Your doctor will check a sample of your urine. Depending on the results, or if your doctor thinks that your problem may have more than one cause, you may have more tests.
How is overactive bladder treated?
Treatment may start with trying some things at home such as pelvic floor exercises (Kegels) and bladder training. Your doctor may check to see if any medicines you take might be causing your symptoms.
Sometimes medicines can help. This includes topical estrogen if thinning of vaginal tissue (atrophy) is a problem. Or medicine can help if an enlarged prostate is the problem.
Your doctor may suggest that you try certain medicines along with bladder training and exercises. These include:
- Medicines that calm the bladder muscles, such as darifenacin, fesoterodine, and oxybutynin.
- Medicines that help the bladder store more urine, such as mirabegron and vibegron.
If the problem is severe, treatments may include:
- Botulinum toxin injections every 3 to 12 months.
- Electrical stimulation.
- Sacral nerve stimulation (SNS) involves placing an electrical stimulator under your skin. It sends pulses to a nerve in your lower back that plays a role in bladder storage and emptying.
- Percutaneous tibial nerve stimulation (PTNS) involves sessions where mild electrical stimulation is given through a needle placed behind the ankle. It's done to help reduce symptoms.
- Surgery to treat an enlarged prostate, make the bladder bigger (augmentation cystoplasty), or make another way to store and pass urine (urinary diversion).
How can you care for yourself?
- Limit caffeine, carbonated drinks, and alcohol. They make you urinate more.
- Try pelvic floor (Kegel) exercises. (If these exercises cause pain, stop doing them and talk with your doctor.) To do Kegel exercises:
- Squeeze your muscles as if you were trying not to pass gas or trying to stop the flow of urine. Your belly, legs, and buttocks shouldn't move.
- Hold the squeeze for 3 seconds, then relax for 5 to 10 seconds.
- Start with 3 seconds, then add 1 second each week until you are able to squeeze for 10 seconds.
- Repeat the exercise 10 times a session. Do 3 to 8 sessions a day.
- Keep a bladder diary. This can help with bladder training. You can find bladder diary forms and instructions for bladder training online.
- Stay at a weight that’s healthy for you. Talk to your doctor if you need help losing weight.
- Take care of your mental health, and get support if you need it. An overactive bladder can affect many aspects of your life, including your mental health. Talk to your doctor if you are feeling sad or anxious and it is not getting better. Support can also come from a counselor, support group, or trusted friend or family member.