What to know about treating overactive bladder

Overactive bladder (OAB) causes you to experience incontinence or a sudden urge to pee.

About 33 million people in the United States have the condition, which affects 40% of women and 30% of men. 

OAB is a chronic condition that is more common in older adults, people with obesity, and those with GI disorders, such as irritable bowel syndrome.

In the United States, OAB is also more common in African American and Hispanic people than in white people. Symptoms include an uncontrollable urge to urinate, involuntary loss of pee, and frequent waking up at night to urinate. 

OAB is a treatable and manageable condition. Medications, lifestyle strategies, and surgery are some options to treat OAB.

Treatment for overactive bladder

Many medical treatment options for OAB involve medications, therapies, and surgery. 

Medications

Medications to treat OAB aim to relieve symptoms and reduce incontinence and the urge to urinate. Doctors will prescribe these medications to address specific symptoms. Some of these medications include:

Antimuscarinic medications

Antimuscarinic medications reduce unwanted muscular contractions that cause urination. They work by blocking specific receptors in the bladder muscles. These medications include:

• darifenacin (Enablex) 
• oxybutynin (Ditropan XL)
• tolterodine (Detrol)

These drugs are available as oral tablets, and you can take them two to three times daily. 

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Antidepressants

The antidepressant duloxetine (Cymbalta) may help by increasing the muscle tone of the urethra and reducing incontinence. Studies show that duloxetine is a viable alternative to antimuscarinic medications in treating OAB and, in some cases, may carry a reduced risk of treatment side effects.

Duloxetine comes in tablet form, and a typical dosage is twice daily.

Diuretics and antidiuretics

Doctors may prescribe diuretics like desmopressin (DDAVP) if you frequently urinate at night (nocturia). Small studies show that this medication can significantly reduce nocturia frequency and improve sleep quality, but desmopressin prescription for OAB treatment remains uncommon.

You may need to take this in the late afternoon to increase the production and flow of urine and remove excess fluid in the body. This may improve bladder function during the night.

Mirabegron

Mirabegron (Myrbetriq) is a drug that can help relax the bladder muscles, allowing the bladder to store more urine. This medication typically causes fewer side effects than antimuscarinic treatments while remaining an effective OAB treatment. However, mirabegron is typically a more expensive option.

This medication is available as a capsule or tablet and is suitable to take once daily.

Procedures and therapies

Some procedures and therapies may be an option if medications alone can’t help relieve OAB symptoms. These include:

• Pelvic floor physical therapy: Physical therapy can help train and strengthen your pelvic floor and bladder muscles. Kegel exercises, specifically, can improve OAB symptoms either independently or with prescription treatment.
• Botox: Botox can help calm the nerves that stimulate bladder muscles and produce the urgent feeling to pee.
• Nerve stimulation: Several nerve stimulation therapies can help with OAB, such as tibial nerve stimulation and sacral nerve stimulation.

Surgery

Surgery is an option to treat OAB if medications and therapies do not relieve symptoms. Surgical options for OAB include:

• catheterization
• sling surgery
• colposuspension
• increasing the size of the bladder

Increasing the bladder size in a procedure known as augmentation cystoplasty can cause various long-term complications, such as urinary tract stones and an increased risk of urinary tract infections. This procedure is typically a last resort, used only if all other treatments do not improve symptoms.

Talk with your doctor about the options, risks, and benefits of surgery to address OAB. 

Lifestyle strategies to manage OAB

Lifestyle strategies can help you manage OAB symptoms. Some of these lifestyle strategies include:

• reaching or maintaining a moderate weight
• limiting consumption of caffeinated products and alcohol
• bladder training
• practicing exercises that relax and strengthen pelvic muscles 
• making diet changes
• avoiding fluids 2 hours before sleeping

How to cope and live with OAB

OAB is a chronic condition that can have a negative impact on personal, professional, and educational life. About 65% of people with OAB say the condition affects their quality of life.

If OAB symptoms interfere with your daily life, talk with a doctor. You can also find support and information from these resources:

• Bladder & Bowel Community
• Urology Care Foundation
• Bladder Health UK
• National Association for Continence

Summary

An overactive bladder can cause an urge to urinate frequently and experience incontinence. 

OAB is a chronic but treatable and manageable condition. Treatment options include medications, therapies, and surgery.

If you are experiencing symptoms of OAB, speak with a doctor. Healthcare professionals will help find the best treatment options to help you manage the condition and improve your quality of life.