What exactly is overactive bladder, and what can you do about it?
Proper hydration is essential to your health. And consistent trips to the bathroom can indicate that your body is getting enough water. But when does the need to urinate become a reason to call your doctor?
Maybe you wake up to pee a few times during the night. Or you can’t pee, even though you feel like you really have to go. Perhaps you lose full control of your bladder. You might assume that these are just normal signs of getting older, but they aren’t. They’re possible signs of overactive bladder (OAB).
While OAB does affect children and young adults, it’s more common in people over 40. As many as 30% of men and 40% of women in the U.S. live with OAB, according to the Urology Care Foundation.
OAB can be disruptive and embarrassing. But you can manage it with your doctor’s help, says Steven Tillem, MD. He’s a urologist and ProHEALTH’s division chief of Queens Urology in New York.
“This is a common problem, and there’s no need for people to suffer in silence,” Dr. Tillem says. “There are many treatment options available.”
Here’s everything you need to know about OAB so that you can take steps to live more comfortably.
(And if your doctor prescribes a medication to treat your OAB, we want to help. Download our discount prescription coupon app for savings of up to 80%.)
What are the signs of an overactive bladder?
It’s normal to pee between 6 and 8 times a day. Sometimes you might go more often, especially when you drink more fluids than usual. But certain urination habits might mean it’s time to call your doctor. These include:
- Feeling sudden urges to pee that are hard to control
- Unintentional loss of pee after feeling an urgent need to go
- Urinating more than 8 times within 24 hours
- Waking up more than twice a night to pee (nocturia)
What causes overactive bladder?
When a healthy bladder is full of urine, it sends signals to your brain that trigger the need to pee. Your body relaxes the pelvic floor and urethra muscles. Then the bladder muscles contract to push out urine.
With OAB, the bladder muscles contract on their own, even without a lot of urine in your bladder, according to the Mayo Clinic.
There could be several reasons behind your body’s mixed messages. Neurological disorders, diabetes and urinary tract infections (UTIs) could all play a role in OAB.
OAB can even happen because of certain medications you take or drinking too much caffeine or alcohol. Your doctor can help figure out what’s causing your OAB.
What can I expect when I talk to my doctor?
Treating overactive bladder varies from person to person. Your doctor might suggest you see a specialist, such as a urologist, who can diagnose and treat you.
Your doctor may also suggest a urine test or do an ultrasound to see how much urine is left in your bladder after going to the bathroom.
Your doctor will likely recommend lifestyle changes to ease your symptoms.
What lifestyle changes treat OAB?
You can make several changes to your daily routine to improve your quality of life. Adding medication to the mix also could help you get relief from your OAB symptoms.
Change your diet
What you eat and drink can affect, or even cause, your OAB. It’s especially helpful to limit alcohol and caffeine, which can make OAB symptoms worse. The Urology Care Foundation also recommends limiting or avoiding:
- Soda and other fizzy drinks
- Acidic or citrus fruits
- Tomato-based foods
- Milk or dark chocolate
- Spicy foods
On the other hand, eating more high-fiber foods can help improve OAB symptoms. These include:
- Whole grains
- Non-acidic, non-citrus fruit
Manage your other health problems
If a medical issue is behind your OAB, getting the condition under control could help relieve OAB symptoms.
Say a UTI is causing your symptoms. Taking medication to treat your infection could cure your OAB. Chronic conditions such as diabetes can bring on OAB symptoms as well. So it’s important to work with your doctor to have a treatment plan in place.
Some men get OAB from an enlarged prostate. You might want to consider getting a routine prostate screening. It can help your doctor identify and treat any related issues that might contribute to your OAB.
Women who are post-menopause might have OAB symptoms due to a lack of estrogen. Hormone replacement therapy can help treat low estrogen, which in turn could improve OAB symptoms.
Keep a bladder diary
This can help you determine the cause of your OAB. This daily diary can track:
- Frequency of urination
- How often you feel an urgent need to pee
- What (and how much) you eat or drink
After a few weeks, your doctor can look at your diary to find any patterns that might be contributing to your OAB.
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Try exercises to relax your bladder muscles
With OAB, your bladder muscles start to contract on their own. Certain exercises can help relax those muscles, reducing your symptoms.
Your doctor might recommend Kegel exercises, which involve tightening and holding your pelvic muscles. You could also practice “quick flicks” — quickly squeezing and relaxing your pelvic floor muscles repeatedly.
Change your bathroom schedule
You can do things to switch up when and how often you pee. If you have trouble fully emptying your bladder, your doctor might suggest “double voiding.” This is when you pee, wait a few seconds and then try peeing again. Or they might work with you to create a daily urination schedule, setting specific times for you to go every day.
“Timed voiding, basically going by the clock and not waiting for your bladder to get full, is the primary action,” Dr. Tillem says. The timing may vary from person to person depending on how much liquid you drink.
What medications treat OAB?
“When lifestyle modifications aren’t enough, we usually [add] medication,” Dr. Tillem says. There are 2 main types of medication that treat OAB: anticholinergics and beta-3 agonists.
Anticholinergic medications (antimuscarinics) relax the bladder muscles, reducing your urge to pee. They include:
Several trials have found that antimuscarinics significantly improve symptoms or even cure patients with OAB. These medications have been in use for decades. But they can have side effects, including dry mouth, constipation and memory issues, Dr. Tillem says.
Beta-3 agonists, a newer class of medications, tend to be more expensive. But patients report fewer side effects from them, Dr. Tillem says. These medications include:
If your OAB is caused by bladder muscle spasms, your doctor may prescribe an antispasmodic, such as oxybutynin. This type of medication helps reduce the spasms and the resulting frequent urge to pee.
No matter what steps you and your doctor decide are best for you, perseverance and patience are key, Dr. Tillem says.
What other treatments are available?
For more resistant OAB cases, you may have to go beyond lifestyle changes and medication.
Bladder Botox treatment
Botox injections work by relaxing your bladder wall muscles. When these muscles are relaxed, you won’t feel the urge to pee as often or as suddenly.
“Botox works very well and can be administered directly into the bladder, usually twice a year,” Dr. Tillem says.
In 2018, Current Urology reviewed a study of 100 OAB cases. The study found that 88% of patients showed significant improvement in quality of life and OAB symptoms after undergoing bladder Botox treatment. But the effects of Botox last only up to 6 months. Repeated treatments might be needed if symptoms return.
These treatments are also known as neuromodulation therapy. They work by sending electrical pulses to help the nerves connected to your bladder send the correct signals to your brain.
There are 2 types: percutaneous tibial nerve stimulation (PTNS) and sacral neuromodulation stimulation (SNS).
- PTNS involves having a small electrode placed near your ankle. The electrode sends pulses along your knee to your lower back (the tibial nerve) to correct the nerves in your bladder. Studies have shown a 60% to 80% success rate and no serious side effects with repeated treatments.
- SNS is recommended for more severe cases of OAB that haven’t responded to lifestyle changes or medication. SNS uses a bladder pacemaker to control the signals between the spinal cord and the bladder. Studies showed that the average number of times people emptied their bladder decreased. And the amount of urine they released per trip increased.
In extreme cases of OAB, 2 types of bladder surgeries are available:
- Bladder reconstruction, to enlarge your bladder
- Urinary diversion surgery, which reroutes how urine flows in your body
These surgeries are offered only when no other options are available.
OAB can be frustrating. But lifestyle changes, medications and other treatments can help you find relief. And if you’re prescribed a bladder medication, be sure to print out your free prescription discount card. Just show it to your pharmacist at checkout.
OAB facts: Urology Care Foundation
OAB overview: Mayo Clinic
OAB treatment options: Current Urology (2018). “Overactive Bladder Syndrome: Evaluation and Management”