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What is Overactive Bladder & How Do You Treat It?

Overactive Bladder & How You Treat It

Overactive bladder (OAB) is not a disease, rather it is a syndrome (a group of symptoms that together characterize a disorder).  You may be experiencing an overactive bladder if you feel the need to urinate frequently or suddenly and have trouble controlling the release of your urine, making you incontinent

Overactive bladder is common, with the Urology Care Foundation reporting that as many as 30 percent of men and 40 percent of women experience symptoms.

OAB has also been referred to as spastic bladder, irritable bladder, hyperactive bladder, and nervous bladder syndrome


What is the main cause of overactive bladder?

There is no main cause but rather a number of possible underlying conditions that can lead to overactive bladder. It also differs from other causes of leakage like temporary incontinence in that it's often chronic.

First, let's make sure we understand how a bladder typically functions.

Normally, the bladder holds about 2 cups of urine before it signals to the brain that it is full and ready to empty.  When this happens, the bladder muscles contract, and the sphincter at the top of the urethra relaxes, allowing urine to flow when you are ready for it.

With an overactive bladder, the signals from the bladder to the brain are disrupted and fire sooner than they are supposed to, causing the brain to think the bladder is full when it actually is not.

This causes the bladder to contract suddenly and the sphincters to open at the wrong time making it difficult to get to the toilet in time, even when the bladder is mostly empty. The amount of urine that leaks out can range from a few drops to a full void.

The biggest causes of overactive bladder are:

  • Alzheimer’s, dementia or other cognitive disorders of the brain
  • Neurological disorders such as a stroke, Parkinson's disease or Multiple sclerosis
  • Disorders of the endocrine system including diabetes
  • Reproductive changes in women including hormonal changes from menopause or childbirth
  • An enlarged prostate in males
  • An obstruction in the urinary system such as a kidney stone or a tumor
  • Mobility issues that make it difficult to arrive at the toilet in time
  • Failure or inability to empty the bladder completely with each urination, causing the brain to continually fire off the signal that the bladder is full
  • Obesity (that may require bariatric care)

What are the symptoms of an overactive bladder?

An overactive bladder is a frustrating and embarrassing experience that can, at times, even be painful.

Some common signs that indicate you may be experiencing an overactive bladder are:

  • A sudden and frequent strong urge to urinate, even when the bladder is not full.
  • Difficulty controlling the urge long enough to make it the toilet.
  • Urinating more than 1-2 times throughout the nighttime.
  • Urinating multiple times every 30 minutes to an hour.
  • Involuntary leaking of urine throughout the day or overnight.

How does a doctor diagnose overactive bladder?

If you believe that you are experiencing symptoms of urinary urgency and a spastic bladder make an appointment to be evaluated by your physician.  He or she will start by asking you specific questions related to your symptoms, your medical history, as well your social and lifestyle habits followed by a thorough physical exam.

The physical will likely include a pelvic/vaginal exam in women and a prostate exam in men. 

There are several tools and exams that a physician can use to help them diagnose an overactive bladder including:

  • Blood tests - basic laboratory testing to check your sugar levels and general organ health
  • Urinalysis - an examination of the urine itself to check for infection, evaluate the components in the urine, and see if there are any abnormalities of the urinary system/kidneys.
  • Radiological testing - an ultrasound of the bladder may reveal if the bladder is emptying properly and if there is anything obstructing the flow of urine.
  • Cystoscopy - a camera is inserted into the urethra and bladder so the physician can visualize the structures and functioning of the urinary system.

The exam you are given varies according to your level of incontinence and your medical history.

How do you calm an overactive bladder?

While there is no cure for OAB, there are many ways to manage your symptoms including diet, exercise, and lifestyle changes.  The first thing you will want to do is start a Bladder Diary to evaluate what your symptoms are, when they occur, how severe they are, what triggers them, and what alleviates it. 

Since everyone's needs can vary with OAB, this will allow you to tailor a plan to address your specific symptoms and help you to gain some control over them. 

Some other measures used to manage overactive bladder include:

Avoid food, beverages, & habits that irritate the bladder

  • Alcoholic drinks, carbonated drinks, caffeine, spicy foods, tomato/tomato-based sauces, high-sugar foods and drinks, processed foods, fruits high in acid (oranges, pineapple, strawberries)
  • Quit smoking. Tobacco products are a known bladder irritant that lead to increased coughing episodes which end with urine leakage. 

To read more about how your diet affects your incontinence, click here.

Strengthen your bladder with these exercises

  • Kegel exercises: contract your pelvic muscles and hold them for 3-5 seconds, then relax for 3-5 seconds. Repeat 10 times per session for 3 sessions a day. This will strengthen the muscles that help to hold back the flow of urine.
  • Quick flick maneuvers: A series of 5 or 6 quick contract and release muscle spasms that will help reduce the urge to urinate.
  • Bladder training: Empty your bladder completely when you wake up. Then, choose a time interval in which you will urinate (start with 1 hour). Use the toiler every hour whether you feel the urge to go or not. Then, increase the time intervals every few days until you reach your goal, typically 3 hours. This allows you to retrain your bladder to wait longer and hold more urine between trips to the restroom. 
  • Double voiding: Once you have emptied your bladder, stay put.  Wait a few minutes...then try to empty it again.  This ensures complete emptying of the bladder and strengthens the muscles of the pelvic floor as you bear down to try and push out any remaining urine.  Do not strain though, this can actually weaken the muscles.

Change your lifestyle

  • Maintain a healthy weight.
  • Manage your diabetes responsibly.
  • Mange medications that may be causing you to urinate more frequently by going over them with your physician. Medications such as diuretics can be taken at a certain time of the day to reduce the impact of the excess trip to the restroom (especially at night).

What is the best medication for overactive bladder?

There is a multitude of medications that can be prescribed to help lessen the symptoms of OAB. Talk to your doctor to find out which is best for you.

Anti-muscarinic medications (also known as an anticholinergics) help reduce muscle spasms in the bladder and help to relax the bladder so it can fill and empty properly. The most common side effects of these medications are dry mouth and constipation.

  • Oxybutynin (Ditropan, Oxytrol or Anutrol)
  • Tolterodine (Detrol)
  • Darifenacin (Enablex)
  • Solifenacin (Vesicare)
  • Fesoterodine (Toviaz)

Another type of medication used to treat OAB is a beta-3 adrenergic called mirabegron (Myrbetriq). It works by relaxing the smooth muscles in the bladder so it can hold more urine.

Antidepressants have been used to treat overactive bladder as they have been found to reduce the urge to urine in some people (although this use has not been reviewed yet by the FDA). 

Two of the most common medications in this category are desipramine and imipramine. Side effects can include sleepiness, so this is a good option for you if you find yourself urinating a lot at night.

Hormone therapy is a great option for women who are suffering from a leaking bladder due to menopause. Estrogen treatments can be either oral or topical (a patch or a cream) and can strengthen the muscles in the pelvis. There is a significant risk of cancers, blood clots, and stroke associated with taking Estrogens, so this option should be carefully considered. 

The topical estrogen creams (Premarin and Estrace) carry the least risk.

Medical Treatments for Overactive Bladder

Sometimes, when medications are not enough (or not working at all), more invasive therapies may be needed.

  • Botox injections: Botulinum toxin (aka Botox) can be injected into the tissues of the urethra and bladder allowing the muscles to relax, giving you more time to make it to the toilet when you need to go.  An adverse effect is paralysis of the bladder, so this option definitely carries some risk.
  • Bulking agents: Collagens can be injected into the urethra to “bulk up” the tissues and help to close up a leaky urethral sphincter by increasing the pressure in the area.
  • Nerve stimulation: A small device is implanted inside the abdomen that sends an electrical signal to the sacral nerves, helping to correct any abnormalities in the firing of information to the brain.
  • Surgery: The last option for many, but very effective most times, is surgical intervention.

Your surgeon will discuss which procedure would be best for you as well as the risks and benefits involved.

The most common surgical procedures for OAB are:

  • Inserting a hammock or a sling to help hold the bladder in place and reduce pressure.
  • Removal of or bypassing the bladder. An artificial bladder can also be inserted.
  • Augmentation of the size of the bladder by sourcing tissue from the intestines.

What can I wear to prevent leaks due to overactive bladder?

For anyone with urinary incontinence, no matter the severity, there are several options to help minimize the effects and allow for a more normal lifestyle.  Choosing the right product for you is based on the severity of your symptoms, the size of your body, and your activity levels.

Here are some commonly used products to address urinary incontinence:

  • Tabbed Briefs - Looks and operates like a classic diaper, featuring tabs on either side of the underwear that attach in the front to secure the brief.
  • Pull-Up Underwear - Similar to regular underwear, pull-ups can be pulled on and off. The sides tear away for easy removal.
  • Pads & Guards - An absorbent strip for men and women that sits between your underwear and your skin. The adhesive along the back of the pad attaches to your underwear (or brief) allowing for leakage protection during activity, without the need for a full diaper.
  • Bed Liners - An absorbent sheet that is placed under you in bed or while sitting in a chair.  This protects the linens from any leaks.

Disclaimer: The information presented here is purely for educational purposes and should not be used in place of the advice of your doctor or physician.