Overactive bladder

Most women who aren’t pregnant urinate between four and seven times a day and once at night. Routinely using the bathroom eight or more times a day and more than once at night can be a sign of overactive bladder.

What is overactive bladder?

If you have overactive bladder, the bladder muscles may suddenly contract, creating a strong urge to urinate, even when the bladder isn’t full. At the same time, the muscles of the urethra and pelvic floor relax to allow the passage of urine. That means you may urinate when you don’t mean to or rush to the bathroom frequently, even when you have just urinated. 

This common problem affects up to 15% of women and happens more often with age. It can be a sign of other health problems, so you should always talk to your doctor about it.

Lifestyle tips

Your doctor might recommend managing your symptoms with these simple lifestyle habits.

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  • Don’t delay a trip to the bathroom once your bladder is full. Make sure you have a place to go and can excuse yourself in social situations.
  • Once in the bathroom, empty your bladder completely. Instead of straining muscles, stand up or shift position, then sit down and urinate again.
  • To deal with urine leakage, use only all-cotton or incontinence pads (not menstrual pads). All-cotton pads are gentler on the skin and are more breathable. This helps prevent skin irritation and infection. Let the skin air out and dry when possible.
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  • Limit coffee, tea, sodas and other beverages with caffeine. Artificial sweeteners, fruit juices and alcohol can also bother your bladder. 
  • Keeping a diary of what you drink and how you feel afterward can help you look for a connection between your diet and bladder symptoms. Share this diary with your doctor. 
  • Drink 60 to 80 ounces of water per day. Drinking too much water will make you need to use the bathroom more often. Drinking too little water will make your urine concentrated and irritate your bladder. 
  • Eat plenty of fiber to keep your bowels working normally, as constipation can worsen overactive bladder.
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  • Do yoga, especially poses designed to strengthen the pelvic floor region. 
  • Do Kegel exercises 
  • Ask your doctor if pelvic floor physical therapy can help you.
Manage your health
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  • Check whether any of your medications or supplements list overactive bladder or urinary incontinence as a side effect.
  • Control your blood sugar levels if you have diabetes.
  • Maintain a healthy weight with diet and exercise.
  • Don’t smoke. Nicotine is a bladder irritant, and tobacco can cause urinary tract cancers. Smoking may also cause you to cough, which can cause bladder leakage.

Treatment options

Getting treatment can help you enjoy a more active, higher-quality life. About 80% to 90% of women who get treatment see improvement. Options include:

  • Botox® injections – Block the urge to urinate and enable the bladder to hold more urine.
  • Medication – Helps you extend your time between visits to the restroom.
  • Pelvic floor physical therapy – Strengthens the muscles and ligaments of the pelvic floor region
  • Bladder retraining – Teaches you how to use your pelvic floor muscles to prevent the urine loss using “mind over bladder” techniques.
Nerve stimulation
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Sacral nerve stimulation uses an implanted device to activate the nerve above your tailbone that controls the bladder. An in-office procedure can check if this controls your symptoms. If it works, a doctor can put the device in your body during a minor surgical procedure.

Tibial nerve stimulation uses a thin needle in the doctor’s office to stimulate a nerve on the inside of the ankle, which connects to the sacral nerve and helps control the bladder.

Frequently asked questions

What’s the difference between overactive bladder and incontinence?
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Incontinence refers to the involuntary loss of urine for any reason, including:

  • Coughing, laughing or sneezing (stress incontinence)
  • Inability to get to the toilet in time due to a mental or physical barrier (functional incontinence)
  • Sudden and strong urge to urinate (urge incontinence)

Overactive bladder is a combination of symptoms, including:

  • Feeling that you need to urinate now and can’t put it off (urinary urgency)
  • Need to use the toilet often (urinary frequency)
  • Urge incontinence
  • Waking up twice or more at night to urinate (nocturia)
What causes overactive bladder?
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Overactive bladder may happen due to:

  • Bladder pain syndrome/interstitial cystitis
  • Bladder stones
  • Caffeine and alcohol use
  • Certain medications (diuretics)
  • Chronic constipation
  • Diabetes
  • Lack of estrogen in the vagina and urethra (genitourinary syndrome of menopause)
  • Multiple sclerosis or other neurological problems
  • Overactive pelvic floor muscles
  • Tumors (lumps), including bladder cancer
  • Urinary tract infection

In addition, your bladder may spasm (contract) due to environmental cues, such as the sound of running water or the sight of the toilet.

I’m embarrassed. How do I talk to my doctor about this?
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Your provider wants to be aware of all your health concerns and connect you with the care you need. At your next appointment, try using words such as, “I’m concerned because there have been several times when I couldn’t control my bladder, and this hasn’t happened to me before. What do you recommend?"

How is overactive bladder diagnosed?
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  • Bladder diary you fill out with your symptoms and bring to your appointment
  • Cough stress test, in which you cough to see if you leak urine with a full bladder
  • Cystoscopy, which places a camera into the bladder to look for problems
  • Physical exam
  • Post-void residual urine test, which does an ultrasound of the bladder after you urinate to see if your bladder empties completely
  • Urinalysis to check your urine for signs of a urinary tract infection
  • Urodynamic testing, a more complex type of testing of bladder function
What if I don’t seek help for my symptoms?
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Don’t ignore your symptoms. They could damage your bladder and kidneys or be a sign of an infection or other serious health condition. They may also affect your desire to participate in physical and social activities, which can contribute to anxiety and depression. Treatment can have a significant impact on your quality of life and your ability to be active and live your life the way you want.

Contact us

Talk to a care navigator or schedule an appointment at the Women’s Health & Wellness Center.