How Overactive Bladder Is Treated

Overactive bladder (OAB) is a condition characterized by the sudden and frequent need to urinate that is difficult to control, often leading to leakage and incontinence. Because the exact cause of OAB is unknown, the condition can be difficult to treat and often requires a multifactorial approach involving lifestyle, medications, and specialized procedures.

Surgery is rarely recommended but may be pursued if no other options are available and the person’s quality of life is severely impacted.

According to the American Urological Society, around 60% of people treated for OAB will experience the complete resolution of symptoms within a year. Although others may continue to have symptoms, their severity and frequency can usually be alleviated with treatment.

Lifestyle

Lifestyle plays a major role in the treatment of OAB irrespective of the underlying cause. By changing habits and behaviors that contribute to OAB, many people will experience far better relief than with any single medication or medical treatment.

Fluid Restriction

One of the simplest and most effective lifestyle changes is fluid restriction. This not only involves cutting back on fluids before bedtime, but also before times when you know you will be away from home or with others (such as during work, social functions, or shopping).

You will also need to cut out drinks and foods that are diuretic (promote urination) or irritate the bladder. These include:

• Coffee, tea, and other caffeinated drinks
• Alcohol, including beer and wine
• Sodas and other fizzy drinks
• Artificial sweeteners
• Citrus fruit drinks
• Tomato and tomato-based vegetable juices
• Chocolate

High sodium intake can also increase the frequency and volume of daytime and nighttime urination. It causes a buildup of fluids in peripheral tissues that is later shifted to the kidney, resulting in increased urination. Reducing salt intake is one strategy that can help reduce this pattern (known as storage syndrome).

There is also evidence that eating higher quantities of dark leafy vegetables can alleviate storage syndrome, particularly in older adults.

Bladder Retraining

Bladder retraining is one of the first-line treatments of OAB. Also known as scheduled voiding, it is a behavior therapy used to shift the pattern, frequency, and severity of abnormal urination.

The goals of bladder retraining are to increase the length of time between voidings (emptying the bladder) and increase the amount of fluid your bladder can hold. It also can help alleviate leakage and the sense of urgency associated with OAB.

It typically starts with a bladder diary in which you record when you go to the bathroom and what events preceded severe urinary symptoms. By better understanding your urination patterns, you and your healthcare provider can formulate a schedule that can begin to alter them, usually over the course of six to 12 weeks.

Bladder retraining requires some preparation, including the use of mind-body therapies to better address urinary urgency (the sudden, immediate urge to urinate). Thereafter, bladder retraining typically involves the following steps:

1. Empty your bladder as soon as you awaken.
2. Go to the bathroom at the specific times you and your healthcare provider discussed.
3. Be sure to empty your bladder even if you don’t feel the need to.
4. When you finish, wait for several moments and try again. This is called “double voiding” and is especially useful for people who have trouble emptying their bladders.
5. When you feel the sudden urge to urinate outside of the prescribed schedule, use techniques to suppress the urge for as long as possible. This may involve deep breathing exercises, guided imagery, and progressive muscle relaxation (PMR).
6. If you cannot suppress the urge, try delaying for at least five minutes and walk, rather than run, to the bathroom.
7. Keep a record of your bathroom visits to increase the time between visits by 15- and 30-minute increments.

Pelvic Floor Exercises

The deterioration of pelvic floor muscles contributes in part to OAB symptoms both in women and men. Pelvic floor muscles are the “hammock” of muscles that run from the pubic bone (pubis) in the front to that tailbone (coccyx) in the back.

In women, the pelvic floor muscles support the bladder, uterus, and colon and are the structure through which the urethra, vagina, and anus pass. In men, the pelvic floor muscles support the bladder and colon and are the structure through which the urethra and anus pass.

The loss of pelvic muscle strength directly corresponds to an increase in the risk of leakage and urinary incontinence.

Kegel exercises can help strengthen these muscles and train you to activate them whenever there is urinary urgency. The technique varies slightly between women and men but typically involves the following steps:

1. Squeeze and draw in the muscles between the anus and genitals. In women, this is between the anus and vagina, and in men, between the anus and scrotum.
2. Hold for 3 to 5 seconds.
3. Release for a count of three without pushing the muscles out.

Steps 2 and 3 are repeated 11 more times for one set of 12 kegel exercises.

Over-the-Counter (OTC) Therapies

There are a number of over-the-counter (OTC) medications marketed for use in people with OAB. Although there is little in the way of well-controlled studies supporting their use, they are widely embraced by consumers who will often use them in complement to prescribed therapies.

These include:

• Oxybutynin transdermal patches: Available over-the-counter, these adhesive patches are said to deliver 3.9 milligrams (mg) of oxybutynin—the same prescription drug used to treat OAB (see “Prescription” below)—over 24 hours. Oxytrol is one of the more popular transdermal brands for women. For men, a prescription version is available.
• OAB supplements: A number of dietary supplements are sold as OAB remedies. Many contain gelatin, plant-based cellulose, capsaicin, and other ingredients thought to reduce urinary frequency and urgency. Popular brand names include Azo Bladder Control Go-Less and Swanson Bladder Control Go-Less Formula.

Prescriptions

OAB is largely defined by the dysfunction of the detrusor muscles that regulate the contractions of the bladder. In people with OAB, these muscles can be overly sensitive and can go into spasm whenever exposed to even a small amount of urine in the bladder.

Muscarinic Receptor Antagonists (MRAs)

The prescription drugs commonly used in the first-line treatment of OAB are called muscarinic receptor antagonists (MRAs). MRAs work by relaxing the bladder muscles and removing the sense of urgency.

The MRAs commonly prescribed for OAB include:

• Detrol (tolterodine)
• Ditropan (oxybutynin)
• Enablex (darifenacin)
• Levsin (hyoscyamine)
• Sanctura (trospium)
• Toviaz (fesoterodine)
• VESIcare (solifenacin)

Side effects are common and may include insomnia, nervousness, dizziness, daytime sleepiness, headache, blurred vision, dry mouth, constipation, nausea, and upset stomach. In some cases, MRAs can cause difficulty with urination and urinary retention (the inability to empty the bladder).

The risks tend to increase with higher doses and are more commonly seen with Ditropan and generic oxybutynin. The long-term use of MRAs is also linked to an increased risk of dementia.

MRAs are moderately effective in treating OAB symptoms and are commonly used in tandem with lifestyle changes and bladder retraining. They are especially useful in the relief of frequency urination, which for some people with OAB can occur 12 or more times per day.

Beta-3 Adrenergic Agonists

Another class of drugs used to treat OAB blocks a neurotransmitter called beta-3, whose receptors occur in the bladder and gallbladder. These drugs, called beta-3 adrenergic agonists, relax the detrusor muscle and increase the bladder capacity so that it can hold more urine without going into spasms.

The two beta-3 adrenergic agonists commonly used to treat OAB are:

• Gemtesa (vibegron)
• Myrbetriq (mirabegron)

These can be used on their own or combined with MRAs for more severe cases. Side effects include an increase in blood pressure in 10% of users, as well as dry mouth, headache, sinusitis, back pain, joint pain, and dizziness.

Urinary retention can also occur with beta-2 adrenergic agonists, the risk of which increases when combined with an MRA.

Surgeries and Specialist-Driven Procedures

Numerous procedures used for OAB have been approved or given clearance by the Food and Drug Administration (FDA). These are more commonly used in people with refractory (treatment-resistant) OAB symptoms.

Botox

Botox (botulinum toxin A), widely used to treat a variety of neurological disorders like multiple sclerosis, was licensed for use by the FDA to treat OAB in January 2010.

The drug, delivered by injection into the detrusor muscle, suppresses involuntary bladder contractions and provides sustained urinary control for up to nine months. The injection can be delivered in an office setting at a dose of 100 units (0.5 milliliters) per session.

In some people, Botox use can trigger adverse urinary side effects, including:

• Dysuria (pain with urination)
• Urinary retention
• Urinary tract infections

Percutaneous Tibial Nerve Stimulation

Percutaneous tibial nerve stimulation (PTNS) is a minimally invasive procedure used to alleviate urinary urgency, urinary frequency, and urge incontinence. In 2010, the FDA formally included OAB as an indication for treatment.

PTNS is a form of nerve stimulation. An acupuncture needle with attached electrical current is inserted into the ankle. It stimulates the peripheral endings of nerves innervating the bladder.

Although the exact mechanism of action remains unclear, PTNS has proven to be safe and as effective as OAB medications in people with severe OAB. PTNS is performed once weekly on an outpatient basis and involves a total of twelve 30-minute sessions. People tend to experience an improvement of urinary function within six weeks.

Sacral Neuromodulation

Sacral neuromodulation (SNS) is similar to PTNS but involves the implantation of an electrical device in the lower back near the sacral nerve. By delivering mild electrical pulses to the sacral nerve, which controls the bladder, bowel, and pelvic floor muscles, severe OAV symptoms can be reduced by up to 80%.

SNS requires surgery under general anesthesia to implant the device in the area between the lower back and buttock. External leads are then connected to a permanent battery in a second outpatient procedure.

Side effects of the SNS procedure include:

• Bleeding
• Post-operative infection
• Radiating nerve pain in the leg, buttock, or lower back
• Transient leg weakness

Surgery

Surgery is less commonly used in the treatment of OAB, with outcomes varying significantly from one person to the next. Even so, surgery may be an option when OAB symptoms are severe and when less-invasive options have failed to provide relief.

There are two types commonly used:

• Augmentation cystoplasty: This surgical procedure enlarges the bladder. Performed laparoscopically or with open surgery, it involves the removal of a section of the small or large intestine. After cutting open and flattening the tube, the tissue is grafted into another incision made at the top of the bladder to increase its size.
• Urinary diversion: This open or laparoscopic surgery diverts the flow of urine by linking the ureters (the tubes that connect the kidneys to the bladder) to a section of the intestine that has been rerouted outside of the abdomen. The urine then drains continuously into a bag you wear underneath your clothes.

As with all surgeries, there is a risk of pain, infection, blood clots, and adverse reactions to the anesthesia. In rare cases, bowel obstruction and an incisional hernia can occur.

Complementary and Alternative Medicine (CAM)

There are many complementary and alternative therapies used to treat OAB. These include mind-body therapies that help minimize urinary urgency and symptoms of stress incontinence (see “Bladder Retraining” above).

Naturopathic doctors and others also use herbal remedies to treat OAB, but few of these are strongly supported by research. Among those that have some evidence of a positive effect are:

• Gosha-jinki-gan (GJG): This traditional Chinese medicine remedy is composed of 10 herbs. Animal studies suggest GJC can “mute” bladder sensations that contribute to urinary urgency. Small studies in women and men have shown positive results, albeit with side effects in 1 in 10 users (including diarrhea, nausea, and increased urinary frequency).
• Saw palmetto: Saw palmetto (Serenoa repens) is a popular herbal remedy said to increase testosterone levels and alleviate prostate enlargement that can contribute to OAB symptoms in men. A 12-week study involving 44 men with OAB reported improved bladder control and decreased prostate size compared to men who didn’t take it.

Always speak with your healthcare provider before using a herbal remedy to treat OAB. The overuse of herbal remedies, especially imported ones, can expose you to substances that may be toxic to your liver and kidneys or interact with drugs you are taking.

A Word From Verywell

Overactive bladder is a common condition that affects around 1 in 4 women and 1 in 6 men in the United States at some point in their lives. While many cases can be effectively treated with lifestyle changes and short-term therapies, others may persist despite treatment.

In such cases, seek treatment from a specialist in urological conditions. These include urologists and specialists in female pelvic medicine and reconstructive surgery (FPMRS), who are urologists or gynecologists specially trained in female pelvic health.

These professionals are best qualified to diagnose the underlying causes of OAB and best apprised of the latest treatments and treatment approaches.