5 Urogynecologist Tips for People With Overactive Bladder
As a urogynecologist, I help people with overactive bladder (OAB) live their lives without the anxiety of constantly needing the restroom or accidentally leaking. With behavioral changes and effective medical treatments, people are able to get some independence back, and it’s really rewarding to be a partner in their care. Everyone has different goals when it comes to treating their OAB; some people are happy with a 50% reduction in urinary frequency or leakage, while others want more or less. Because there are a lot of factors contributing to OAB, the treatment path is unique for each patient. Understanding what you can do every day to manage your OAB is one of the most important ways to stay in control.
When I first start to treat someone with overactive bladder, I’ll ask them to keep a voiding diary. For three days, they will write down how much they drink, what they drink, when they go to the bathroom, and if they leaked at all. This data is really enlightening for the patient and for their doctor. Most people don’t know how many times they went to the bathroom on a given day–I certainly don’t. But that information can be useful as we address OAB. If someone has gotten into the habit of urinating frequently, we suggest that they try delaying it. Going to the bathroom every two hours during the day is considered normal. If you’re going once an hour, what happens if you wait? Often, you can train your bladder to wait and to learn new patterns, and I’ll work with people on bladder retraining. On the flip side, we all live busy lives, and some people realize they are only urinating two or three times a day. In that case, of course you’re rushing to the bathroom! Anyone would do that with a very full bladder. Understanding your habits is the first step to understanding what’s needed to manage your OAB.
A voiding diary also helps us assess someone’s eating and drinking habits. What you consume can play a big role in your OAB; caffeine is known to irritate the bladder and cause urgency, while alcohol is a diuretic, which means it causes your body to produce more urine. Drinking too many fluids every day can also, unsurprisingly, lead to more frequent urination. I recommend drinking 64 fluid ounces of fluid each day; if you’re consuming more than that, try to cut down–you’ll likely notice you’re more in control of your bladder. People with OAB may also want to try avoiding or reducing carbonated beverages, sugar substitutes, and spicy foods, which are also bladder irritants. Work with your doctor to come up with a plan that’s doable so you can stick to it.
Many people with OAB also benefit from learning distraction techniques. It’s very common for someone to notice that as soon as they get home from work and walk in the door, they immediately have to run to the bathroom or else they will leak. Their body associates coming home with urinating–it’s a trigger for them. Interrupting this trigger can be really helpful, and there are a lot of ways to distract yourself. One of my patients found that using the front door rather than the garage door solved this problem. Another woman figured out that picturing George Clooney in her kitchen is the key for her! It’s silly, but it works. She tells herself it would be rude to run past him and she definitely can’t leak urine in front of him. By the time she’s imagined this scenario, her urge to urinate has been suppressed, and she can walk in, let the dogs out, and then go to the bathroom without the hurry or stress.
Often, I’ll prescribe pelvic floor physical therapy to people with OAB. It’s helpful to have a professional take the time to actually coach you on the pelvic floor muscles, to show you what it means to contract and release them, to understand what’s actually going on with your pelvic floor and how that’s related to your overactive bladder. This type of physical therapy can also teach you how to hold on a little longer to avoid leaking or hurrying to the bathroom. Your physical therapist can show you how to contract your pelvic floor muscle when you get an urge to urinate, and this sends a signal to the bladder to calm down for 10 seconds or so. That way, you can walk to the bathroom, instead of rushing.
Medication can be very effective in treating overactive bladder, but I’ve found that often, if someone’s doing really well on meds, they might slack off a bit when it comes to behavioral changes. They get braver because they feel more confident and in control of their OAB, which is great–but that doesn’t mean drinking caffeine isn’t going to irritate their bladder. Medication or not, you still shouldn’t wait six hours between bathroom breaks. It can also be tempting to stop taking your medication regularly as time goes by and you feel more independent. Unfortunately, when you skip your medication, your bladder will feel the effects, so it’s important to stick with it. Managing OAB is about using all the tools in your arsenal, from medication to bladder training to making the right food and drink choices.