Overactive Bladder

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What is overactive bladder?

Overactive bladder (OAB) is a sudden, intense urge to urinate that you cannot control. It can also cause a need to urinate more than normal during both the daytime and nighttime. Sometimes, these uncontrollable urges result in leakage of urine—or urinary incontinence. When this occurs, it is called urge incontinence. Another name for it is “OAB wet.” When the urge occurs without leakage, it is “OAB dry.”

Normal bladder function involves an interplay between muscles and nerve signals. While the bladder fills with urine, the bladder muscles stay relaxed and the sphincter muscles contract around the urethra. When the bladder is full, it triggers the brain to send signals to the muscles. The bladder muscles squeeze around the bladder and the sphincter relaxes to let urine flow. In OAB, the brain communicates the need to urinate or the muscles react when the bladder is not full.

Overactive bladder is very common in the United States. Up to 30% of men and 40% of women struggle with overactive bladder symptoms. Several problems can cause OAB. Often, OAB is the result of a combination of problems, such as weak pelvic muscles and being overweight. For men, having an enlarged prostate is one of the most common causes of OAB. For women, being postmenopausal is a common contributing factor. While these overactive bladder causes are age-related, OAB is not a normal part of aging and treatments are available.

Overactive bladder treatment usually starts with lifestyle changes and behavioral strategies. These steps may be enough to improve urinary control. If symptoms persist, doctors may prescribe medications or recommend surgery.

Left untreated, OAB may continue to worsen and can lead to other health problems, such as depression, anxiety, and sleep problems. See your doctor if a frequent or urgent need to urinate, with or without incontinence, disrupts your life or interrupts your sleep.

What are the symptoms of overactive bladder?

The most common symptom of overactive bladder is a sudden, strong need to urinate that is hard to control. This is commonly called urgency. Other common symptoms include:

  • Frequent urination, which generally means going more than eight times in 24 hours

  • Nocturia, which is needing to urinate two or more times during the night

  • Urge incontinence, which is the leakage of urine due to an urgent need to urinate and not making it to the toilet in time

If you have symptoms of overactive bladder, make an appointment with your doctor. OAB and incontinence tend to worsen with time. Addressing it early may help prevent it from becoming more bothersome. Urinary symptoms can also be a sign of a more serious condition.

What causes overactive bladder?

Overactive bladder occurs when something interferes with normal bladder function and control. A problem with the muscles that control bladder emptying or the nerves that trigger bladder emptying causes OAB. It is not a normal part of aging, as some people believe. Several underlying diseases, disorders and conditions can contribute to OAB including:

Other contributors include excess weight, menopause, and substances, including alcohol, caffeine, and certain medications, such as diuretics. Sometimes, there is no clear explanation for overactive bladder symptoms.

What are the risk factors for overactive bladder?

Overactive bladder becomes more likely with aging. This does not happen as a normal part of the aging process. Instead, OAB is more common in older people because the conditions that contribute to it are more common.

Other risk factors for overactive bladder include:

  • Consumption of alcohol and caffeine

  • Family history

  • Female sex

  • Smoking

  • Obesity, being overweight, or being constipated, which puts more stress on the bladder

  • Weak pelvic floor muscles, which are unable to properly support the bladder

Reducing your risk of overactive bladder

Risk reduction in healthcare involves changing risk factors you can control. To lower your risk of overactive bladder, try these healthy lifestyle tips:

  • Avoid constipation by eating fiber-rich foods, drinking fluids, and getting regular physical activity

  • Limit bladder irritants, such as alcohol and caffeine

  • Maintain a healthy body weight

  • Stop smoking

  • Strengthen your pelvic floor with Kegel exercises

  • Treat medical conditions, such as diabetes and BPH (enlarged prostate)

Talk with your doctor if you have concerns about overactive bladder. Ask about your risk factors and find out how to lower your personal risk of OAB.

What are the diet and nutrition tips for overactive bladder?

Several foods can irritate the bladder or make overactive bladder symptoms worse. Try decreasing or eliminating the following foods and liquids, one at a time, to see if it improves your symptoms:

  • Acidic foods and drinks, including citrus fruits and juices, tomatoes, and tomato products

  • Alcohol and carbonated drinks

  • Artificial sweeteners

  • Caffeinated drinks, including colas, coffee and tea

  • Chocolate

  • Spicy foods

On the other hand, there are dietary changes that may help improve your symptoms by avoiding constipation. This includes:

  • Drinking the right amount of fluids, which your doctor can help you determine. Too many fluids can worsen your symptoms. Drink water when you are thirsty, and limit fluid intake 2 to 3 hours before bedtime.

  • Eating fiber-rich foods, including fresh fruits and vegetables, dried fruits, beans, and whole-grain products

Ask your healthcare provider for guidance before making significant changes to your diet.

How do doctors diagnose overactive bladder?

To diagnose overactive bladder, your doctor will take a medical history, perform a physical exam, and possibly order testing. Questions your doctor may ask about overactive bladder include:

  • What symptoms are you experiencing, such as urgency or increased frequency of urination?

  • How often do you urinate during the day?

  • Are you having symptoms of overactive bladder at night? How often do you urinate during the night?

  • How long have you had these symptoms?

  • When you void, is it a large or small volume?

  • Do you have other symptoms, such as feeling tired during the day?

  • How much caffeine and alcohol do you have each day?

  • What medical conditions do you have?

  • What medications are you taking?

Your doctor will also perform a physical exam to look for possible causes of overactive bladder. For women, this may include a pelvic exam. For men, it may involve a digital rectal exam (DRE) to feel the prostate gland.

Tests, tools, and diagnostic exams your doctor may request include:

  • Bladder diary where you will record what you eat and drink, how often you go to the bathroom, and if you leak urine. This can reveal patterns in your symptoms that can be helpful.

  • Urinalysis to test your urine for signs of infection and other health problems

  • Pelvic ultrasound to create images of the kidneys, ureters, bladder and urethra

  • Cystoscopy to examine the inside of the bladder. This procedure involves inserting a thin tube through the urethra.

  • Urodynamic tests to measure how well the bladder, bladder muscles, nerves, and urethra are working. These tests can check the speed and volume of urination, amount of urine the bladder can hold, bladder pressure, fullness of the bladder when you feel the urge, amount of urine left in the bladder after urination, and if the bladder contracts without your control.

It is not always possible to diagnose an underlying cause or condition. If the problem persists and your provider is unable to determine a cause, seeking a second opinion may give you more information and answers.

What are the treatments for overactive bladder?

In treating overactive bladder, the goals include correcting any underlying physical problem and improving symptoms and quality of life. Treatment usually starts with lifestyle changes and behavioral strategies. Overactive bladder treatment options include:

  • Behavior modification, such as decreasing your fluid intake, not drinking close to bedtime, and limiting caffeine and alcohol.

  • Bladder training, which consists of scheduled urination with gradually increasing the time between trips to give you more control over urges. Double voiding—urinating and waiting a few minutes before trying again—is another form of bladder training. 

  • Pelvic floor training, which primarily involves Kegel exercises—tightening the muscles that stop urination, holding them briefly, and gradually increasing the time you can hold them tight. Sometimes, people need a physical therapist to help identify the right muscles to use. Biofeedback and electrical stimulation can also be helpful for pelvic floor training.

  • Medications, which relax the bladder muscles, including darifenacin (Enablex), fesoterodine (Toviaz), mirabegron (Myrbetriq), oxybutynin (Ditropan XL), solifenacin (Vesicare), tolterodine (Detrol), and trospium (Sanctura XR). Prostate medicines for BPH and estrogen therapy may also help.

  • Nerve interventions, such as bladder (sacral) nerve stimulation and onabotulinum A toxin (Botox) injections

  • Surgery, which is rarely necessary, to reconstruct and enlarge the bladder

     

What are the potential complications of overactive bladder?

Overactive bladder can cause stress in your personal, social and work relationships and affect your quality of life. Complications that can contribute to a reduction in quality of life include:

  • Anxiety and depression

  • Sexual problems and issues with sexuality

  • Sleep disturbances

Talk with your primary care provider or a urologist if you have signs and symptoms of OAB. Treatment is available.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Aug 4
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
  1. Overactive Bladder. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/14248--overactive-bladder- 
  2. Overactive Bladder. Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/overactive-bladder/symptoms-causes/syc-20355715 
  3. Urodynamic Testing. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/diagnostic-tests/urodynamic-testing 
  4. What Is Overactive Bladder (OAB)? American Urological Association. https://www.urologyhealth.org/urology-a-z/o/overactive-bladder-(oab) 
  5. What Is Overactive Bladder (OAB)? National Association for Continence. https://www.nafc.org/overactive-bladder 
  6. What Is Urinary Incontinence? American Urological Association. https://www.urologyhealth.org/urology-a-z/u/urinary-incontinence