Overactive bladder (OAB) treatment has many approaches, from medication to behavioral changes (or a combination of both). Visiting your doctor for a thorough evaluation and following their instructions carefully can help you get the OAB treatment you need to get back into your old routine.
Medications for Overactive Bladder
In people with overactive bladder, muscles in the bladder wall contract at the wrong time. Medications can help treat overactive bladder.
Anticholinergics
A group of drugs called anticholinergics combat this problem by blocking the nerve signals related to bladder muscle contractions. Research suggests that these drugs also might increase bladder capacity and decrease the urge to go.
Anticholinergic drugs include:
- Darifenacin (Enablex)
- Fesoterodine (Toviaz)
- Oxybutynin (Ditropan, Ditropan XL, Gelnique, Oxytrol)
- Solifenacin (Vesicare)
- Tolterodine (Detrol, Detrol LA)
- Trospium (Sanctura)
Oxytrol for women is the only drug available over the counter. Overall, these drugs work about the same in treating overactive bladder, and generally, people tolerate all of them well. The main side effect is dry mouth, but anticholinergics can also cause constipation, blurred vision, and increased heartbeat.
Anticholinergic medications are widely used in the treatment of overactive bladder, as well as for short-term treatment of bladder symptoms following a variety of urologic surgeries. Growing evidence points to an association between anticholinergic medications and the increased risk of incident dementia. Chronic use (three months or longer) of OAB anticholinergic medications is likely linked to an increased risk of new-onset dementia.
Short-term (less than four weeks) use of most OAB anticholinergic medications is likely safe in most individuals. Clinicians should consider potential cognitive risks in all populations when prescribing OAB anticholinergics for chronic use. Consideration should be given to progressing to advanced therapy (botulinum toxin or neuromodulation) earlier in the OAB treatment paradigm.
Some people with glaucoma, urinary retention, or gastrointestinal disease should avoid using anticholinergic drugs.
Beta-3 adrenergic agonists
The drugs mirabegron (Myrbetriq) and vibegron (Gemtesa) are called beta-3 adrenergic agonists. These medications work by activating a protein receptor in bladder muscles that relaxes them and helps the bladder fill and store urine.
Another type of drug for overactive bladder is the tricyclic antidepressant imipramine hydrochloride (Tofranil), which also relaxes bladder muscles.
Botox injections
Botox (onabotulinumtoxinA), more commonly known for removing wrinkles, can be injected into the bladder muscle, causing it to relax. This can increase the capacity of the bladder and lessen contractions. You’ll get the shots in your doctor’s office. About 6% of people who get Botox may temporarily be unable to pee. You must be able and willing to have a catheter put in if this happens. Botox is only recommended for people who can’t control symptoms with behavioral therapies or oral medications.
Studies have found that the lack of estrogen that occurs after menopause can affect urination, and some women are treated for OAB with estrogen. But there isn’t strong evidence to show that estrogen is an effective treatment for OAB.
Other medications for overactive bladder treatment
Sometimes, overactive bladder treatment for men includes a type of blood pressure medication called alpha-blockers, but again, the research on these drugs isn’t conclusive.
Doctors also treat men with drugs that relax a muscle at the bladder neck and prostate to help with emptying. These include:
- Alfuzosin (Uroxatral)
- Doxazosin (Cardura, Cardura XL)
- Silodosin (Rapaflo)
- Tamsulosin (Flomax)
- Terazosin (Hytrin)
Capsaicin, which is the active ingredient in chili peppers, may target the nerves of the bladder. A related substance, resiniferatoxin, has also shown positive results in early research involving patients with spinal cord injury.
Behavioral Therapies for Overactive Bladder
If you have an overactive bladder, your doctor is likely to recommend behavioral therapies. These are simple habits that don’t involve drugs or fancy medical equipment. They typically work well and don’t have any side effects.
Bladder training
This means setting a schedule for going to the bathroom. When it’s time, pee even if you don’t have to. After a week, start adding 15 minutes between bathroom breaks. Over time, this trains your bladder to hold more pee before nature calls. You should see results in six to eight weeks.
Pelvic floor exercises
Also called Kegel exercises, these moves strengthen your pelvic floor muscles and urinary sphincter. This helps your bladder avoid squeezing before it’s time to go.
A doctor or physical therapist will show you how to do the exercises. If you practice them regularly, they should begin to work within six weeks.
Double voiding
If you have an overactive bladder, you might not feel like you get all the pee out when you go. But despite the way it feels, most people with the condition do empty their bladder completely.
The only way to tell if you’re really getting all the pee out is to get an ultrasound of your bladder after going to the bathroom, says Karyn Eilber, MD, a professor of urology at Cedars-Sinai in Beverly Hills, California.
If your doctor says you’re not completely emptying your bladder, you can try double voiding. This means that after you pee, you wait a few minutes and try again. This strategy helps to fully empty the bladder and avoid accidents.
Lifestyle Remedies to Manage Overactive Bladder
Other ways to manage overactive bladder (OAB) include lifestyle remedies. These can help address OAB symptoms.
Keep a journal
The first step to understanding your bladder is to track your habits. Keep a journal of when you feel like you need to pee or when you leak. Note what you ate and drank beforehand. This will help you identify patterns, such as if a certain food makes your symptoms worse. Just three days of tracking your bladder habits can help you get a better idea of your OAB symptoms.
Be mindful of how much fluid you get
Forget the myth about needing eight glasses of water a day — everybody is different, and some people need more or less water than others. Ask your doctor how much you should drink in a day. Drinking too much can make an overactive bladder worse. But if you don’t drink enough, it can irritate your bladder lining and make you feel like you have to go.
Keep a healthy weight
Being overweight can put extra pressure on your bladder, making it feel like you have to go to the bathroom. If you are overweight or have obesity, talk to your doctor about safe ways to lose weight. Staying active through exercise can also help manage overactive bladder.
Steer clear of bladder irritants
Some foods and drinks can upset your bladder. These include:
- Alcoholic beverages
- Tea and coffee
- Soda and other bubbly drinks
- Citrus (such as oranges and drinks such as lemonade)
- Chocolate
- Spicy foods
- Acidic foods, including tomatoes
- Artificial sweeteners
Everyone responds to these things differently, so try avoiding them, and see if your symptoms improve.
Treat constipation
Constipation can make you feel like you have to pee. Keep things moving by eating plenty of fiber, drinking enough water, and exercising regularly.
Set a schedule
Timing your trips to the bathroom can help avoid accidents. For example, if you know that you are likely to have an accident after not using the bathroom for two hours and 15 minutes, then go every two hours.
Avoid smoking
Smoking can bother your bladder muscles, making an overactive bladder worse. Talk to your doctor if you need help quitting.
Prepare for leaks
Sometimes, leaks happen. Absorbent pads and underwear can trap pee, hide its smell, and protect your clothes. There are other products that can help with OAB symptoms such as incontinence, including:
- Catheters
- Adaptive clothing and swimwear
- Protection for chairs and bedding
- Skincare products to soothe irritated skin
When Do You Need Surgery for Overactive Bladder?
In rare cases when all OAB treatments fail and the OAB is severe, doctors may recommend one of many types of surgery.
Augmentation cystoplasty
A procedure called bladder augmentation uses part of the bowel to increase bladder capacity. Or, urinary diversion offers an alternate route for bladder drainage for severe, complicated OAB. These procedures are considered last-resort treatments and are not commonly done.
Sacral nerve stimulation
Another procedure called sacral nerve stimulation implants a small device, similar to a pacemaker, under the skin. The device is connected to a wire, which sends small electrical pulses to nerves around the pelvic floor that control the bladder and muscles surrounding it. This helps build bladder control. It’s often called a bladder pacemaker. The main limitation of this treatment is that it keeps you from having a spinal MRI.
Percutaneous tibial nerve stimulation
The doctor places a needle on nerves near your ankle that affect bladder control. You’ll have one session a week for 12 weeks and then maintenance treatments as needed. This procedure is done in the office.
An overactive bladder doesn’t have to get in the way of your daily life. Whatever treatment for overactive bladder you and your doctor decide upon, it’s important that you stick with it. If you do, chances are your condition will improve in time.
Can Alternative Therapies Treat Overactive Bladder?
Some studies suggest acupuncture might help with overactive bladder, but it hasn’t been proven.
“There’s not a lot of research showing [acupuncture and yoga] help,” says Diane Newman, a urology and pelvic floor specialist at the University of Pennsylvania in Philadelphia, Pennsylvania.
Some people also turn to herbal supplements for OAB symptoms. But these also don’t have much evidence to back them up. For example, some researchers study supplements such as:
- Capsaicin
- Cleavers used in tea
- Gosha-jinki-gan (GJG), a special blend of traditional Chinese herbal medicine
- Hachi-mi-jio-gan (HE), another Chinese herbal medicine blend
Always talk to your doctor before adding any kind of herbal supplement to your diet.
Overactive Bladder (OAB) and Your Mental Health
Having an overactive bladder can be hard. It might be stressful to always have to know where the bathroom is. Or you might worry about having accidents in public. Some researchers have found a connection between overactive bladder and anxiety. People with OAB reported more anxiety. In one study, half the participants with OAB had anxiety. There may be a connection between anxiety and worse OAB symptoms, too. But researchers are still studying this link.
There may also be a link between OAB and depression. One study found an increased risk for depression that correlates to how much overactive bladder affected participants’ lives. In another study, researchers found a positive association between suicidal ideation and OAB, meaning that people with overactive bladder may be more likely to consider suicide. But we need more research about the intersection between overactive bladder and mental health.
Talk to your doctor, a therapist, or friend about how you’re feeling. Joining a support group can also be helpful.
Remember, you’re not alone. Overactive bladder is very common, and more people may understand than you think.
Takeaways
Living with an overactive bladder isn’t always easy, but it is manageable. There are many medicines, therapies, and lifestyle changes that can help. If you constantly feel the need to pee, make an appointment with your doctor. They can talk you through the best options for you.
FAQs About Overactive Bladder
Is overactive bladder fully curable?
When overactive bladder is caused by a curable medical condition, such as a severe urinary tract infection, it can go away with treatment. But for most people, overactive bladder is a chronic condition that can be controlled but not cured.
What medication stops frequent urination at night?
There are many medications that can help with overactive bladder. They generally fall into two categories: anticholinergics and beta-3 agonists. But there are also other types of medication you may be able to take.
What happens if OAB is left untreated?
Over time, people who have overactive bladder might be at higher risk for urinary tract infections.
