Overactive bladder is the medical term used to describe a condition in which you have a strong urge to urinate multiple times a day and overnight, even though your bladder is not full. People who urinate eight or more times during the day or at least twice overnight may be diagnosed with the condition. About one-third of people with overactive bladder experience urinary incontinence.
Up to 30% of men and 40% of women in the United States have overactive bladder, which can be a standalone condition or a symptom of a chronic health condition, such as diabetes or multiple sclerosis.
Overactive bladder can negatively impact a person’s quality of life. People with this problem may significantly limit their fluid intake, hoping it will help limit the urge to urinate. They may turn down social engagements if there aren’t bathrooms nearby, leading to social isolation.
They may also assume their symptoms are a normal part of aging, so they don’t seek treatment. Or they may be too embarrassed to tell their doctor about the problem, preventing themselves from finding a solution.
Fortunately, several treatments are available to improve the symptoms of overactive bladder. Treatment can significantly improve their quality of life.
What is overactive bladder?
Overactive bladder is a condition that arises when a person experiences an urgent need to urinate multiple times per day and/or at night; the urge does not accurately reflect how full the bladder is and if it’s truly ready to void.
The bladder is an organ that holds urine. Normally, the bladder fills to capacity before the brain receives a signal that it’s time for the bladder to empty. When the brain sends that signal, the bladder muscles tighten, squeezing urine out of the bladder and into the urethra, where it can exit the body.
In those with overactive bladder, however, a breakdown in the normal process occurs. Either the brain receives a signal that it’s time to urinate well before the bladder has been filled, or the bladder muscles contract too frequently, signaling that it’s time to visit the bathroom, even though the bladder isn’t full.
Treatments can address both aspects of overactive bladder, whether related to poor neurological signaling or overactive muscle contractions.
What causes overactive bladder?
There are several causes of overactive bladder. In some cases, however, the cause is unknown.
Common causes include:
- Neurologic disease
- Drinking too many fluids
- Consuming too much caffeine
- Taking diuretics (medication that leads to urination)
- Prior bladder surgery
- Prior surgery to the uterus
Health conditions that can cause overactive bladder symptoms include:
What are the symptoms of overactive bladder?
People with overactive bladder experience symptoms like:
- A sudden, strong urge to urinate
- Frequent trips to the bathroom throughout the day
- Nighttime awakenings to use the bathroom
- Incontinence (leaking or accidents, in rare cases)
What are the risk factors for overactive bladder?
These factors may increase the risk of overactive bladder:
How is overactive bladder diagnosed?
Patients with overactive bladder can be diagnosed after doctors learn about their medical history, perform a physical exam, and offer diagnostic tests.
When sharing your personal medical history, let doctors know how often you are experiencing the urge to urinate throughout the day and whether you experience leaks or incontinence on the way to the bathroom. Some people keep a diary of how often they use the bathroom, including the time of day and any relevant symptoms, such as extreme urgency or leaking urine.
You should also share information about your personal habits, including how often you consume fluids, how many beverages per day contain caffeine, and whether you smoke. If you have depression, anxiety, irritable bowel syndrome, multiple sclerosis, or another neurological disease, share that information with the doctor. Also mention any surgeries you have had to the urethra or uterus, as well as a family history of overactive bladder.
During a physical exam, doctors will examine the abdomen, pelvis, and rectum. During a pelvic exam, they should check for pelvic organ prolapse; the pressure of other organs on the bladder may cause feelings of urgency. They should also perform a neurological exam.
No single diagnostic test can confirm overactive bladder. Rather, doctors try to rule out other causes of urinary urgency before diagnosing the condition. You may need to give a urine sample to ensure that the cause is not a urinary tract infection.
Doctors may also order blood work to rule out infections. If a neurological condition is suspected, your doctor may order electromyography (EMG), a diagnostic test that checks the health of muscles and the nerves that control them.
How is overactive bladder diagnosed?
A variety of treatments are available for overactive bladder, ranging from simple lifestyle changes to surgery.
Doctors may recommend lifestyle changes before offering other treatments.
Lifestyle changes include:
- Limiting or avoiding caffeinated beverages, including coffee, tea, and soda
- Limiting or avoiding carbonated beverages
- Limiting or avoiding alcoholic beverages, which have a diuretic effect
- Removing certain foods from your diet temporarily to see if symptoms occur in their absence; foods that can affect the bladder include spicy foods, citrus fruit, tomatoes, tomato sauce, and chocolate.
- Keeping a diary of your bathroom habits to determine how often you’re urinating and whether certain foods or liquids make symptoms better or worse
- Practicing “double voiding,” which means emptying the bladder, then emptying it again a few seconds later
- Going through bladder training or stretching out the time between bathroom visits by waiting a few minutes when you have the urge to urinate
- Following a timed urination schedule as prescribed by a doctor, which means going to the bathroom every 2, 3, or 4 hours, whether or not you think you have to go
- Going for pelvic floor physical therapy to help strengthen the muscles that are involved in urination
Medications that improve symptoms of overactive bladder include:
- Medications that help relax the bladder muscles, including anti-muscarinics (anticholinergics), beta-3 adrenoceptor agonists which may delay the urge to urinate until the bladder fills completely
- Botulinum toxin (Botox) injections, which help to relax the bladder muscles for six months at a time
Nerve stimulation therapy may also help to ease the symptoms of overactive bladder. During percutaneous tibial nerve stimulation, electrical impulses are sent through a nerve near the shinbone (tibia) to the sacral nerve, which controls communication between the bladder and spinal cord. Patients often improve after 12 sessions.
When no other treatments are effective, surgery may be an option. Some patients have a procedure to alter the function of the sacral nerve, which sends signals between the bladder and spinal cord; they may receive a bladder pacemaker. Other patients may receive reconstructive surgery to enlarge the bladder or reroute the urine flow.
What is the outlook for people with overactive bladder?
People who seek treatment for overactive bladder are usually able to find relief from unwanted symptoms, leading to fewer feelings of urinary urgency and fewer bathroom visits.
People with overactive bladder who suffer silently don’t recover on their own; their quality of life will not improve without treatment.
This article was medically reviewed by Marianne Passarelli, MD, MBA.