Overactive Bladder (OAB)

Urgency: This is the main symptom of OAB. It is a strong (urgent) need to pass urine that can’t be ignored. This “gotta go” feeling makes people afraid they will leak urine if they don’t find a bathroom right away. People with OAB may also:

• Leak urine: Sometimes OAB causes urine to leak out before getting to the bathroom. This is called urgency incontinence. Some people may leak just a few drops, while others can have a sudden gush.
• Pass urine often: OAB may also cause people to go to the bathroom many times during the day. Experts say that frequent urination is when you have to pass urine more than eight times in 24 hours.
• Wake up at night to pass urine: OAB can wake a person from sleep to pass urine more than once a night. This is called nocturia.

OAB does not cause pain. If you feel pain while passing urine, you may have a urinary tract infection (UTI). Please talk with your health care team about pain.

How Can OAB Affect Your Life?

Without treatment, OAB symptoms can have a negative impact on your life. It can be hard to get through the day without many visits to the bathroom. OAB can impact relationships and interrupt time with family and friends. You may not want to do things you enjoy as you worry about having to be near a bathroom all the time, or worry about leaking urine. It can disrupt sleep and your sex life, causing you to feel tired and short-tempered. Frequent leaks can lead to a skin rash or infections. Sometimes people with OAB may feel hopeless or unhappy.

Once your health care team understands the problem, they can tell you about treatment options. There’s no single treatment that’s right for everyone.

Who Gets OAB?

Both men and women can have OAB. Older women who have gone through menopause and men who’ve had prostate problems are more likely to have OAB. Growing older can be a factor, but not all people get OAB as they age. It’s NOT a normal part of aging. People with diseases that affect the brain or spinal cord like stroke and multiple sclerosis are more likely to have OAB symptoms.

This Overactive Bladder Assessment Tool can be used to assess your symptoms. Download the assessment tool and answer the questions based on the last month. Then bring your completed assessment to your health care team.

This assessment and your answers may make it easier for you to start talking about your symptoms. The questions will help measure which Overactive Bladder (OAB) symptoms you have and how much your symptoms bother you. The better your health care team knows the level and impact of your symptoms, the better they can help you manage them.

Overactive Bladder Diary

What is a Bladder Diary?

A bladder diary is an assessment tool used by you and your health care team to better understand your bladder symptoms. It may help you track a number of things: when and how much fluid you drink, when and how much you pass urine, how often you have that “gotta go” urgency feeling, and when and how much urine you may leak.

When is a Bladder Diary Used?

You can use a Bladder Diary before or after visiting with your health care team. Having a Bladder Diary during your first visit can be helpful because it describes your daily habits, your urinary symptoms and how they may be affecting your life. Your health care team may use this information to help treat you.

How to Use a Bladder Diary

1. Wake up. Begin writing in your diary when you wake up each day. Take notes throughout the day, and continue until you complete 24 hours. For example, if you wake up at 7 a.m. on the first day of your diary, take notes until 7 a.m. the next day.
2. Note your drinks. Write down what you drink (i.e., water, juice, coffee, wine) and how much. It is helpful to measure the amount. If you are unable to measure your drinks, then it’s of great value to take a good guess about the number of ounces every time you drink something. Most containers will list the number of ounces they contain. Use these listings to help you make an estimate, for example, an 8 oz. cup of juice, 12 oz. can of soda, or 20 oz. bottle of water.
3. Measure urine. During both the day and night, write down when and how much urine you pass. Health care teams often provide a special measuring collection device to use. It sits under your toilet seat and is marked with measurements to let you know how much urine you passed. If you are keeping the diary on your own before visiting a health care provider, then you may want to collect your urine in a cup from your home, such as a kitchen measuring cup. You could also choose a cup you know holds a certain amount of liquid, such as 8 oz. Rinse the collection device with water after each use. Keep the device close to your toilet until you’ve finished your diary.
4. Three days. It’s best to keep a diary for at least three days. A one-day diary may not provide enough information to give a true picture of your bladder condition. Also, the three days you keep your diary don’t have to be three days in a row. Any three days you chose will be fine, as long as they represent three “typical days” for you.
5. Start tracking. Get started by using this OAB Bladder Diary to start tracking! Print as many pages of the Bladder Diary you need to complete the three days. Also, don’t forget to bring your completed diary with you to your first office visit.

What Are My Next Steps?

Be sure to let your health care team know about any other symptoms you may have. (For example, do you have urine leakage when sneezing or exercising? Do you have bladder pain? Do you have to strain to start passing urine?) When you tell your health care team about your symptoms, you may be asked other questions and may be asked to do some test. This will help your health care team figure out if your symptoms could be caused by something other than OAB. Or, you may be asked to visit a specialist who can better diagnose and treat you.

To learn what’s happening, your health care team will likely:

• Ask about your health history. You may be asked about how you feel, how long you’ve had symptoms, and how they impact you. You may be asked about medicine you take – both over-the-counter and prescribed. You should also talk about what you eat and drink during the day. This lets your provider learn about your health.
• Do a physical exam. Your health care provider will look for things that could cause symptoms. Doctors often feel your organs in and below your belly to include a pelvic exam or a rectal exam.
• Order tests, as needed. Sometimes talking is not enough, so your health care team may suggest other tests to learn more about you. Test could include a urine test (to make sure you don’t have an infection or other problems in your urine) and a bladder scan (to see how well you empty your bladder). More sophisticated testing is usually not needed, unless your provider suspects problems other than OAB.
• Suggest you keep a bladder diary. A bladder diary helps you and your health care team learn about daily events and patterns. In this diary, you write down how often you pass urine and when you leak urine.

There are a number of things you can do to manage OAB. Everyone has a different experience with what works best. You may try one treatment alone, or several at the same time. You and your health care team should talk about what you want from treatment and about each option. OAB treatments include:

• Lifestyle Changes
• Prescription Medications
• Bladder Botox® Treatments
• Nerve Stimulation (peripheral and central)
• Surgery

Together, you and your health care team can choose a treatment plan that’s best for you so you can start living your life again.

Lifestyle Changes

For OAB treatment, health care providers may first ask a patient to make lifestyle changes. These changes may also be called behavioral therapy. This could mean you eat different foods, change drinking habits, and pre-plan bathroom visits to feel better. Many people find these changes helpful.

Other people need to do more, such as:

1. Limit food and drinks that bother the bladder. There are certain foods and drinks known to irritate the bladder of some people. You can start by avoiding diuretics - these drinks include caffeine and alcohol and they encourage your body to make more urine. You can also try taking several foods out of your diet, and then add them back one at a time. This will show you which foods make your symptoms worse, so you can avoid them. You can add fiber to your diet to improve digestion. Oatmeal and whole grains are good. Fresh and dried fruit, vegetables, and beans may help. Many people feel better when they change the way they eat and drink.

Some foods and drinks that may affect your bladder:

• Coffee / caffeine
• Tea
• Alcohol
• Soda and other fizzy drinks
• Some citrus fruits
• Tomato-based foods
• Chocolate (not white chocolate)
• Some spicy foods

2. Keep a bladder diary. Writing down when you make trips to the bathroom for a few days can help you understand your body better. This diary may show you things that make symptoms worse. For example, are your symptoms worse after eating or drinking a certain kind of food? Are they worse when you don’t drink enough liquids?
3. Double voiding. This is when you empty your bladder twice. This may be helpful for people who have trouble fully emptying their bladder. After you go to the bathroom, you wait a few seconds and then try again.
4. Delayed voiding. This is when you practice waiting before you pass urine, even when you have to go. At first, you wait just a few minutes. Gradually, you may be able to wait two to three hours at a time. Only try this if your health care provider tells you to. Some people feel worse or have urine leaks when they wait too long to go to the bathroom.
5. Timed urination. This means you follow a daily bathroom schedule. Instead of going when you feel the urge, you go at set times during the day. You and your health care team will create a reasonable schedule. You may try to go every two to four hours, whether you feel you have to or not. The goal is to prevent that urgent feeling and to regain control.
6. Exercises to relax your bladder muscle. You may be familiar with exercises to strengthen your pelvic floor muscles, also called Kegel exercises. A special exercise using those same pelvic floor muscles may help relax your bladder during those “gotta go” moments. “Quick flicks” are when you quickly squeeze and relax your pelvic floor muscles over and over again. So, when you feel the urge to go, a number of quick flicks may help control that “gotta go” feeling. It helps to be still, relax and focus on just the exercise. Your health care team or a physical therapist can help you learn these exercises. Biofeedback may also help you learn about your bladder. Biofeedback uses computer graphs and sounds to monitor muscle movement. It can help teach you how your pelvic muscles move and how strong they are.
7. Avoid constipation. Constipation can put pressure on your bladder and worsen your OAB symptoms. By keeping healthy bowel habits, you may be able to prevent constipation and help lessen OAB.

To prevent constipation:

• Eat plenty of fiber. Good sources of fiber include:
  • Whole grains, such as whole wheat bread and pasta, oatmeal and bran flake cereals
  • Legumes, such as lentils, black beans, kidney beans, soybeans and chickpeas
  • Fruits, such as berries, apples with the skin on, oranges and pears
  • Vegetables, such as carrots, broccoli, green peas and collard greens
  • Nuts, such as almonds, peanuts and pecans
• Drink water to make your stools softer and easier to pass.
• Limit low fiber foods or foods without fiber, such as:
  • Chips
  • Fast food
  • Meat
  • Prepared foods, such as some frozen meals and snack foods
  • Processed foods, such as hot dogs or some microwave dinners
• Exercise every day to get your bowels moving.
• Timing may help, so try to have a bowel movement at the same time every day.
• Stool softeners or gentle laxatives may help you have a soft, daily bowel movement.

Prescription Drugs

When lifestyle changes aren’t enough, the next step may be to take medicine. Your health care team can tell you about special drugs for OAB.

There are several drug types that can relax the bladder muscle. These drugs, like anti-muscarinics and beta-3 adrenoceptor agonists, can help stop your bladder from squeezing when it’s not full. Some are taken as pills, by mouth. Others are gels or a sticky transdermal patch to give you the drug through your skin.

Anti-muscarinics and beta-3 adrenoceptor agonists can relax the bladder muscle and increase the amount of urine your bladder can hold and empty. Combination drugs, like using both anti-muscarinics and beta-3 adrenoceptor agonists together may help control OAB when one option alone isn’t working.

Anticholinergic drugs treat OAB by helping the bladder muscle to relax. Common medications include oxybutynin, tolterodine and solifenacin. They work well for the bladder but are also linked to many bothersome side effects such as dry mouth, constipation, blurred vision, and lately, some concern for causing confusion or dementia with longer-term use. Trospium chloride does not diffuse into the brain so is not thought to have a risk of confusion or dementia.

Another medication for OAB is mirabegron. It is not an anticholinergic medication, so it is not linked to any of the side effects described above. It is an alpha-agonist, so works a little differently on the bladder, but in the end has the same effect of getting the bladder to relax. It can cause increases in blood pressure so should be used with caution in patients with hypertension. A newer medication for OAB is vibegron. It works much like mirabegron but will not affect blood pressure, so it may be a good option for patients with OAB and high blood pressure.

Your health care team will want to know if the medicine works for you. They will check to see if you get relief or if the drug causes problems, known as side effects. Some people get dry mouth and dry eyes, constipation or blurred vision. If one drug you try doesn’t work, your health care team may ask you to take different amounts, give you a different one to try, or have you try two types together. Lifestyle changes and medicine at the same time help many people.

Bladder Botox® Treatment

If lifestyle changes and medicine aren’t working, there are other options. In appropriate patients, a trained urologist or urogynecology & reconstructive pelvic surgery (URPS) specialist can help. They may offer bladder Botox® (onabotulinumtoxin).

Botox® works for the bladder by relaxing the muscle of the bladder wall reducing urinary urgency and urge incontinence. It can help the bladder muscles from squeezing too much. To put Botox® into the bladder your doctor will use a cystoscope passed into the bladder that enables the doctor to see inside the bladder. Through the cystoscope, the doctor will inject tiny amounts of Botox® in the bladder muscle. This procedure is performed in the office using local anesthesia, where numbing gel and medications are used to help numb the urethra and bladder. The effects of Botox® last up to twelve months, but the average is six months and repeat treatments will be necessary when OAB symptoms return.

Your health care team will want to know if Botox® treatments work for you. They will check to see if you get relief or if you aren’t holding in too much urine. A small number of people have trouble emptying their bladder for a short time after this treatment and may need to use a catheter (small tube) to get the urine out of the bladder until their voiding improves.

Nerve Stimulation

Another treatment for people who need extra help is nerve stimulation, also called neuromodulation therapy. This type of treatment sends electrical pulses to nerves that share the same path for the bladder. In OAB, the nerve signals between your bladder and brain do not communicate correctly. These electrical pulses help the brain and the nerves to the bladder communicate so the bladder can function properly and improve OAB symptoms.

Some types are:

• Percutaneous tibial nerve stimulation (PTNS). PTNS (peripheral) is another way to correct the nerves in your bladder. PTNS is performed during an office visit that takes about 30 minutes. PTNS is done by placing a small electrode in your lower leg near your ankle. It sends pulses to the tibial nerve. The tibial nerve runs along your knee to nerves in your lower back. The pulses help control the signals that aren’t working right. Often, patients receive 12 treatments, depending on how it’s working.

Percutaneous Tibial Nerve Stimulation (PTNS)

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• Sacral neuromodulation (SNM). SNM (central) changes how the sacral nerve works. This nerve carries signals between the spinal cord and the bladder. Its job is to help hold and release urine. In OAB, these nerve signals aren’t doing what they should. SNM uses a bladder pacemaker to control these signals to stop OAB symptoms. SNM is a two-step surgical process. The first step is to place a small wire under the skin in your lower back. This wire is first connected to a handheld pacemaker to send pulses to the sacral nerve. You and your doctor will test whether or not this pacemaker can help you. If it helps, the second step is to implant a permanent pacemaker that can regulate the nerve rhythm.

Sacral Neuromodulation (SNM)

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Newer devices are now available to allow at home treatment. They are:

• Implantable devices, such as implantable tibial nerve stimulation (ITNS)
• Wearable devices, such as transcutaneous tibial nerve stimulation (TTNS)

The Truth about OAB

Don’t let myths about OAB stop you from getting the help you need. Learn the truth about OAB:

• OAB is not just part of being a woman.
• OAB is not just having an issue with the prostate.
• OAB is not a normal part of getting older.
• OAB is not caused by something you did.
• Surgery is not the only treatment for OAB.
• There are treatments that can help people manage OAB symptoms.
• There are treatments to help, even if your symptoms are minor and you don’t leak urine.

If you are bothered by your OAB symptoms, then you should seek treatment!

Bladder Reconstruction / Urinary Diversion Surgery

Surgery is only used in very rare and serious cases. There are two types of surgery available. Augmentation cystoplasty enlarges the bladder. Urine diversion re-routs the flow of urine. There are many risks to these surgeries, so it is offered only when no other option can help.

Providers and Specialists Who Treat OAB

Many types of health care providers can offer basic help for OAB. Here are the types of providers you may meet:

• Urologists are surgeons who evaluate and treat problems of the urinary tract. Most urologists are very experienced with incontinence. But not all of them specialize in treating OAB. A patient should ask if their provider specializes in treating OAB.
• Gynecologists are doctors who focus on women’s health. Most are knowledgeable about incontinence, but not all are trained to treat OAB. A patient should ask if their provider specializes in treating OAB.
• Urogynecology and Reconstructive Pelvic Surgery (URPS) specialists are urologists or gynecologists who are trained as experts in female pelvic health. The public often refers to URPS specialists as female urologists or urogynecologists.
• Primary Care Practitioners are doctors who can diagnose and treat common health concerns. If a primary care provider is experienced with OAB, they will tell you your options. Or, they may refer you to a specialist, especially if lifestyle changes haven’t helped.
• Internists are general doctors who may or may not be primary care providers. They will often refer you to a specialist.
• Nurse Practitioners (NP) are highly trained nurses, able to treat many medical problems. Some NPs specialize in issues like OAB, or they will refer you to a specialist.
• Physician Assistants (PA) are professionals licensed to practice medicine with a doctor’s oversight. NPs and PAs are often part of the health care team. Many can diagnose and treat non-surgically and can help with exercises and lifestyle changes. Some specialize in issues such as OAB.
• Geriatricians are doctors who treat older patients, and many are able to evaluate and treat OAB. But, not all treat OAB.
• Physical Therapists are licensed health professionals who provide physical therapy. If they have special training in pelvic floor disorders, they can help with exercises and lifestyle changes for OAB.

Typically, specialists who treat OAB and incontinence include urologists and Urogynecology and Reconstructive Pelvic Surgery specialists. It helps to ask if your health care provider has direct training or experience with OAB.

Tips for Healthcare Visits

It’s normal to feel uncomfortable when talking about OAB symptoms. Who wants to talk about bathroom problems or incontinence? Still, knowing more about OAB is the best way to take control of the problem. A little planning will give you confidence. Here are some tips to help:

• Be prepared. Before your appointment, help your health care team learn what’s going on by gathering some information. Also, be ready to take notes about what you learn. It is helpful to bring:
  • A list of the prescription drugs, over-the-counter medicines, vitamins and herbs you take.
  • A list of your past and current illnesses or injuries.
  • Results from the Overactive Bladder Assessment Tool, to help you discuss your symptoms.
  • A way to take notes about treatments.
• Bring a friend. Ask a close friend or relative to go with you to the doctor. An “appointment buddy” can help remind you of things you may forget to ask, or remind you of things the health care provider said.
• Bring up the topic. If your health care provider doesn’t ask about your OAB symptoms, then bring up the topic yourself. It may not be wise to wait until the end of your visit, so you can be sure you have time for questions.
• Speak freely. Share everything you’re experiencing. Your health care team has heard it all! It’s okay to tell them about your symptoms and how they impact your daily life.
• Ask questions. A visit to your health care team is the right time to ask questions. It is best to bring your list of questions with you so you don’t forget them.
• Ask for a referral: If your symptoms are not getting better with your current treatment, ask for a referral to see a specialist who treats OAB.

Talking with Your Health Care Team

Questions to Ask your Health Care Team

• Are my symptoms from OAB or from something else?
• What tests will I need to find out if I have OAB?
• What could have caused my OAB?
• Can I do anything to prevent OAB symptoms?

Questions to Ask about Treatment

• What would happen if I don’t treat my OAB?
• What lifestyle changes should I make?
• Are there any exercises I can do to help?
• Do I need to see a physical therapist?
• What treatment could help my OAB?
• How soon after treatment will I feel better?
• What are the good and bad things that I should know about these treatments?
• What problems should I call you about after I start treatment?
• What happens if the first treatment doesn’t help?
• Will I need treatment for the rest of my life?
• Can my OAB be managed?
• What are my next steps?

Questions to Ask Yourself about Symptoms

• Do my symptoms make me stop doing the things I enjoy, or prevent me from going to events?
• Am I afraid to be too far from a bathroom?
• Have my symptoms changed my relationships with friends or family?
• Do my symptoms make it hard to get a good night’s sleep?
• What are my treatment goals?

Updated November 2024.