Overactive bladder can have a major impact on just about every aspect of your life. It can force you to avoid vacations, dinners out, and other social situations. You can even miss out on valuable time with family and friends because you're afraid your overactive bladder -- also called OAB -- will trigger at the wrong time and embarrass you.
Fortunately, there are ways to combat the problem. Overactive bladder treatment has many approaches, from medication, to behavioral changes, to 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.
Natural Treatment for Overactive Bladder
Bladder training and pelvic floor exercises are just two natural treatments for overactive bladder. Research suggests that these nondrug remedies can be very effective for many women, and they have almost no side effects.
- Bladder training. This is the most common OAB treatment that doesn’t involve medication. Bladder training helps change the way you use the bathroom. Instead of going whenever you feel the urge, you urinate at set times of the day, called scheduled voiding. You learn to control the urge to go by waiting -- for a few minutes at first, then gradually increasing to an hour or more between bathroom visits. It’s easier if you do it while sitting down. Sit still, and squeeze your pelvic floor muscles several times in a row. When the urge to pee passes, walk slowly to the bathroom. Be patient. It may take up to 8 weeks to see results.
- Pelvic floor exercises. Just as you exercise to strengthen your arms, abs, and other parts of your body, you can exercise to strengthen the muscles that control urination. During these pelvic floor exercises, called Kegels, you tighten, hold, and then relax the muscles that you use to start and stop the flow of urination. Using a special form of training called biofeedback can help you find the right muscles to squeeze. Start with just a few Kegel exercises at a time, and gradually work your way up to three sets of 10. You’ll have to do them a few times a day for 6 to 8 weeks before you see a change in your OAB symptoms.
Another way to strengthen pelvic floor muscles is electrical stimulation, which sends a small electrical pulse to the area via electrodes placed in the vagina or rectum.
Until you get your overactive bladder under control, wearing absorbent pads can help hide any leakage.
Other lifestyle tips for preventing incontinence include:
- Avoid drinking caffeine, tea, sodas, alcohol, juices, or a lot of fluids before activities. That also goes for fruits like oranges and grapefruit, and spicy foods.
- Don’t drink fluids right before you go to bed. Ask your doctor if you should limit how much you drink at other times of the day.
- Keep your weight down. Exercise and weight loss can improve urinary incontinence and OAB symptoms. They can ease the stress on your bladder and lead to fewer accidents.
- Double void. This means you pee, wait a few minutes, and then go again. It’ll help make sure your bladder’s empty. That way, you can avoid a quick trip back to the bathroom.
- Set a schedule. If you can, try to space out your bathroom visits. Aim for every 2 to 4 hours. This way, you train yourself to pee at the same times every day.
- Stop smoking. Cigarette smoke irritates your bladder. It can also cause a hacking cough, which could trigger leaks.
Drugs for Overactive Bladder
In people with overactive bladder, muscles in the bladder wall contract at the wrong time. 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 also can cause constipation, blurred vision, and increased heartbeat.
Anticholinergic medications are widely used in the treatment of overactive bladder (OAB), as well as for short-term treatment of bladder symptoms following a variety of urologic surgeries. Mounting evidence points to an association between anticholinergic medications and the increased risk of incident dementia.
Chronic use (3 months or longer) of OAB anticholinergic medications is likely associated with an increased risk of new-onset dementia.
Short-term (less than 4 weeks) use of most OAB anticholinergic medications is likely safe in most individuals. Clinicians should consider potential cognitive risks in all patient 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.
The drugs mirabegron (Myrbetriq) and vibegron (Gemtesa) 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.
Botox (Onabotulinumtoxin A), more commonly known for removing wrinkles, can be injected into the bladder muscle, causing it to relax. This can increase capacity in 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. However, there isn’t strong evidence to show that estrogen is an effective treatment for OAB. 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. They 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 had favorable findings in preliminary research of patients with spinal cord injury.
Other Treatments to Try
In rare cases when all OAB treatment fails and the overactive bladder is severe, doctors may recommend one of several types of surgery.
Augmentation cystoplasty. A procedure called bladder augmentation uses part of the bowel to increase bladder capacity. Or, urinary diversion, an alternate route for bladder drainage for severe, complicated OAB patients. These procedures are considered last-resort treatments and are not commonly performed.
Sacral nerve stimulation. Another procedure 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 with 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. With a little time, patience, and the right treatment, you can regain control -- and peace of mind. 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.