Before medications, your doctor might suggest *these* changes first.
Overactive bladder (OAB) affects an estimated 33 million Americans, and fewer than half of those individuals seek help for their symptoms—despite the frustrating impact it can have on their quality of life. That’s because many people believe the urgency and frequency of their urination is simply a part of growing older.
However, OAB is a real medical condition with many treatment options. In fact, the sooner you begin treatment for OAB, the more likely you’ll find treatment options effective.
Lifestyle Treatments for OAB
“A substantive portion of treatment for overactive bladder is lifestyle modification. You need to start there,” says Lauri Romanzi, MD, urogynecologist in New York City. “We like to avoid the more severe therapies if we can.”
After diagnosis, the first step is education of how your lifestyle can influence your OAB symptoms. Your doctor may go over a few key parts of managing OAB, such as:
Diet: “Some of the foods that are more irritating to patients with overactive bladder are coffee, tea, [and] sodas that have a lot of caffeine in them, [and] chocolate,” says Dr. Romanzi. Here are more foods that may cause bladder irritation.
Bladder training: Like all muscles, the muscles that control urination can be trained. Bladder training starts by gradually increasing the amount of time between bathroom visits. Learn more about bladder training for OAB here.
Kegels: The pelvic floor muscles help control the contractions of the bladder muscle to start and stop urination. Strengthening this muscle helps restore muscle function to reduce incontinence. Find out the right way to do kegels here.
Hydration: You want to avoid both over-hydrating and under-hydrating. Learn more about the right amount of water to drink with OAB here.
Bladder diary: This is a space to log the amount of liquid you drink, when you’re using the bathroom, and when you experience leaks. It can also help schedule bathroom visits during bladder training.
Pelvic floor physical therapy: This type of therapy is done with a trained pelvic physical therapist, and can treat a number of issues affecting the pelvic floor, including incontinence.
Medications for OAB
“If they’ve engaged the behavior modifications to the best extent possible, and they’re still having significant problems that are causing big quality of life difficulties, it might be time to consider medications,” says Dr. Romanzi.
There are three main categories for OAB medications:
Antidepressants are one of the oldest treatments for OAB. They work by calming the smooth bladder muscle.
Anticholinergics help by blocking signals to the brain that trigger an abnormal bladder response.
Beta-agonists also help relax the smooth bladder muscle. They do this by reducing the sensitivity of receptors in the bladder to various irritants.
If severe overactive bladder doesn’t respond to medications, there are surgical options that may help. Here are the surgeries that treat overactive bladder.
Treatment for OAB may involve a variety of techniques and medications, but the final ingredient is persistence. “Keeping their hope up and keeping them involved in the challenge of finding what’s gonna work for them can be a big key to successful therapy,” says Dr. Romanzi.
Dr. Romanzi is a urogynecologist and reconstructive pelvic surgeon based in New York City.
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A substantive portion of treatment for
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overactive bladder is
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If they're dehydrated or over-hydrating,
you need to start there.
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The treatment for overactive bladder
starts with an evaluation method.
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You can begin to learn what
the dietary triggers are.
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Some of the foods and drinks that are more
irritating to patients with overactive
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bladder are coffee, tea, sodas that have
a lot of caffeine in them, chocolate.
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Very often the patient has a mix
of therapies that they're using.
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Pelvic floor physical therapy
is often very helpful.
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Physical therapists also are well trained
in behavior modifications that can help.
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We like to avoid the more
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if we can, when we're helping
a patient with bladder problems.
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If they've engaged the behavior
modifications to the best extent possible
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and they're still having significant
problems that are causing
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big quality of life difficulties,
it might be time to consider medications.
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There are three categories of
medications that can be used to
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treat overactive bladder.
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Historically, the oldest
are the antidepressive medications.
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Certain ones of the older antidepressants
can significantly improve
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overactive bladder symptoms.
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The second are called
the anticholinergic group and
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these are far more common.
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The third is a new category and
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there's only one medication
in that category right now.
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But they reduce the bladder
hypersensitivity directly at the level
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of the bladder receptor and the smooth
muscle reaction to bladder irritation.
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Medications and surgeries and
things that are more commonly under
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the purview of a doctor,
are often, but not always,
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part of the mix of the treatments
that will work for any given patient.
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Keeping their hope up and keeping them
involved in the challenge of finding
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what's gonna work for them,
can be a big key to successful therapy.
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Bladder diary. Urology Care Foundation. (Accessed on May 6, 2019 at https://www.urologyhealth.org/educational-materials/bladder-diary.)
Bladder retraining. National Association for Continence. (Accessed on May 6, 2019 at https://www.nafc.org/bladder-retraining.)
Pelvic physical therapy: another potential treatment option. Cambridge, MA: Harvard Health Publishing, 2018. (Accessed on May 6, 2019 at https://www.health.harvard.edu/womens-health/pelvic-physical-therapy-another-potential-treatment-option.)
What are kegel exercises? National Association for Continence. (Accessed on May 6, 2019 at https://www.nafc.org/kegel.)
What is overactive bladder (OAB)? National Association for Continence. (Accessed on May 6, 2019 at https://www.nafc.org/overactive-bladder.)