Five things you can do right now to treat an overactive bladder
If you often experience a sudden urge to pass urine, or have to pass small amounts of urine more often than normal, it may be a sign that you have an overactive bladder.
An overactive bladder may also be known as an irritable bladder or detrusor instability (named after the detrusor muscle in the bladder wall). The rapid contraction of this muscle results in a sudden need to pass urine, and for some women can result in a leakage of urine. This is known as urge incontinence.
What causes overactive bladder?
An overactive bladder is when when your bladder suddenly squeezes when it is not full, and when you do not have control over when this happens. Often, no specific cause can be found for overactive bladder, but there are a number of things we can do to help it.
Women may also suffer from similar symptoms of urgency if they have a urine infection, so it is important to see your doctor if this is a new problem, if your urine has a strong smell, if you’re passing any blood, or if it is uncomfortable to pass urine.
An overactive bladder is different to stress incontinence, which can cause leakage of urine when you jump, cough, or sneeze, for example.
Symptoms of overactive bladder can include a sudden and urgent need to pass urine (urgency). This means you are unable to delay going to the toilet and need to go more often than other people (more than seven times a day). You may need to get up to go to the toilet at night more than once, and you may experience urge incontinence.1
Fortunately, there are many things you can do to improve the symptoms of overactive bladder. Five easy lifestyle changes you can make to try to reduce your symptoms are detailed below.
1. Reduce your caffeine and alcohol intake
Caffeine is present in several drinks and foods including tea, coffee, energy drinks, cola, and even chocolate. Not only does caffeine result in urine being made more quickly (it acts as a diuretic, so works on the kidneys causing more water to pass into the urine than would otherwise), it is also thought to be an irritant to the bladder (detrusor) muscle. This can make sensations of urgency worse. It is worth trying the reduction or removal of caffeine from your diet for a few weeks to see if this helps.
In a similar way to caffeine, when drinking alcohol you tend to produce urine more quickly as it is a mild diuretic, and alcohol may act to irritate (stimulate) the detrusor muscle. Try cutting it out to help improve your irritable bladder.
2. Drink normal amounts of water
If you are taking very frequent trips to the toilet, you may try reducing the amount you drink to try to decrease the amount you need to go. However, it appears that passing small amounts of more concentrated urine may actually make the problem worse. Anything that makes urine more acidic can act as a bladder irritant, and concentrated urine is a fraction more acidic. For this reason, concentrated urine is thought to cause irritation to the bladder, making sensations of urgency more marked. Instead, aim for a healthy two litres of fluids a day to keep the urine more diluted.
3. Go to the toilet only when you need to
This may sound obvious, but if you are worried about being caught out, you may find yourself visiting the toilet more often, or “just in case”. Unfortunately, over time, this can make the problem worse because your bladder will get used to holding smaller and smaller quantities of urine. Then, if you go out and need to hold your urine a little longer, you are more likely to hit a problem. The best alternative is to make sure you are aware of where the toilets are, so when you are out and about you can make a quick exit if needed.
For many people with an overactive bladder (or other conditions that mean they need to use the toilet urgently), going out and about can pose a problem. The Bladder and Bowel Community issue a universally recognised Just Can’t Wait card. Many women find this helpful as it helps to explain potentially difficult situations and help them reach the toilet that little bit sooner.
4. If you are overweight, losing weight can often be helpful
This can be hard to do, but if you are overweight and you are able to lose weight (aim at losing 5 to 10% of your body weight), this can make a real difference. Obesity is a risk factor for all types of incontinence including urge incontinence and irritable bladder. The exact cause for this is unclear but it is thought that excess body weight increases abdominal pressure. This in turn increases bladder pressure and mobility of the urethra, which can cause both stress incontinence and an irritable bladder. Losing weight is thought to help reduce the pressure.
5. Bladder training
This is something you can work on in the comfort of your own home, but if can be helpful to have guidance from your doctor, or a continence nurse. The aim of bladder training is to gradually increase the amount of urine you can hold on to over time by slowly decreasing how often you go to the toilet.
The first step of bladder training is to keep a diary for a few days to see how often you are going to the toilet. When you go, write down where you go, whether it was urgent, whether there were any leaks, and the amount of urine passed. There are lots of template charts you can print off to help you fill the information in. Some people try measuring the amount of urine they pass in an old measuring jug.
Once you find out how often you are going, for example every hour, the aim is then to slowly increase the time between toilet visits. To start with you may find you can only manage to increase the time by a couple of minutes, but over time you will see the times increasing and the feelings of urgency improving.
When do you need to visit your GP?
Unless your symptoms are mild and not new, it is a good idea to be seen by your GP to ensure that you have the correct diagnosis. It is important to seek help if you are concerned, or if things are not improving. Symptoms that may suggest a different problem include seeing traces of blood in your urine, developing faecal incontinence, or passing frequent large volumes of urine, the latter of which can sometimes be a sign of diabetes.2
Sometimes you may be unsure if you have overactive bladder or stress incontinence (leakage when you cough, sneeze, or run). In reality, many women may have a mixture of the two — this is something that your GP can talk through with you. If you have a mixture of the two, the above measures are still useful, but you may also benefit a lot from pelvic floor exercises and some other approaches to improve the stress incontinence side as well.
Over the counter or herbal remedies are generally not recommended to treat an overactive bladder.
Other treatments for an overactive bladder
If bladder training is not as effective as you would like, there are a number of other options that can be tried. Usually, the next option is to trial some medication. Examples include oxybutynin and tolterodine; these medications are known as antimuscarinics and work by blocking certain nerve impulses to the bladder causing the detrusor muscle to relax. Although often effective, these medications can cause a number of side effects such as a dry mouth or constipation.
If medication is not helpful, there are still a number of options available to try, including botox treatments to the bladder wall, nerve stimulation, or occasionally surgery. Most women, however, find that they may have a significant improvement from bladder training, so it is definitely worth trying this first.
- NICE, ‘Urinary incontinence in women: management’, NICE Clinical Guideline CG171, [website], 2013, https://www.nice.org.uk/guidance/CG171, (accessed 26 March 2018).
- L. Wood and J. Anger, ‘Urinary incontinence in women’, (State of the Art Review), British Medical Journal, 2014, 349:g4531.