Overactive Bladder

Some of the drug commercials on television make having an overactive bladder seem almost comical. But if you’re one of the 33 million Americans with overactive bladder symptoms, you know there is nothing funny about it.

If you are bothered by your bladder symptoms, you may constantly worry about where the bathrooms are and avoid doing the activities you enjoy. You may feel trapped at home — unwilling to face the very real possibility of having an accident in a public place.

The pelvic floor specialists at Virginia Mason have helped thousands of people manage their overactive bladder symptoms. And we can help you, too. There’s no need to be shy or embarrassed — this is what we talk about every day, and our patients are soon comfortable with the topic as well.

Causes and Symptoms of Overactive Bladder
Lifestyle Changes Can Help
Non-invasive Treatments for Overactive Bladder
Surgery for Overactive Bladder

At Virginia Mason, we take the time to listen carefully and to discuss your treatment goals. Our comprehensive evaluation includes a complete medical history and a physical examination, and may include specialized tests in our urodynamics lab or cystoscopy.

Causes and Symptoms of Overactive Bladder

Overactive bladder is a condition that brings on sudden, urgent needs to urinate. You may urinate frequently, day and night. You may also have urge incontinence because leakage often occurs when someone cannot get to the bathroom in time.

The cause of overactive bladder is connected to the nerves that signal a full bladder. If these nerves become overly-sensitive for some reason, they communicate the urge to urinate way too often.

Symptoms include:

  • The need to urinate more than eight times a day — and as often as 40 times per day in some people
  • The need to get up to urinate often during the night
  • Leaking of urine, often on the way to the bathroom

Overactive bladder can be a symptom of many underlying problems, including:

  • An irritated bladder, often caused by tobacco, caffeine, chocolate and spicy or acidic foods
  • Diabetes, multiple sclerosis, or Parkinson’s disease
  • Stroke
  • Spinal cord damage
  • An enlarged or obstructed prostate gland

Overactive bladder is different from stress incontinence. It does not cause leaking when coughing, sneezing or laughing.

Lifestyle Changes Can Help

Many lifestyle changes have been successful in helping people with overactive bladder symptoms.

Limiting fluids:

  • Limit your fluids intake to 4–6 (8-ounce) glasses of fluid a day
  • Stop drinking fluids completely after dinner

Avoiding bladder-irritating substances, such as:

  • Tobacco products of all types
  • Tea and coffee — including decaf coffee, which has some caffeine
  • Carbonated drinks
  • Alcohol of all types
  • Spicy foods
  • Chocolate
  • Acidic fruits including oranges, grapefruit, pineapple and cranberry juices

Losing weight: If you are overweight, losing even a few pounds may reduce excess pressure on the bladder. 

Retraining your bladder: Bladder retraining techniques can also help with overactive bladder. At Virginia Mason, we may recommend a six-week bladder-retraining program that includes tracking frequency of urination and making key behavior changes.

Vaginal estrogen: Because the bladder lies next to the vagina, it can also be affected by hormonal changes. Vaginal estrogen comes in various forms – including creams, suppositories and rings – and can help decrease bladder sensitivity.

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Non-invasive Treatments for Overactive Bladder

If lifestyle changes and retraining your bladder do not relieve overactive bladder, medical and minimally invasive treatments are available.


Various medications work by relaxing the bladder muscles to reduce urgency, frequency, and incontinence associated with urgency. Examples include oxybutynin and registered drugs such as Ditropan, Vesicare, Enablex, Detrol, Toviaz, Oxytrol, Gelnique, Sanctura and Myrbetriq. Using a combination of medications and lifestyle changes can be effective.

The most common side effects include dry eyes, dry mouth and constipation. Increasing your intake of fiber can help the constipation, and frequent sips of water can ease dry mouth. As with any prescription, read the label carefully.


Minimally invasive treatments that focus on changing the nerve signals that lead to bladder spasms include:

Percutaneous tibial nerve stimulation (Urgent PC® neuromodulation): 

During this procedure, a stimulator is used to deliver an electrical impulse to the nerves of your bladder via a small needle placed near your ankle.

It is done in a clinic exam room, and involves weekly office visits for the first three months, followed by monthly visits to maintain improvement.

Sacral neuromodulation (InterStim®):
This outpatient procedure has two stages: In the first stage a small pacemaker wire is placed near the nerves that go to your bladder to help improve urgency, frequency, urgency incontinence, urinary retention and fecal incontinence. 

If your symptoms improve by 50 percent or more during the first phase, then the second stage involves placement of a small battery under your skin in the upper buttock area.

Botulinum toxin injections (Botox®):

Botox® can be injected into your bladder muscle at several sites to decrease bladder spasms and improve your urgency symptoms. It is done in the clinic through cystoscopy, a thin telescope inserted into the bladder attached to a camera. It lasts three to 12 months and can be repeated.

Surgery for Overactive Bladder

When no other therapies or treatments work, surgeries are available to alleviate overactive bladder.

Bladder augmentation is a surgical treatment to increase the storage capacity of the bladder.

Urinary diversion is major reconstructive surgery to divert urine away from your bladder. Several options are available including conduit urinary diversion, Indiana pouch continent catheterizable stoma, and neobladder formation.

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