10 Common Overactive Bladder Questions

We understand that finding support can feel challenging and isolating, that’s why the Uqora Community is here for you. We asked Dr. Carrie Aisen, a San Diego-based Urologist, to share the answers to 10 common questions she gets from her patients.

1. How can I tell if I have a UTI vs overactive bladder?

Urinary tract infections are when you have acute onset of burning with urination, urgency, frequency and possibly blood. It is not subtle and is very different from your usual urinary symptoms. Overactive bladder is more likely if you are having consistent urgency and frequency, or urgency and frequency that comes and goes. 

2. What causes overactive bladder?

There are two types of overactive bladder - idiopathic and neurogenic. Neurogenic is when there is a neurologic diagnosis that is impacting the bladder. This can be seen with any disease impacting the brain or spinal cord such as after a stroke, a spinal cord injury, or multiple sclerosis. Idiopathic means we do not know exactly what causes it. We do know the frequency of overactive bladder increases with age, but this does not mean that it has to be a normal part of aging as there are many treatment options. 

3. I feel like I go to the bathroom frequently. How can I tell if this is normal or if I have an overactive bladder?

Overactive bladder is urinary urgency, often with frequency and waking up at night to urinate. You may also have urinary incontinence - leakage where you get an urge to urinate and it leaks out before you can get to the bathroom. Typically we consider the normal frequency of urination to be every 3 or 4 hours during the day, so if you are going more frequently than this you may have an overactive bladder. 

4. I don’t have any symptoms during the day but I wake up frequently to use the bathroom. Is this overactive bladder?

If you have isolated frequency at night but not during the day, it is unlikely you have an overactive bladder. Typically patients with overactive bladder have daytime and nighttime frequency and urgency. If you have isolated nocturnal symptoms then it is likely related to how much urine your body is making at night. Things that can impact how much urine you make at night include: how much water you drink during the evening and overnight, if you have leg swelling, and if you have obstructive sleep apnea. 

The first step I recommend to my patients with isolated nighttime urinary frequency is to avoid eating or drinking for 2 hours before bed and overnight. Additionally, if they have lower leg swelling I recommend elevating their legs for an hour or two before bed and considering wearing compression stockings during the day. 

People typically think of snoring as the main symptom to screen for obstructive sleep apnea but studies show that nighttime urinary frequency is also a very accurate way to screen for OSA. There are several proposed mechanisms for how obstructive sleep apnea causes nocturia including strain on the heart and increase in hormones that cause an increase in the volume of urine that is produced. I recommend my patients with nocturnal urinary frequency have a sleep study, and if they are diagnosed with OSA then encourage them to use their CPAP. For many of my patients this one treatment can completely eliminate their nocturnal urinary frequency. 

5. I urinate very frequently but I like drinking a lot of water. Could this be causing my symptoms?

It is important to pay attention to how much water you are drinking. I recommend drinking 64 oz of water per day. Sometimes you need to drink more, for example if you have a history of recurrent UTIs or kidney stones, but if you are drinking a high volume of water then it is normal to go more frequently. I will often have patients coming in complaining of frequency and they have been drinking a gallon of water per day. A normal bladder holds between 350-400 mL of urine at a time. If you are drinking a gallon of water then it is normal for you to go to the bathroom about 10 times per day which is more than every 2 hours during the day.

6. Does diet impact my overactive bladder?

In the same way diet can affect [gut and vaginal health], what What you eat and drink can vastly impact your overactive bladder. Avoiding bladder irritants can help. This can include coffee, caffeine, fake sweeteners, alcohol, spicy or acidic food, and sparkling water. Different people find different triggers for their bladder symptoms, so best for you to keep track of what you eat and drink and when you find your triggers, avoid them. 

7. Are there things I can do to manage my overactive bladder besides medications or procedures? 

Yes! There are lots of behavioral changes that you can make to help control your overactive bladder. Bladder training can be very successful in treating overactive bladder. This is where you slowly teach your bladder to hold more urine over time. When you get the urge to urinate, you can contract your pelvic floor muscles a few times until the urge passes. Overtime you can use this to try to decrease your urinary frequency closer to 3 hours. 

Additionally, pelvic floor physical therapy can be helpful for patients with a wide range of urinary symptoms. This is a physical therapist who specializes in treating the pelvic floor. They will complete a full exam of your pelvic floor muscles. This includes an internal exam, as well as assessing your hips, legs, back, and core. Then they create a regimen tailored to you to help address your symptoms. They will give you homework and exercises to practice each day. While it is a time investment, if you really put in the effort it can be very helpful.

8. Is stress a trigger for overactive bladder?

Yes, stress and anxiety are triggers for overactive bladder. You may notice that your symptoms get worse surrounding big life events, increased work or school pressures or general anxiety. I recommend meditation to most of my patients that I am treating for overactive bladder, regardless of what other treatments we are doing. Talk therapy and anxiety medications can also help with bladder symptoms if you notice that stress and anxiety is your overactive bladder trigger. 

9. Can menopause cause overactive bladder?

Yes, genitourinary syndrome of menopause can present with urgency, frequency, and urge incontinence. Treating genitourinary syndrome of menopause with vaginal estrogen treatment can effectively treat these overactive bladder symptoms. 

10. Is overactive bladder a sign of something dangerous? Do I have to treat it?

Overactive bladder is typically not something that is dangerous. One of the treatment options is the decision not to do anything. That being said, if you have urinary symptoms it is always a good idea to see your doctor or see a urologist to see if any additional work up is needed to rule out other diagnoses. 

Note: This guide is not intended to replace medical advice. If you experience any symptoms, it is recommended to reach out to your physician for treatment.