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7 ways to manage an overactive bladder and stop worrying about surprise leaks

A woman sitting on a toilet holds the last sheet of toilet paper on a roll.
An overactive bladder is treatable through lifestyle changes like avoiding alcohol and caffeine or retraining your bladder.
  • Overactive bladder is most common in adults over 65 but can also be due to hormonal changes.
  • Maintaining a healthy weight, eating right, and staying hydrated can help control surprise leaks.
  • If lifestyle changes don't work, talk to your doctor about medications or nerve stimulation.
  • Visit Insider's Health Reference library for more advice.

Overactive bladder is a condition in which the bladder walls contract frequently and at the wrong time. 

This causes symptoms such as a sudden and uncontrollable urge to urinate, leaking urine, and nocturia — when you wake up in the night needing to pee.

One in 11 people in the US has an overactive bladder. The condition is more common in adults age 65 and older, and slightly more common in women than men

Other common risk factors include hormone changes, weak pelvic muscles, urinary tract infections, neurological disorders, and diseases like multiple sclerosis that affect the brain or spinal cord, according to Leann Poston, MD, medical advisor for Impakt Fitness.

Fortunately, an overactive bladder is treatable. Below, doctors share the best ways to manage, treat, and prevent this condition.

1. Maintain a healthy weight

Increased weight — especially around the abdomen — puts stress on the bladder and pelvic floor, which can increase the tendency to leak urine, says Poston.

So one way to help mitigate an overactive bladder is to stay at a healthy weight — which means maintaining a body mass index (BMI) between 18.5 to 24.9.

What the research says:

  • A 2019 study found that being obese was associated with overactive bladder in women, and with urgency-related incontinence in both men and women. 
  • Meanwhile, a 2020 study found overweight young women with a higher body fat percentage were 95% more likely to have an overactive bladder than those with a lower body fat percentage.

2. Try bladder retraining

Bladder retraining involves setting and sticking to a fixed schedule for peeing. By training your bladder to hold more urine, Poston says you'll be able to go longer periods of time between urinating and avoid leakage.

Start by tracking when and how much fluid you drink and when/how often you urinate for a few weeks, says Poston. 

Once you've identified your habits, she advises working with your doctor to devise a daily schedule for when to urinate. It's important to always empty your bladder at those designated times, even if you don't feel the urge or your bladder isn't full. 

Conversely, if you feel the urge to urinate before a scheduled time, Poston says you can use pelvic floor exercises to help decrease the involuntary contractions that stimulate the bladder. 

It usually takes about two to three months of bladder retraining to see a difference in your symptoms, says Poston.

3. Eat right

Foods that may exacerbate symptoms of an overactive bladder include:

  • Foods with artificial sweeteners, such as aspartame and acesulfame K
  • Acidic fruits, such as citrus and tomatoes
  • Spicy foods

Acidic and spicy foods can irritate the bladder's lining, while artificial sweeteners can increase the need to urinate, according to Poston.

"Eliminating these foods from your diet and then adding them back one at a time can help you identify which ones may trigger your symptoms," says Poston.

4. Avoid certain drinks

Drinks you should avoid with an overactive bladder include:

  • Alcohol, which can affect your hormone levels, thus triggering certain urinary symptoms.
  • Caffeinated drinks like coffee and tea: Caffeine is a diuretic, meaning it can increase both the urge to urinate and the frequency of urination. For example, a large 2013 study found coffee and caffeine intake were associated with increased lower urinary tract symptoms and overall urinary urgency in men. And increases in coffee consumption were associated with worsened urgency symptoms in women. 
  • Acidic drinks like coffee, orange juice, and grapefruit juice: The acidity in these drinks may irritate the bladder lining.
  • Drinks with artificial sweeteners, such as aspartame and acesulfame K for the same reasons outlined above, that they increase your urge to pee.
  • Carbonated drinks such as soda, diet soda, and seltzer: In a 2013 study, women who consumed soda or increased their soda intake, especially caffeinated diet soda, were more likely to report urinary tract symptoms. Poston says that diet soda, in particular, may be the worst beverage choice of all, as it contains all four known bladder irritants: carbonation, citric and other acids, caffeine, and artificial sweeteners.

Of the listed drinks above, the two main culprits are alcohol and caffeine. Therefore, one of the best ways to manage your overactive bladder symptoms is to lower your alcohol intake and cut back on caffeine

Alternatively, water is the best beverage you can drink for your bladder, says Poston, but there are other more flavorful alternatives as well — such as juices made from low-acid fruits like pear, watermelon, and papaya. 

You can also try non-citrus herbal teas, which are less likely to irritate the bladder than other kinds of tea.

5. Manage constipation

When you're constipated, your colon is full of stool — and that extra weight can put pressure on your bladder, thus worsening symptoms of an overactive bladder, says Linda Peitzman, primary care lead at K Health

A 2018 study found that constipation is associated with an overactive bladder in women, especially in the younger population, and that this association led participants to report lower quality of life.

Peitzman recommends increasing your fiber intake to about 30 grams per day, as dietary fiber has been shown to help alleviate constipation

Additionally, drinking plenty of fluids can help keep your stool soft, making it easier to pass — and exercise can strengthen the muscles that help to support regular bowel movements.

6. Talk to your doctor about medication

If you have tried the aforementioned lifestyle modifications, and continue to have significant symptoms, Peitzman recommends asking your doctor about medication.

According to Poston, anticholinergics (such as ​​Oxybutynin and Tolterodine) are one of the most common types of medications used to treat an overactive bladder. 

These medications reduce the tone or twitchiness of the smooth muscle that lines the bladder, thereby increasing its capacity and reducing the urge to urinate. However, it's important to note that anticholinergics may cause dry mouth, as well as constipation, which can then trigger bladder symptoms.

The drop in estrogen that occurs after menopause can contribute to an overactive bladder — but topical estrogen creams, which don't typically have any side effects — may be effective for relieving symptoms, says Peitzman. 

If your symptoms haven't responded to other medications, your doctor might recommend getting Botox injections into your bladder once or twice a year. Botox helps the bladder muscles to relax, thus reducing urgency and incontinence, says Poston.

7. Consider nerve stimulation

A newer treatment, which has emerged in the last 20 years, for an overactive bladder is percutaneous tibial nerve stimulation (PTNS). 

This treatment involves inserting a small needle electrode near your tibial nerve, which runs along the length of your back legs. The needle then sends vibrations to the sacral nerve, which controls bladder function. 

Most people receive about weekly 30-minute treatments and will see results after two to 12 sessions. Risks include mild pain, and bruising or bleeding at the insertion site. 

Research so far indicated that about 60% to 80% of patients experience an improvement in symptoms after PTNS.

Prevention

Some risk factors that contribute to an overactive bladder are unavoidable. For example, you're at a higher risk of developing this condition as you age. 

However, there are steps you can take to reduce other risks that trigger this condition — such as being overweight, having weak pelvic floor muscles, consuming a diet high in bladder irritants, and being a smoker, says Poston.

To help delay or prevent the onset of an overactive bladder, Poston says to try the following:

It's a common misconception that you should drink less water to avoid the urgent need to urinate. Peitzman notes that concentrated urine — which results from dehydration — can irritate the bladder and increase the likelihood of bladder infections, which will actually make you feel the need to pee more often, not less.

While she says 64 ounces is generally a good guideline to follow, Peitzman recommends talking with your doctor about your hydration needs. 

She also advises drinking smaller amounts of fluid more frequently throughout the day, which may help to mitigate symptoms of an overactive bladder.

Insider's takeaway

An overactive bladder is a very treatable condition. Experts agree that you should exhaust all options when it comes to lifestyle changes before considering medications, which can come with side effects. 

However, if you aren't seeing results from maintaining a healthy weight, modifying your diet, retraining your bladder, and doing pelvic floor exercises, consult with your doctor about whether or not medication may be right for you.

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7 ways to manage an overactive bladder and stop worrying about surprise leaks
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