Middle-aged women and men over age 60 suffer most from overactive bladder (OAB) -- but anyone, at any age, can develop this sudden urge to urinate, also known as urge incontinence. While there are many strategies for leading a normal life with overactive bladder, the condition can often be dramatically improved in painless, nonsurgical ways, without drugs.
Unfortunately, sufferers often mistakenly assume they're stuck living with overactive bladder symptoms, according to the National Association for Continence. In a 2011 Harris Poll, women 46 to 64 ranked a weak bladder as one of the most embarrassing issues to bring up with a doctor, so they don't. Yet an accurate evaluation and diagnosis is the best first step to solving the problem.
Here are five solutions doctors often recommend for OAB:
Overactive bladder fix #1: Physical therapy
"Strengthening the pelvic muscles is the key to bladder health," says ob-gyn Jill Rabin, coauthor of Mind Over Bladder, or I Never Met a Bathroom I Didn't Like and chief of ambulatory care and urogynecology at the Albert Einstein College of Medicine in Hyde Park, New York.
A simple exercise you can do at home: Locate the muscles involved in urination by consciously stopping the flow midstream. Later (when you're not urinating), contract these same muscles for a count of five, then release for a count of ten. Repeat five times in a row. (That's one set.) Work up to doing between five and ten sets a day.
Both men and women can do these basic pelvic floor muscle exercises (or PFMEs, which you may know as Kegels, after the doctor who popularized them). "It's very similar to the muscles you build up in your arms," Rabin says. And as with other kinds of workouts, it can take up to six weeks of dedicated practice to see results.
If you feel you need help locating the right muscles, or want to be sure you're doing PFMEs properly, ask your doctor (especially a specialist like a gynecologist or urologist) to refer you to a physical therapist who specializes in these moves. "If you're not motivated to stick with it, work with a physical therapist," Rabin says.
Retraining and weight lifting
Overactive bladder fix #2: Bladder retraining
"A lot of bladder control issues start in the brain," ob-gyn Jill Rabin says. By adjusting your mental associations with bathroom visits, you can help extend the length of time you can last between them.
If, say, you feel the need to urinate every 20 minutes, work on extending that amount of time by small increments -- just five minutes a week. Instead of giving in automatically to the overwhelming urge, try to sit quietly for a few minutes. Focus on deep breathing or distract yourself in another way (listening to one more song on the radio, doing a series of pelvic floor muscle exercises). Know that the need to urinate is felt in waves, so an initial urge that's resisted tends to subside a bit.
Don't be discouraged by occasional breakthrough leaks. "Through timed voiding, you can gradually stretch the interval from every 20 minutes to every 2 hours," Rabin says.
Some people find it useful to set a timer to help extend the intervals between bathroom breaks. Urinating on a timed schedule -- whether you feel the need or not -- is another way to introduce a structure of less-frequent bathroom visits.
Overactive bladder fix #3: Weight lifting
Another way women can build up the muscles of the pelvic floor: Work out with weights. Internal weights, that is. Special cone-shaped weights inserted into the vagina are often prescribed to women experiencing leakage that's at least partly caused by stress incontinence. Variously called vaginal weights, vaginal cones, and Kegel weights, these sterile plastic devices come in sets of five, ranging in weight from half an ounce to more than three ounces.
"You put one in, like a tampon, and wear it for a specific length of time until you can go 30 days without it falling out," Rabin says. "If it doesn't, you put the next-heavier weight in. If it does fall out, you start over at day one until you can reach 30 days."
As the pelvic floor muscles work to hold in the cones, they strengthen. It can take up to three months for the therapy to take effect. A doctor or physical therapist can suggest a specific program and supervise progress.
Electrical stimulation and weight loss
Overactive bladder fix #4: Electrical stimulation
Because overactive bladder is a nerve-signaling problem, many patients have success with a therapy known as percutaneous tibial nerve stimulation (PTNS).
Done in the doctor's office, PTNS involves inserting a small needle near the ankle, which is attached to a device that sends electrical impulses to nerves in the pelvis that communicate with the bladder. Sessions last about 30 minutes and are repeated weekly or biweekly for several months.
Initially, critics wondered if the shocks merely produced a placebo effect. In 2010, the Journal of Urology reported that a multicenter trial showed that it was, in fact, stimulation of the tibial nerve (a continuation of the sciatic nerve) that caused a significant reduction in overall overactive bladder symptoms, including frequency, urgency, and nighttime bathroom visits.
A doctor may suggest other, slightly more invasive new therapies that also feature electrical nerve stimulation. These include a pacemaker-type stimulator placed near the urethra and bladder, or a sterile probe in the vagina. These therapies are usually paired with biofeedback.
Overactive bladder fix #5: Old-fashioned weight loss
Depending on your starting weight, this approach may not be a quick fix, but it's an effective one. There's a strong connection between weight gain and overactive bladder incontinence, ob-gyn Jill Rabin says. Losing extra pounds spares your bladder as well as your heart and vascular system. A body mass index over 30 seems to be the tipping point.
"But losing as little as 5 percent of your weight can result in a big difference in symptoms," she says. In a 2009 study in the New England Journal of Medicine, incontinent overweight or obese women who underwent an intensive weight-loss program, dropping an average 8 percent of their body weight (17 pounds), saw their bladder problems cut almost in half. A comparison group that lost 1.6 percent of body weight (about 3 pounds) had about one-quarter fewer incontinence episodes. (Both groups also learned about bladder training and pelvic floor exercises.)
While you're improving your eating habits, try to identify and eliminate the food types known to irritate the bladder, including caffeinated foods, alcohol, acidic foods, or spicy foods.