When you have an overactive bladder (OAB), it means you get lots of sudden urges to pee. These urges can be hard to control, and might wake you up during the night, too.
OAB can also cause a type of urinary incontinence called urge incontinence – when you don’t make it to the toilet before peeing.
If you’re affected, you’re not alone – research suggests that about 15% of women have OAB. But it can be hard to live with. When you need to rush to the toilet without much warning, everyday things such as travel and socialising can become challenging.
OAB can have a big impact on your life and your mood, if you don’t address it. Fortunately, however, there are self-care measures and treatments that can really help – so read on to learn how to deal with it.
How do I know if I have overactive bladder symptoms?
We all have days when we feel as though we need to pee more often and more urgently than usual. So when is this normal, and when is it OAB?
The following symptoms are all clues that you may have OAB:
- sudden, hard-to-control urges to pee
- needing to pee often – typically at least 8 times in 24 hours
- waking up in the night to pee
- leaking pee as soon as you get the urge to go – around a third of people with OAB also have urge incontinence, sometimes known as ‘wet OAB’
Overactive bladder or urinary tract infection (UTI)?
Needing to pee suddenly or more often than usual can also be symptoms of a urinary tract infection (UTI). But with a UTI, you’ll normally get some or all of the following symptoms as well:
- pain or a burning feeling when you pee
- pee that looks cloudy or contains blood
- lower tummy pain or pain in your back, below your ribs – this could mean the infection is also affecting your kidneys
- a high or very low temperature – you may feel either hot or shivery
How your bladder should work
The walls of your bladder are mainly made up of a group of muscle fibres known as the detrusor muscle. This allows your bladder to stretch to hold pee, and to squeeze (contract) to push pee out.
When your bladder becomes full and stretched with pee, nerve signals tell the detrusor muscle to squeeze. They also tell the ring of muscle that keeps your bladder closed (urethral sphincter) to relax, to let pee flow out. After you’ve finished peeing, nerve signals tell your urethral sphincter to close the opening again, and your detrusor muscle to relax.
Normally, you should first feel the urge to pee when you have about 240ml of pee in your bladder. You should then be able to hold about 480ml of pee before you really need to go. So you have some time to get to the toilet before your bladder is completely full.
What happens with OAB
When you have OAB, however, this sensitive process goes wrong. Your detrusor muscle gets stimulated too soon, so you get the urge to pee when there isn’t much pee in your bladder. Scientists are still trying to understand exactly how and why this happens. But thankfully, there are lifestyle steps that can help.
5 reasons why you might have an overactive bladder
There isn’t always a clear reason for OAB, but some things can increase your risk, including:
- UTIs – not only do UTIs share some symptoms with OAB, but they may also be 1 of the underlying causes. Bacterial infection may cause inflammation in your bladder, triggering the nerves to become overactive, which usually happens over a short period
- being overweight or obese – you’re more likely to have OAB if you’re overweight. Researchers don’t understand exactly why this is, but excess weight puts more pressure on your bladder, and it’s thought this may trigger it to be overactive
- middle age – research shows women in midlife are more likely to have OAB. This could be partly due to the menopause. Falling levels of oestrogen may have an effect on the muscles that span the base of your pelvis (pelvic floor muscles), as well as cells in your bladder and pee tube (urethra), which could raise the risk of OAB. Other things linked to OAB – such as weight gain – can also be more common around the menopause. Read more about urinary incontinence and menopause
- medicines – OAB can be a side effect of certain medicines, such as water tablets (diuretics), which push excess fluid out of your body
- other health conditions – conditions such as stroke and multiple sclerosis (MS) can be linked with OAB, because they can affect the nerves that send signals to your bladder
Lifestyle steps that can help
There are several general self-care measures for urinary incontinence you can try. And with OAB, it may also be especially important to focus on your fluid intake, so try these tips too:
- drink enough fluid – it can be tempting to avoid drinking, so that you don’t keep needing to run to the toilet. But if you don’t drink enough, your pee will become more concentrated, which can irritate your bladder and make you need to pee more often
- pace your fluid intake – try to drink smaller amounts, regularly throughout the day (think little and often)
- time it right – if you’re having to get up in the night to pee, try drinking more of your daily fluid intake in the morning
- limit certain drinks – caffeinated drinks such as tea and coffee, alcohol and fizzy drinks can increase how much pee you make or irritate your bladder
Some women also find certain foods can irritate their bladder, such as acidic fruits, tomatoes, chocolate and spicy food. You could try cutting these out for a week if you think they could be causing your symptoms. If it makes a difference, try reintroducing them 1 at a time to help you figure out what’s causing the problem. Sometimes, just cutting down on something might be enough to help.
When to see a doctor
If you’re not sure whether you could use self-care measures or you need to see a doctor, try our award-winning Smart Symptom Checker – it’s created with doctors to help you work out the best next steps for your symptoms.
You should talk to your doctor if OAB symptoms are affecting your quality of life or mental health, or if they don’t improve with self-care or they’re getting worse.
If you also have other symptoms, you may need urgent medical help. You should see a doctor as soon as possible if you:
- notice blood in your pee
- feel very thirsty and are peeing often
- feel very tired
- keep getting UTIs
- have pain when you pee or in your lower tummy
You should get emergency medical help if you:
- have severe tummy pain or a high temperature (fever)
- suddenly can’t pee
- suddenly can’t control when you pee or poo
How is overactive bladder diagnosed?
Your doctor will diagnose OAB in a similar way to urinary incontinence (read about how urinary incontinence is diagnosed). Usually, they’ll diagnose based on your symptoms, once they’ve ruled out an infection.
Occasionally, they may refer you for urodynamic tests, which test how well your bladder muscle is working, or an ultrasound scan.
In some cases, you might also need to see a specialist called a urologist, who may do further tests, such as a cystoscopy to look at your bladder.
How your doctor can help
If lifestyle measures don’t work, there are several things your doctor can offer. The first step is usually a course of bladder training, which helps you learn how to increase the amount of time between when you first get the urge to go to the toilet and actually peeing.
In some specialist cases, your doctor may suggest injections of Botox into your bladder, to help it relax. Read more about Botox injections and other procedures for urge incontinence.
Your health questions answered
Could my overactive bladder be linked to stress or anxiety?
“There’s thought to be a connection, but the link isn’t well understood. It’s hard to know whether OAB symptoms contribute to stress and anxiety, or if there’s an underlying biological reason for both bladder and psychological symptoms. But as stress and anxiety can have a negative impact on your life in all sorts of ways, it’s really worth taking steps to support your mental health. Speak to your doctor for advice, and get information about stress relief.”