As a pelvic health physiotherapist, I often meet patients who quietly suffer from sudden urges to urinate, frequent trips to the bathroom, or unexpected leakage. These symptoms may be signs of a condition called Overactive Bladder (OAB)—and the good news is, it’s treatable.
What is Overactive Bladder?
OAB is a condition where the bladder muscle (called the detrusor) contracts involuntarily, causing a sudden and powerful urge to urinate—even when the bladder isn’t full. People with OAB may:
- Feel urgent, frequent urges to urinate (8+ times per day)
- Leak urine before getting to the bathroom (urge incontinence)
- Wake up multiple times at night to urinate (nocturia)
You are not alone—studies show that nearly 30% of adults over age 40 experience some form of OAB (Hsu et al., 2019).
Why Does It Happen?
There’s no single cause for OAB. Common contributors include:
- Age-related changes in bladder or nervous system
- Neurological conditions (e.g., stroke, multiple sclerosis)
- Tight or weak pelvic floor muscles
- Stress or anxiety
- Medications or bladder irritants (like caffeine or alcohol)
Sometimes, the bladder muscle becomes overly sensitive or “trained” to signal urgency too often, even if it’s not truly full.
Common Coping Strategies That Backfire
Some people try to manage symptoms by:
- Toilet mapping (always knowing where the nearest washroom is)
- Fluid restriction
- “Just in case” urination
These seem logical but can actually worsen symptoms by training the bladder to hold less and become more sensitive over time.
What Actually Helps?
1. Bladder Retraining (with Physiotherapy Support)
This is a proven method that helps you gradually increase the time between bathroom visits using:
- Scheduled voiding (e.g., every 90 minutes instead of every hour)
- Urge suppression techniques, like:
- Deep breathing
- Mental distraction
- Reverse Kegels (relaxing pelvic floor muscles)
In a randomized controlled trial, behavioral therapies (like bladder training) improved urgency and leakage with minimal side effects, often matching or exceeding medication benefits (Scaldazza et al., 2017).
2. Pelvic Floor Physiotherapy
- As a physiotherapist, I assess whether your pelvic floor is:
- Too weak (needs strengthening)
- Too tight (needs relaxation)
Both can contribute to OAB. A personalized program, often including biofeedback and exercises, can make a big difference.
3. Lifestyle Changes
Hydrate smartly: Sip fluids throughout the day but reduce intake 2–3 hours before bedtime.
Avoid bladder irritants: Caffeine, alcohol, spicy foods, and artificial sweeteners.
Manage constipation and stress: Both can increase pressure on the bladder.
4. Medical Options (When Needed)
When lifestyle changes aren’t enough, your doctor might recommend:
- Anticholinergic medications (e.g., oxybutynin)
- Beta-3 agonists like mirabegron—shown to have fewer cognitive side effects in older adults (Welk & McArthur, 2020).
If medications don’t help, advanced options like tibial nerve stimulation or Botox injections into the bladder wall may be considered (Keller et al., 2017).
Takeaway
OAB is not a normal part of aging. It’s a treatable condition that responds well to physiotherapy, behavior change, and, if needed, medication. If you’re constantly searching for bathrooms, waking up at night, or feeling anxious about leaking—know that you can take control again.
A pelvic health physiotherapist can be your first step toward regaining confidence and comfort.
References
Benner, J., Nichol, M., Rovner, E., Jumadilova, Z., Alvir, J., Hussein, M., & Brubaker, L. (2010). Patient‐reported reasons for discontinuing overactive bladder medication. BJU International, 105(9), 1276–1282. https://doi.org/10.1111/j.1464-410x.2009.09036.x
Fontaine, C., Papworth, E., Pascoe, J., & Hashim, H. (2021). Update on the management of overactive bladder. Therapeutic Advances in Urology, 13, 17562872211039034. https://doi.org/10.1177/17562872211039034
Hsu, Y. P., Chuang, F. C., Chang, S. J., & Yang, S. S. (2019). Prevalence and associated factors of overactive bladder among the elderly in Taiwan. International Urogynecology Journal, 30(7), 1091–1099. https://doi.org/10.1007/s00192-018-3776-4
Keller, N., Schmid, S., & Haemmerle, B. (2017). Successful therapy of overactive bladder syndrome with percutaneous tibial nerve stimulation: A case report. The International Annals of Medicine, 1(11), 387. https://doi.org/10.24087/iam.2017.1.11.387
Scaldazza, C., Morosetti, C., Giampieretti, R., Lorenzetti, R., & Baroni, M. (2017). PTNS vs. pelvic floor muscle training in women with OAB: A randomized study. International Braz J Urol, 43(1), 121–126. https://doi.org/10.1590/s1677-5538.ibju.2015.0719
Welk, B., & McArthur, E. (2020). Dementia risk in patients treated for OAB: Anticholinergic vs beta‐3 agonists. BJU International, 126(1), 183–190. https://doi.org/10.1111/bju.15040
