Skip to main content

How to Manage Your Overactive Bladder

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Aug 27, 2021.

What Exactly is Overactive Bladder?

Do you feel like you always need to go? Unable to get out the house for fear of always needing the restroom?

You are one of many. More than 33 million Americans suffer from overactive bladder. Overactive bladder (OAB) is a common condition that can affect up to roughly 40% of women in their lifetime. OAB can lead to urinary incontinence - the loss of bladder control, obviously an embarrassing problem.

Those with OAB, also called urge incontinence, experience a sudden, strong urge to urinate during the day and night; they may also leak urine before getting to the restroom.

OAB results in someone needing to urinate more than the usual 7 to 8 times per 24 hours. Therefore, OAB usually consist of four symptoms:

  • an urgent need to urinate
  • a need to urinate more frequently than normal
  • waking from sleep to urinate
  • urgency incontinence (urine leakage).

OAB is not due to effects from a urinary tract infection or from a neurologic condition such as multiple sclerosis, and your doctor should rule this out.

Is Overactive Bladder (OAB) the Same as Stress Incontinence?

No. Stress incontinence occurs when pelvic muscles, located beneath the bladder, are not strong enough. These muscles cannot handle any pressure being exerted on the bladder, and this leads to urine leaking.

Stress incontinence may occur when someone is sneezing, lifting heavy items, laughing, or coughing.

Pregnancy and after childbirth is also a time when stress incontinence may be bothersome, and it may continue to be a problem long after childbirth.

Urge incontinence is another name for overactive bladder (OAB). Stress incontinence and OAB can also occur together, known as mixed incontinence.

Other types of incontinence include overflow incontinence and functional incontinence.

How Will I Know if a Urinary Tract Infection is Causing My Symptoms?

Leaking of urine, whether a small or large amount of urine, is the main symptom of incontinence due to overactive bladder (OAB).

OAB can also lead to leakage during sleep. Urine leakage due to a urinary tract infection (UTI) is usually a short-term problem, but visit your doctor as you may need an antibiotic.

If urine leakage is accompanied by the following symptoms, you may have a UTI:

  • Pain or a burning sensation during urination.
  • Fever
  • Pink or red urine discoloration
  • A strong urine odor or cloudy urine
  • Stomach or back pain
  • Frequent urination

How is an Overactive Bladder Diagnosed?

If you are experiencing overactive bladder (OAB) symptoms, and especially if they interfere with your normal routines like sleep, work or leisure time, see your doctor.

Leaking urine at any age is not normal. Do not feel ashamed or embarrassed to mention these symptoms to your doctor; OAB is a common condition for which many women seek treatment. You will not be the first.

What happens during my doctor visit for overactive bladder?

  • Your medical history will be reviewed
  • You may be asked to keep a voiding dairy for a few days
  • A neurologic and pelvic exam will be done
  • Your doctor may check your urine for signs of a urinary tract infection (UTI).
  • Depending upon your results, imaging tests like a CT or MRI may be needed to determine if your OAB is due to a nerve injury.

What Treatments are Suggested for OAB?

For women who suffer with overactive bladder (OAB) symptoms treatment options include:

  • Pelvic muscle exercises
  • Bladder management techniques
  • Prescription and over-the-counter medications
  • Surgery
Obesity, older age, excessive caffeine intake, smoking and lack of exercise may be OAB risk factors.

Kegel exercises which strengthen the pelvic muscles can improve symptoms, especially in stress incontinence.

Bladder retraining, such as scheduled bladder emptying, behavioral modification, and fluid management can also be useful for OAB.

What is Fluid Management for OAB?

It is important not to severely restrict fluids for overactive bladder (OAB) as this could lead to dehydration. However, most people need roughly 4 to 8 eight ounce glasses of fluid per day; more may be required with exercise, hot weather, or excessive perspiration.

It's true that cutting back on fluids may help with leakage and embarrassing moments. However, if you do not drink enough liquids, your urine may become dark and concentrated and dehydration may occur.

One option is to drink small amounts at regular intervals throughout the day, instead of a large glass all at once. If you awaken frequently at night to urinate, avoid fluids right before bed, and cut back on alcohol and caffeine.

If you take a diuretic for high blood pressure, take it in the morning rather than at night, to help prevent nighttime trips to the bathroom.

Which Medications Are Used for OAB?

Your doctor may use multiple strategies to relieve your overactive bladder (OAB) symptoms.

In addition to the exercises and behavioral modifications, many medications are available; one is even available over-the-counter.

Extended-release forms may cause less dry mouth as a side effect.

Medications include:

Tolterodine (Detrol, Detrol LA)

Detrol and Detrol LA are brand names of tolterodine, approved to treat overactive bladder (OAB) with symptoms of urinary frequency, urgency, and incontinence (urine leakage). Tolterodine acts as an antispasmodic on the bladder muscles to lessen the symptoms of OAB.

Detrol and Detrol LA are both available in cost-saving generics. The extended-release formulation is given once daily, and the immediate-release is given twice-a-day.

Common side effects include constipation, dry mouth, headache, or drowsiness. If serious allergic reactions such as swelling of your lips, throat or face, difficultly breathing or swallowing, itch, or rash appear, call 911 immediately.

Tolterodine should be avoided in patients with a heart rhythm condition (arrhythmia) due to possible worsening of their condition (QT prolongation).

Oxybutynin (Oxytrol, Oxytrol For Women, Gelnique)

Oxybutynin is available in different dose forms, both over-the-counter and by prescription.

Gelnique is a prescription gel form applied to the skin (transdermal) once daily.

In 2013, the first over-the-counter (OTC) treatment for overactive bladder (OAB) in women, Oxytrol For Women, was FDA approved. The transdermal patch releases 3.9 mg per day.

  • Oxytrol For Women patch is applied to the abdomen, hips or buttocks area every four days. After 4 days, remove the patch and apply a new one to a different area of the skin. Each time you put on a new patch, change the area where you put it (i.e., abdomen, hips or buttocks).
  • Oxytrol is still available with a prescription, too, but it is much more costly unless your insurance covers it. No generic option is available yet. Cost runs close to $700 per 8 patches.
  • Cost for a one month supply of OTC Oxytrol for Women can vary but ranges from $15 to $35 at retail outlets. Be aware the cartons come with either 4 or 8 patches.

Both versions of Oxytrol have the same formulation and same dosage strength, but the nonprescription Oxytrol for Women is only indicated for women 18 years of age or older. For any other use, including in men, a prescription is needed.

Oxytrol side effects include skin irritation, dry mouth, and constipation. Transdermal delivery of oxybutynin by gel or patch may reduce side effects.

Trospium

The Sanctura and Sanctura XR (extended-release form) brands have been discontinued by the manufacturer and are now only available as a generic product, known as trospium.

The tablets are taken either once or twice a day, and the extended-release form is a capsule taken once per day. Take either tablet or capsule on an empty stomach one hour before meals.

As with other many drugs used to treat overactive bladder (OAB), trospium can cause side effects such as:

  • constipation
  • dry mouth
  • drowsiness
  • blurred vision
  • headache.

A severe, but uncommon allergic side effect that may require emergency treatment is angioedema -- a swelling of the face, lips, tongue, and throat. Angioedema can be life-threatening. Stop taking this medicine immediately and seek prompt medical attention, such as calling 911, if you have edema (swelling) of the tongue or throat or have any difficulty breathing.

Solifenacin (VESIcare, VESIcare LS)

VESIcare (solifenacin), first approved in 2004, is taken by mouth in tablet form once a day. The tablets come in 5 mg and 10 mg strength. Generic solifenacin tablets are also available and are inexpensive. The tablet form is for use in adults only.

VESIcare LS is a 5 mg/5 mL oral suspension (liquid) used to treat overactive bladder caused by a neurologic disorder (such as multiple sclerosis or spinal cord injury) in children at least 2 years old. Dosing is based on weight. Generic VESIcare LS is not yet on the market.

Like all of the oral muscarinic antagonists used for overactive bladder, side effects like dry mouth, blurred vision, and drowsiness may occur.

If you have any kind of heart rhythm electrical issue, such as atrial fibrillation, you may need to avoid VESIcare due to worsening of your heart condition. It is important you do not use muscarinic antagonists like VESIcare if you have any form of gastric (digestive tract) retention, narrow-angle glaucoma, or urine retention.

Darifenacin ER (Enablex)

Enablex (darifenacin), an extended-release 7.5 mg or 15 mg tablet given once a day, was approved in 2004. A generic for both strengths is also on the market.

Due to the common anticholinergic side effects that occur with this drug class, constipation may be severe, so check with your doctor if this problem arises. If you have liver disease or take certain medicines, you may need a lower dose of Enablex, so be sure to discuss this with your doctor and pharmacist If you have severe liver disease you should not use Enablex.

Enablex undergoes breakdown in the liver and can lead to multiple drug interactions, so always have your doctor or pharmacist check for interactions. Be sure to tell them all the medicines you take, including prescription, over-the-counter, herbal and vitamin products.

Mirabegron (Myrbetriq)

The use of overactive bladder (OAB) medications can be a problem for patients who are sensitive to side effects like dry mouth, constipation, and blurred vision. Myrbetriq works by a unique mechanism of action to stimulate beta-3 receptors, causing bladder muscle relaxation and improved bladder storage.

Myrbetriq (mirabegron) by Astellas Pharma is an oral, extended-released tablet FDA-approved in 2012. It comes as a 25 mg or 50 mg strength and as a granule formulation for children.

  • The tablets are approved for use for adults with OAB, either alone or with another medicine called solifenacin (Vesicare).
  • Myrbetriq is also used to treat neurogenic detrusor overactivity (NDO) in children 3 years and older. NDO results in urinary incontinence from conditions such as multiple sclerosis or spinal injury.
  • Myrbetriq tablets may be used in adults and children at least 3 years old who also weigh at least 77 pounds (35 kilograms). If the child is less than 35 kg but at least 3 years old, use the granules.
  • The Myrbetriq granules and tablets are two different products and they are not substitutable on a milligram-per-milligram basis. See Mybetriq dosing here.

Myrbetriq side effects include high blood pressure and the risk for urinary retention in patients receiving other antimuscarinic agents for OAB or with bladder outlet obstruction. Myrbetriq can also result in serious drug interactions, so have your pharmacist run a drug interaction check.

OnabotulinumtoxinA (Botox)

Botox is made from the bacteria that causes botulism and blocks nerve activity in the muscles. One Botox dose, which requires injection into the bladder (detrusor) muscle via a special procedure. Botox is used:

  • to treat overactive bladder symptoms such as a strong need to urinate with leaking or wetting accidents (urge urinary incontinence), a strong need to urinate right away (urgency), and urinating often (frequency) in adults when another type of medicine (anticholinergic) does not work well enough or cannot be taken.
  • to treat leakage of urine (incontinence) in adults with overactive bladder due to neurologic disease when an anticholinergic does not work well enough or cannot be taken.
  • to treat overactive bladder due to a neurologic disease in children 5 years of age and older when an anticholinergic does not work well enough or cannot be taken.

In treating OAB or destrusor overactivity due to a neurologic condition in adults, the most common side effects are urinary tract infection, painful or difficult urination, and a temporary inability to fully empty the bladder. For destrusor overactivity due to a neurologic condition in children, urinary tract infection, white blood cells in the urine, and bacteria in the urine.

How long does a Botox injection last for overactive bladder? In studies in adults, on average, patients who received a second injection, received it in 169 days (roughly 24 weeks). A reinjection should not occur any sooner than 12 weeks from the prior bladder injection.

Fesoterodine (Toviaz)

Toviaz (fesoterodine) by Pfizer is a muscarinic antagonist (anticholinergic) agent used:

  • in adults to treat overactive bladder (OAB), including urge urinary incontinence (leaking or wetting accidents due to a strong need to urinate), urinary urgency (having a strong need to urinate right away), or urinary frequency (having to urinate too often).
  • in children 6 years of age and older with a body weight greater than 55 pounds (25 kg) to treat neurogenic detrusor overactivity (NDO) to increase the amount of urine the bladder can hold and reduce urine leakage.

Toviaz is available in 4 and 8 milligram (mg) extended-release tablets taken once-a-day. Swallow the tablet whole with liquid. Do not chew, divide, or crush the tablet. You can take it with or without food. Generics for Toviaz have been approved but may not be commercially available yet.

If you have an allergy to tolterodine (Detrol, Detrol LA), you should not take Toviaz as it is chemically-related. Your doctor may adjust your dose or tell you not to use Toviaz if you use medicines that are potent CYP450 3A4 inhibitors. Be sure to tell your doctor and pharmacist about all the medicines you use so they can check for drug interactions.

Common side effects with Toviaz include:

  • dry mouth and constipation in adults with OAB
  • diarrhea, urinary tract infection (UTI), dry mouth, constipation, abdominal (stomach) pain, nausea, weight gain, and headache in children with NDO.

Desmopressin acetate (Noctiva)

In March 2017, the FDA approved the first treatment for frequent urination at night due to overproduction of urine.

  • Serenity's Noctiva (desmopressin acetate) is for adults who wake up at least twice per night to urinate due to a condition known as nocturnal polyuria (overproduction of urine during the night). Noctiva has not been studied in patients less than 50 years of age.
  • It's classified as a vasopressin analog, in nasal spray form, and is used once nightly, 30 minutes before going to bed.
  • Noctiva, an anti-diuretic, reduces urine production. In two, 12-week studies looking at its effectiveness, patients treated with Noctiva had at least one fewer night-time urination.

Noctiva contains a boxed warning for low sodium levels in the blood (hyponatremia), which if severe, can be life-threatening.

Common side effects included:

  • nasal discomfort or congestion
  • common cold symptoms
  • sneezing
  • high or elevated blood pressure
  • back pain
  • nose bleeds (epistaxis)
  • bronchitis
  • dizziness

Nocdurna Sublingual Tab for Frequent Nighttime Urination

Nocturnal polyuria occurs when the kidneys produce too much urine at night leading to frequent awakenings.

  • In June 2018 the FDA approved Nocdurna (desmopressin acetate) from Ferring Pharmaceuticals.
  • Nocdurna is a vasopressin analog for adults. It is the first under the tongue (sublingual) tablet for the treatment of nocturia polyuria (needing to wake up frequently at night to urinate). It is used in those who wake up at least two times per night to void.
  • The dose of Nocdurna for women is lower than the dose for men as women are more senstitive and may be at greater risk of low sodium levels.
  • The Nocdurna tablet is taken sublingually (placed under the tongue) once daily one hour before bedtime, without water.

In clinical studies, the mean baseline (before the study started) nighttime voiding was 2.9 times for women and 3.0 for men. Results showed that Nocdurna led to an average reduction of nocturnal voids by 52% in 118 women and 43% in 102 men relative to mean baseline (reduction of 1.5 and 1.3 voids, respectively).

Common side effects included dry mouth, decreased blood sodium, and dizziness. Like Noctiva, Nocdurna can cause low sodium levels which can be life-threatening, leading to seizures, passing out, trouble breathing, or death.

Gemtesa for OAB

In Dec. 2020, the FDA approved Gemtesa (vibegron) in adults for the treatment of overactive bladder (OAB) with symptoms of urge urinary incontinence (a strong need to urinate with leaking or wetting accidents), urgency (the need to urinate right away), and urinary frequency (urinating often).

  • Like Myrbetriq, Gemtesa is classified as a beta-3 adrenergic agonist and stimulates beta-3 receptors.
  • It works by relaxing the detrusor bladder muscle so that the bladder can hold more urine and reduce symptoms of OAB.
  • It is taken as one 75 mg tablet once daily. Gemtesa is from Urovant Sciences.

Common side effects (>2%) are headache (4%), urinary tract infection, nasopharyngitis (common cold), diarrhea, nausea, and upper respiratory tract infection.

Many Americans Struggle With Incontinence

There is a wide array of overactive bladder (OAB) treatments, and an FDA report discusses overactive bladder (OAB) and it's implication on health. If you have OAB, know that you are not alone. OAB is common in older women (about 50%), but roughly 25% of older men suffer from its effects, too.

If you have symptoms of OAB, consider talking to your healthcare provider about treatment options.

  • OAB can have a negative impact on social, family and work routines.
  • Experts state that patients need to take the first step to seek advice from their doctor to determine whether their symptoms are due to OAB (or another condition) and which treatment is the best.
  • Be sure to discuss any possible side effects and cost of prescribed medications.

Also, you should consider joining the Drugs.com Overactive Bladder Support Group to ask questions, keep up with research and news, and voice your opinion with medications.

Finished: How to Manage Your Overactive Bladder

Don't Miss

Menopause Symptoms & Stages: What Woman Need to Know

Society tends to treat menopause as a disease; something to be avoided at all costs. But menopause can be positive. No more monthly mood swings, period accidents, or pregnancy worries. Self-confidence and self-knowledge...

Sources

  • Lukacz E, et al. Patient education: Urinary incontinence in women (Beyond the Basics). Updated Dec. 12, 2017. Accessed August 27, 2021 at https://www.uptodate.com/contents/urinary-incontinence-in-women-beyond-the-basics
  • Gemtesa Prescribing informatin. Urovant Sciences. Accessed August 27, 2021 at https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/213006s000lbl.pdf
  • Nocdurna Prescribing Information. Ferring Pharmaceuticals. Accessed August 27, 2021 at https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/022517s000lbl.pdf
  • Urology Care Foundation. American Urological Foundation. What is Overactive Bladder (OAB)? Accessed August 27, 2021 at https://www.urologyhealth.org/urologic-conditions/overactive-bladder-(oab)
  • Urology Care Foundation. American Urological Foundation. What is urinary incontinence? Accessed August 27, 2021 at http://www.urologyhealth.org/urologic-conditions/urinary-incontinence
  • Diagnosis and Treatment of Overactive Bladder (Non-Neurogenic) in Adults: AUA/SUFU Guideline. Accessed August 27, 2021 at https://www.auanet.org/guidelines/overactive-bladder-(oab)-guideline

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.