If you’re dealing with a bladder condition, you’ve probably found yourself drowning in treatment options. There are medications your GP might prescribe, procedures your urologist might recommend, and an ever-growing list of complementary therapies that friends, family, and the internet insist will change your life. The challenge is figuring out what’s actually worth trying.

I’ve put together this guide to help you make sense of your options. I won’t pretend every treatment has solid evidence behind it, but I will tell you what we know, what we don’t, and where you might want to focus your attention.

Medical Treatments: The Conventional Approach

Medications for Overactive Bladder

The most commonly prescribed medications for overactive bladder are antimuscarinics (also called anticholinergics). These include drugs like oxybutynin, solifenacin, and tolterodine. They work by blocking nerve signals that cause the bladder muscle to contract involuntarily.

Do they work? For many people, yes. A Cochrane review of 86 trials found that antimuscarinics reduced urgency episodes by about one per day and reduced incontinence episodes by about half 1. That might not sound dramatic, but for someone experiencing eight or ten episodes daily, cutting that number in half is meaningful.

The catch is side effects. Dry mouth affects roughly 30% of people taking these medications, and constipation is also common. If you’ve ever wondered why your GP seems reluctant to keep you on these drugs long-term, there’s also growing concern about cognitive effects in older adults, though the research on this is still evolving 2.

Mirabegron offers an alternative approach. Rather than blocking nerve signals, it relaxes the bladder muscle directly through a different mechanism (beta-3 adrenergic activation). It causes less dry mouth than antimuscarinics, making it a reasonable option if you couldn’t tolerate the older drugs.

Antibiotics for Bacterial Cystitis

For straightforward bacterial cystitis, antibiotics remain the gold standard. Nitrofurantoin and trimethoprim are the usual first choices in the UK. They’re effective, relatively safe, and resistance rates remain manageable when they’re used appropriately.

The problem arises with recurrent UTIs. If you’re getting three or more infections per year, your doctor might discuss prophylactic (preventive) antibiotics. This works for many women, but it comes with concerns about antibiotic resistance and effects on your gut microbiome. The NHS now recommends exploring non-antibiotic prevention strategies first where possible.

Intravesical Treatments for Interstitial Cystitis

For interstitial cystitis and painful bladder syndrome, treatments become more specialised. Intravesical instillations, where medication is placed directly into the bladder through a catheter, offer a way to target the bladder lining without systemic side effects.

Hyaluronic acid (brand names include Cystistat and Hyacyst) aims to restore the protective layer of the bladder wall. The evidence is mixed but generally positive. One systematic review found that about 60% of patients reported symptom improvement 3. My honest take: it’s worth trying if other options haven’t worked, but don’t expect miracles.

DMSO (dimethyl sulfoxide) has been around since the 1970s and is actually the only intravesical treatment with FDA approval specifically for interstitial cystitis. It’s thought to work as an anti-inflammatory agent. The main drawback is a garlic-like odour that comes through your breath and skin for up to 72 hours after treatment. Some people find this intolerable; others consider it a minor inconvenience for symptom relief.

Alkalinised lidocaine (sold as Cystilieve) provides local anaesthetic effect and can offer immediate pain relief for some patients, though the effect is temporary.

Botox Injections

Botulinum toxin (Botox) injected into the bladder wall has become an established treatment for overactive bladder that hasn’t responded to medications. It works by temporarily paralysing the bladder muscle, reducing involuntary contractions.

The evidence is solid. A major trial found that Botox reduced daily incontinence episodes from about 5.5 to 1.6, compared to 3.4 with placebo 4. Effects typically last 6-9 months before the injections need repeating.

The main concern is urinary retention. Some people find their bladder becomes too relaxed and have difficulty emptying completely. In clinical trials, about 5-6% of patients needed to self-catheterise for a period after treatment.

Nerve Stimulation Therapies

When medications and bladder instillations haven’t worked, nerve stimulation offers another avenue. The basic idea is that electrical stimulation of certain nerves can calm an overactive bladder.

Sacral nerve stimulation (also called sacral neuromodulation) involves implanting a small device near the sacral nerves in the lower back. It’s been shown to reduce urgency and incontinence in people who haven’t responded to other treatments. The downside is that it requires surgery to implant, and not everyone responds.

Tibial nerve stimulation is less invasive. A thin needle is inserted near the ankle, and electrical pulses are delivered over a series of weekly sessions. NICE recommends it as an option when medications haven’t worked, though the evidence for long-term benefit is still accumulating.

Complementary Therapies: Where Does the Evidence Stand?

Many people with bladder conditions turn to complementary therapies, either because conventional treatments haven’t helped or because they prefer a more natural approach. I’m not going to tell you these options are worthless, because some do have research support. But I am going to be honest about where the evidence is strong and where it’s thin.

Acupuncture

Acupuncture has been studied for both overactive bladder and interstitial cystitis. For OAB, a systematic review found moderate evidence that acupuncture may reduce urinary frequency and urgency 5. The effect sizes were modest but statistically significant.

For interstitial cystitis, the evidence is more limited. A few small trials have shown promising results, but we’re talking about studies with 30-50 participants, not the large randomised trials that would give us real confidence.

My take: acupuncture is unlikely to cause harm, and there’s enough evidence to suggest it might help. If you’re interested in trying it, look for a practitioner registered with the British Acupuncture Council. Don’t expect it to replace your medications entirely, but it might reduce your reliance on them.

Herbal Medicine

This is where things get complicated. There are hundreds of herbal remedies marketed for bladder health, and the evidence varies enormously.

Pumpkin seed extract has some of the better evidence for urinary frequency and overactive bladder symptoms. A Japanese study found that women taking pumpkin seed extract had significantly fewer night-time bathroom trips 6. The mechanism isn’t fully understood, but it may affect bladder muscle function.

Cranberry is probably the most famous bladder-related supplement. The evidence for preventing UTIs has strengthened recently. A 2023 Cochrane review found that cranberry products reduced the risk of recurrent UTIs by about 25% in women with a history of infections. However, cranberry doesn’t treat active infections, and the evidence for interstitial cystitis is essentially non-existent.

Chinese herbal medicine is popular in some communities, and there are practitioners who specialise in urinary conditions. The challenge is that most Chinese herbal formulations haven’t been studied in rigorous clinical trials. Some individual herbs have shown promise in laboratory studies, but translating that to clinical benefit is another matter. If you do try Chinese herbal medicine, please tell your GP, as some herbs can interact with conventional medications.

Aromatherapy

I have to be honest: there’s very little scientific evidence supporting aromatherapy for bladder conditions specifically. That said, aromatherapy may help with stress and relaxation, which can indirectly benefit people whose symptoms worsen with anxiety.

If aromatherapy helps you feel calmer and cope better with your condition, that’s valuable. Just don’t expect it to treat the underlying problem.

Hypnotherapy

Hypnotherapy has been studied more seriously for conditions like irritable bowel syndrome, and there’s interest in whether similar approaches might help with bladder conditions. The theory is that hypnosis can help retrain the brain-bladder connection and reduce the hypersensitivity that characterises conditions like interstitial cystitis.

The evidence is preliminary. A few small studies have shown promising results, but we need larger trials before drawing firm conclusions.

Reflexology

Reflexology, where pressure is applied to specific points on the feet, is popular but poorly studied for bladder conditions. I couldn’t find any rigorous trials specifically examining reflexology for overactive bladder or interstitial cystitis. Some people report benefits, but without controlled studies, it’s impossible to know whether the effect is real or placebo.

Putting It All Together: A Practical Approach

Here’s what I’d suggest if you’re trying to navigate this landscape:

Start with the basics. Before exploring exotic treatments, make sure you’ve addressed lifestyle factors. Reducing caffeine and alcohol, maintaining a healthy weight, and practising pelvic floor exercises can all make a real difference for many bladder conditions. These interventions are free, low-risk, and have good evidence behind them.

Give conventional treatments a fair trial. Medications work well for many people with overactive bladder. Antibiotics are genuinely necessary for bacterial infections. If your doctor has recommended a treatment, understand why and give it a chance to work.

Be selective about complementary therapies. If you want to try something outside conventional medicine, focus on options with at least some evidence, like acupuncture for OAB or cranberry for UTI prevention. Avoid throwing money at treatments with no research support.

Tell your healthcare team everything. This is crucial. If you’re taking herbal supplements or seeing an acupuncturist, your GP needs to know. Some supplements can interact with medications, and your doctor can’t help you effectively without the full picture.

Be patient but realistic. Chronic bladder conditions often require trial and error to find what works. But if a treatment hasn’t helped after a reasonable period, it’s probably time to try something else rather than hoping things will eventually improve.

When to Seek Specialist Help

Most bladder problems can be managed by your GP initially. But there are situations where referral to a urologist or urogynaecologist makes sense:

Your symptoms haven’t improved after trying first-line treatments
You have blood in your urine (haematuria)
You’re experiencing severe pain
You have suspected interstitial cystitis or another complex condition
You’re considering procedures like Botox or nerve stimulation

Don’t be afraid to ask for a referral if you feel you’re not making progress. Bladder conditions can significantly affect quality of life, and specialist input can make a real difference.

The Honest Truth

There’s no perfect treatment for bladder conditions. Medical options have side effects. Complementary therapies often lack strong evidence. What works brilliantly for one person may do nothing for another.

But that doesn’t mean you’re without options. With patience, willingness to experiment, and good communication with your healthcare team, most people can find a combination of approaches that meaningfully improves their quality of life.

If you’re feeling overwhelmed by the choices, pick one thing to try, give it a fair chance, and then reassess. Progress often comes in small steps rather than dramatic breakthroughs.

References

Nabi G, et al. Anticholinergic drugs versus placebo for overactive bladder syndrome in adults. Cochrane Database Syst Rev. 2006;(4):CD003781. PubMed
Gray SL, et al. Cumulative use of strong anticholinergics and incident dementia. JAMA Intern Med. 2015;175(3):401-7. PubMed
Madersbacher H, et al. GAG layer replenishment therapy for chronic forms of cystitis with intravesical glycosaminoglycans. Eur Urol. 2012;61(3):472-9. PubMed
Chapple C, et al. OnabotulinumtoxinA 100 U significantly improves all idiopathic overactive bladder symptoms. J Urol. 2013;189(5):1388-95. PubMed
Zhao Y, et al. Acupuncture for adults with overactive bladder: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore). 2018;97(8):e9838. PubMed
Terado T, et al. Clinical effect of pumpkin seed extract on urinary function in overactive bladder. J Tradit Complement Med. 2014;4(4):237-41. PubMed