Name: Overactive Bladder FAQ: Common Questions Answered
Creator: COB Foundation
Published: 2018-12-13T00:00:00.000Z

Living with overactive bladder raises plenty of questions. Some are straightforward; others are awkward to ask your doctor. This FAQ covers the issues people most commonly wonder about, from everyday triggers to treatment realities.

Lifestyle and Triggers

Does smoking affect overactive bladder?

Yes, and in more than one way. Nicotine is a bladder irritant that can increase detrusor muscle contractions, making urgency worse 1. The chemical irritation from nicotine may also affect the nerves controlling bladder sensation.

Beyond the direct irritation, smoking causes chronic coughing, and repeated coughing puts pressure on the pelvic floor. Over time, this can weaken the muscles that support the bladder and help you hold on when urgency strikes. If you’re experiencing urge incontinence or stress incontinence, the coughing alone may trigger leakage.

I won’t pretend quitting smoking is easy, but if you’re a smoker with OAB, it’s one of the more impactful changes you could make.

Which drinks make OAB worse?

Caffeine is the main culprit. Coffee, tea, cola, and energy drinks all contain caffeine, which has a diuretic effect (makes you produce more urine) and also directly stimulates the bladder muscle 2. One study found that women consuming more than 329mg of caffeine daily (roughly three cups of coffee) had a 70% higher risk of detrusor overactivity compared to those consuming less than 100mg.

Alcohol also increases urine production and can reduce bladder control. Fizzy drinks, including sparkling water, may irritate some bladders. Citrus juices and tomato-based drinks bother some people but not others.

If you’re not sure what affects you personally, try eliminating one potential trigger at a time for a week or two while keeping a bladder diary. The pattern should become clear.

Do I need to restrict fluids?

This is a common misconception. Many people with OAB deliberately drink less, hoping to reduce toilet trips. The problem is that concentrated urine actually irritates the bladder more, potentially making urgency worse. Dehydration also increases your risk of urinary tract infections, which can dramatically worsen OAB symptoms.

The NHS recommends drinking 6-8 glasses of fluid daily (about 1.5-2 litres) 3. That said, spacing your intake sensibly makes sense. If nocturia is your main problem, reducing fluids in the evening (say, nothing after 6pm) can help, while still drinking normally earlier in the day.

What you drink matters more than the total amount. Water and non-caffeinated herbal teas are gentler on the bladder than coffee or alcohol.

Does weight affect overactive bladder?

There’s reasonable evidence that excess weight contributes to bladder problems, though the link is clearer for stress incontinence than for OAB specifically. Extra abdominal weight puts mechanical pressure on the bladder and pelvic floor, potentially affecting bladder function and reducing the ability to hold on during urgency 4.

Weight loss studies show improvements in incontinence symptoms. Even a 5-10% reduction in body weight can make a noticeable difference for some people. Whether weight loss directly improves OAB or whether the benefits come mainly from reduced pressure on the pelvic floor isn’t entirely clear, but the overall message is that maintaining a healthy weight supports bladder health.

Pelvic Floor Exercises

How do pelvic floor exercises help with OAB?

Pelvic floor exercises (sometimes called Kegels) strengthen the muscles that support the bladder, urethra, and other pelvic organs. Strong pelvic floor muscles give you better control when urgency strikes—you can contract them to help suppress the urge and buy yourself time to reach a toilet.

The muscles may have been weakened by various factors: pregnancy and childbirth, chronic constipation and straining, heavy lifting, persistent coughing, hormonal changes during menopause, or simply ageing. Regardless of the cause, the muscles respond to training.

Proper technique matters. You should be contracting the muscles you’d use to stop urinating midstream (though don’t actually practice by stopping your urine regularly, as this can cause problems). If you’re unsure whether you’re doing them correctly, ask your GP for a referral to a specialist physiotherapist, or look into the NHS Squeezy app which guides you through the exercises.

How long before I see results?

Pelvic floor exercises aren’t a quick fix. Most people need to do them consistently for at least 8-12 weeks before noticing meaningful improvement. The research consistently shows that supervised pelvic floor muscle training improves OAB symptoms, but patience is required 5.

The good news is that once you’ve built strength, maintaining it requires less effort than the initial training phase. The exercises become part of your routine rather than a dedicated programme.

Living with OAB

How can I manage OAB when travelling?

Travel with OAB requires planning, but it’s absolutely manageable. Here are some practical strategies:

Car travel: Know your route and where toilets are located—motorway services, petrol stations, pubs, and restaurants with public facilities. Having a discreet portable urinal or collection device in the car provides backup if you’re caught in traffic. Bring spare clothing and absorbent products just in case.

Air travel: When booking, request an aisle seat near the toilets. Most airlines can accommodate this if you explain you have a medical condition. A letter from your GP or consultant can help if you need special arrangements, such as a seat immediately adjacent to the lavatory on longer flights.

General tips: Avoid peak travel times when possible—crowded stations and security queues add stress. Wear clothing that’s easy to manage quickly in a toilet. Limit caffeine and alcohol before and during travel. The COB Foundation offers a “Can’t Wait” card that explains you have a medical condition requiring urgent toilet access—this can help in queues or when accessing staff toilets.

Does OAB get worse with age?

OAB becomes more common with age, affecting roughly 15-20% of adults over 40 and up to 30% of those over 65 6. However, that doesn’t mean your individual symptoms will inevitably worsen as you get older.

Many factors influence symptom progression. Managing contributing conditions like constipation, maintaining pelvic floor strength, staying active, and controlling your weight all help. Medication and other treatments can keep symptoms stable or even improve them despite advancing age.

What shouldn’t happen is accepting worsening symptoms as inevitable. If your OAB is getting worse, it’s worth reviewing your management approach with your doctor rather than assuming nothing can be done.

Will I have to deal with this forever?

Not necessarily, though I should be realistic: OAB often requires ongoing management rather than a permanent cure. That said, many people find their symptoms improve substantially with appropriate treatment, and some achieve long-term remission.

Bladder training, in particular, can produce lasting changes in bladder behaviour. The aim is to retrain your bladder to hold larger volumes and reduce the frequency of urgency signals. People who stick with the programme often maintain improvements even after formal training ends.

For others, OAB symptoms fluctuate over time—worse during stressful periods or when other health conditions are poorly controlled, better when lifestyle factors are optimised. Having a management toolkit you can deploy when needed makes the condition much more liveable.

Treatment Questions

What treatments are available for OAB?

Treatment typically follows a stepped approach, starting with lifestyle modifications and bladder training, then progressing to medication if needed, and finally considering specialist interventions for people who don’t respond adequately.

First-line treatments include reducing bladder irritants (caffeine, alcohol), maintaining healthy fluid intake, pelvic floor exercises, and bladder training (gradually increasing the time between toilet visits).

Medications fall into two main categories: anticholinergics (like oxybutynin, solifenacin, and tolterodine) and beta-3 agonists (like mirabegron). Both reduce unwanted bladder contractions, though through different mechanisms. See our detailed medication guide for more information on specific drugs and their side effects.

Specialist treatments for people who don’t respond to tablets include Botox injections into the bladder wall, percutaneous tibial nerve stimulation (PTNS), and sacral nerve stimulation with an implanted device.

Do OAB medications have side effects?

Yes, and side effects are a significant reason why some people stop taking them. Anticholinergic medications commonly cause dry mouth (20-30% of users), constipation, dry eyes, and blurred vision. More concerning, especially for older adults, is the risk of cognitive effects—anticholinergics have been linked to confusion and may contribute to cognitive decline with long-term use 7.

Beta-3 agonists like mirabegron avoid the anticholinergic side effects but can cause urinary tract infections, faster heart rate, and raised blood pressure. They’re not suitable for everyone, particularly those with severe hypertension.

The side effect profile is very individual. Some people tolerate one medication well but not another. Extended-release formulations and transdermal patches generally cause fewer problems than immediate-release tablets. Working with your doctor to find the right medication (or combination) at the right dose is often a process of trial and adjustment.

What if tablets don’t work for me?

If you’ve tried several medications without adequate improvement, or the side effects are intolerable, discuss a referral to a urologist or urogynaecologist. Specialist assessment can confirm the diagnosis (sometimes symptoms attributed to OAB have other causes like interstitial cystitis or bladder stones), optimise your current treatment, or offer advanced options.

Botox injections into the bladder can work well for people who haven’t responded to oral medications—around 60% see at least a 50% reduction in incontinence episodes. The effects last 6-9 months before needing repeat treatment.

Nerve stimulation therapies are another option. PTNS involves a series of outpatient sessions stimulating a nerve in the ankle. Sacral nerve stimulation requires implanting a small device (like a pacemaker) but can be highly effective for the right patients.

Practical Concerns

Should I be worried about the underlying cause?

OAB itself isn’t dangerous, but it’s worth ensuring the diagnosis is correct. Your GP will typically want to rule out urinary tract infections, which can cause identical symptoms, and in men, prostate problems that might need different treatment.

In most cases, OAB occurs without any serious underlying condition—the bladder muscle simply contracts when it shouldn’t. However, OAB can sometimes be a feature of neurological conditions like multiple sclerosis, Parkinson’s disease, or the aftermath of a stroke (neurogenic bladder). If your symptoms came on suddenly, are accompanied by other neurological symptoms, or are difficult to control, further investigation may be warranted.

Is OAB the same as incontinence?

Not exactly. OAB is defined by urgency—that sudden, compelling need to urinate that’s difficult to postpone. About one-third of people with OAB also experience urge incontinence (leaking before reaching the toilet), but two-thirds manage to stay dry despite the urgency.

Other types of incontinence have different causes. Stress incontinence involves leaking when you cough, sneeze, laugh, or exercise—it’s caused by weakness in the pelvic floor and urethral support rather than bladder overactivity. Some people have mixed incontinence, with features of both stress and urge incontinence.

Understanding which type (or types) you’re dealing with matters because treatments differ. Stress incontinence responds well to pelvic floor exercises and sometimes surgery, while OAB with urge incontinence is managed more through bladder training and medication.

How do I talk to my doctor about this?

Many people feel embarrassed discussing bladder problems, but GPs hear about these symptoms regularly—you won’t be telling them anything they haven’t dealt with before. Being specific helps: describe how often you go, whether you leak, how much urgency bothers you, and how symptoms affect your daily life.

Keeping a bladder diary for a few days before your appointment provides useful information. Record when you drink, when you urinate, and any urgency or leakage episodes. This gives your doctor objective data to work with.

If you find it hard to raise the topic, writing down what you want to say beforehand can help. You might also bring up the problem in writing—some practices offer the option to complete a questionnaire or send a message before your appointment.

Getting Support

The COB Foundation provides support and information for people with bladder conditions. Members can access detailed fact sheets on all the topics covered here, telephone support, and a “Can’t Wait” card to help with urgent toilet access.

Remember that OAB is common—you’re not alone in dealing with these symptoms, and effective help is available for most people. If your current approach isn’t working, there are always other options to try.