Name: OAB Treatments: Managing Overactive Bladder
Creator: COB Foundation
Published: 2018-12-13T00:00:00.000Z

Overactive bladder affects roughly 12-17% of adults, yet many people suffer in silence for years before seeking help. If you’re constantly scouting for the nearest toilet, waking multiple times a night, or occasionally not making it in time, you’re not alone. There are treatment options that can make a real difference.

I want to be upfront about something: there’s no magic cure for OAB. Treatment usually means management rather than elimination of symptoms. But don’t dismiss “management” as a consolation prize. Reducing urgency episodes from ten per day to two or three changes lives. Most people can achieve meaningful improvement, even if they don’t become completely symptom-free.

This article covers the main treatment approaches from conservative measures through to advanced interventions. The typical treatment pathway starts simple and escalates as needed, which makes sense both clinically and practically.

Starting Point: Lifestyle and Behavioural Approaches

Before reaching for medications, most guidelines recommend trying lifestyle modifications and behavioural therapies first. This isn’t just about saving money or avoiding side effects—these approaches genuinely work for some people. The National Institute for Health and Care Excellence (NICE) recommends supervised pelvic floor muscle training for at least three months as first-line treatment for women with OAB 1.

Bladder Training

Your bladder can learn bad habits. If you’ve spent years rushing to the toilet at the first twinge of urgency, your bladder has essentially been trained to demand attention at increasingly small volumes. Bladder training aims to reverse this.

The basic approach involves gradually extending the time between toilet visits. If you currently go every hour, you’d try to stretch to 75 minutes, then 90 minutes, and so on over several weeks. When urgency strikes, instead of immediately rushing to the bathroom, you stay still, do a few pelvic floor contractions, take slow breaths, and wait for the wave to pass. It usually does within a minute or two.

This sounds almost too simple to work, but studies show bladder retraining reduces incontinence episodes by 50-80% in some patients 2. The catch is that it requires consistent effort over 6-12 weeks. Many people give up too early.

For detailed guidance on implementing bladder training and other behavioural techniques, see our article on lifestyle changes for bladder health.

Pelvic Floor Exercises

Strengthening the pelvic floor helps with both urge incontinence (the sudden “I can’t hold it” leakage) and stress incontinence (leakage with coughing, sneezing, or exercise). For OAB specifically, strong pelvic floor contractions can help suppress urgency signals.

The classic Kegel exercise involves tightening the muscles you’d use to stop urinating mid-stream (though you shouldn’t actually practise while urinating). Hold for a few seconds, relax, repeat. Aim for 8-12 repetitions, three times daily.

Most people do these exercises incorrectly at first. Common mistakes include bearing down instead of lifting up, holding your breath, or engaging the wrong muscle groups entirely. A physiotherapist specialising in pelvic health can teach proper technique and confirm you’re activating the right muscles. Biofeedback devices can help too.

Results typically take three to six months to become apparent, and you need to continue the exercises long-term to maintain benefits. For more on pelvic floor issues, see our article on pelvic floor dysfunction.

Dietary Changes

What you eat and drink genuinely affects bladder function. Caffeine is probably the most significant culprit—it’s both a diuretic (increases urine production) and appears to directly stimulate the bladder muscle 3. Heavy caffeine consumers who cut back often notice improvement within days.

Alcohol, carbonated drinks, citrus fruits, tomatoes, artificial sweeteners, and spicy foods can all trigger symptoms in susceptible people. The frustrating reality is that individual responses vary enormously—what bothers one person might be perfectly tolerable for another.

Fluid management matters too. Drinking too little concentrates your urine, which can irritate the bladder. Drinking too much floods it. Most adults do well with 1.5-2 litres daily, spread throughout the day rather than consumed in large boluses.

Our detailed guide on dietary changes for OAB covers all of this in more depth, including how to systematically identify your personal triggers through an elimination approach.

Products That Help

While working on longer-term treatments, practical products can make daily life more manageable. Absorbent pads and pants provide security against leakage, and bed protectors save mattresses from nighttime accidents. Skin barrier creams prevent irritation from frequent wetness.

Using these products doesn’t mean giving up on treatment. It means managing practically while other interventions take effect. Modern continence products have improved enormously since the bulky options of decades past.

For people with dry mouth from medications, specialised products including artificial saliva sprays, moisturising gels, and toothpastes designed for dry mouth can help manage this common side effect.

Our article on products for living with OAB provides a comprehensive overview.

Medications

When lifestyle measures aren’t providing sufficient relief, medications become the next consideration. Most people with OAB will try at least one pharmaceutical treatment at some point. Understanding your options helps you have more productive conversations with your doctor.

Anticholinergics (Antimuscarinics)

These drugs have been the mainstay of OAB treatment for decades. They work by blocking acetylcholine, a chemical messenger that triggers bladder muscle contractions. By reducing these signals, the bladder relaxes and can hold more urine before demanding attention.

Several anticholinergics are available, including oxybutynin (Cystrin, Ditropan, Lyrinel XL), tolterodine (Detrusitol), solifenacin (Vesicare), fesoterodine (Toviaz), and trospium chloride (Regurin). Extended-release formulations generally cause fewer side effects than immediate-release versions.

The downside is that anticholinergics affect acetylcholine throughout the body, not just in the bladder. Common side effects include dry mouth (affecting 20-30% of users), constipation, dry eyes, and blurred vision. For older adults, there’s genuine concern about cognitive effects. A major study found that long-term anticholinergic use was associated with increased dementia risk 4. This doesn’t mean everyone should avoid them, but it’s a consideration worth discussing with your doctor, especially if you’re over 65 or already taking other medications with anticholinergic properties.

Beta-3 Agonists

Mirabegron (Betmiga) and vibegron work differently. They activate beta-3 receptors in the bladder muscle, causing it to relax during filling. Because they don’t block acetylcholine, they avoid the dry mouth, constipation, and cognitive concerns associated with anticholinergics.

The trade-off is a different side effect profile. Urinary tract infections occur in about 3% of users. There’s also potential for increased heart rate and blood pressure, making these drugs unsuitable for people with poorly controlled hypertension or certain heart conditions.

For older patients particularly worried about cognitive effects, beta-3 agonists represent a genuine alternative to anticholinergics.

Combination Therapy

Some people benefit from taking both an anticholinergic and a beta-3 agonist together when neither alone provides adequate relief. This isn’t first-line treatment, but it’s an option for refractory cases.

Desmopressin for Nocturia

If waking at night to urinate is your primary problem, desmopressin may help. This synthetic hormone reduces overnight urine production, so your bladder fills more slowly while you’re trying to sleep. It’s also used for bedwetting (nocturnal enuresis) in children and adults.

The main concern is hyponatraemia (low blood sodium), which requires monitoring, especially in older adults.

For comprehensive coverage of all OAB medications, including specific drug names, dosing considerations, and detailed side effect information, see our dedicated article on medication for overactive bladder.

When Tablets Don’t Work: Advanced Treatments

Some people don’t respond adequately to oral medications, or can’t tolerate the side effects. Several advanced treatment options exist for these situations.

Botulinum Toxin (Botox) Injections

Botox isn’t just for wrinkles. When injected directly into the bladder wall during a cystoscopy (a procedure where a thin camera is passed into the bladder), botulinum toxin blocks the nerve signals causing unwanted contractions.

The results can be impressive. Around 60% of patients achieve at least a 50% reduction in incontinence episodes 5. Effects typically last six to nine months before wearing off, at which point the injections need repeating.

The main risk is urinary retention (difficulty emptying the bladder completely), which occurs in roughly 5-10% of patients. Before having the procedure, you need to be comfortable with the possibility of learning intermittent self-catheterisation (ISC) to empty your bladder if this happens. Urinary tract infections are also more common after Botox treatment.

Botox for OAB is usually only available through specialist clinics after other treatments have failed.

Percutaneous Tibial Nerve Stimulation (PTNS)

PTNS involves inserting a small needle near the ankle and passing a mild electrical current to stimulate the tibial nerve. This nerve shares a pathway with the nerves controlling the bladder, and the stimulation appears to help regulate bladder activity. The exact mechanism isn’t fully understood, but it works for many people.

Treatment typically involves weekly 30-minute sessions for 12 weeks, followed by maintenance sessions. It’s minimally invasive with few side effects. Studies report that 60-80% of patients see improvement, though the effect is often more modest than with Botox 6.

Sacral Nerve Stimulation (SNS)

Sacral neuromodulation (brand name InterStim) is a more involved option. It’s essentially a pacemaker for the bladder—a device implanted near the sacral nerves that delivers continuous low-level electrical stimulation.

Before permanent implantation, patients undergo a trial period with a temporary external stimulator. Those who respond well can then have the permanent device surgically implanted.

SNS can be highly effective for carefully selected patients, but it involves surgery, and devices occasionally need adjustment or replacement. It’s generally reserved for people who haven’t responded to other treatments.

Sometimes what looks like OAB has additional contributing factors that need addressing.

Constipation is a common culprit. The bladder and rectum sit close together in the pelvis; a full rectum presses on the bladder and can trigger urgency. Simply sorting out chronic constipation improves bladder symptoms for many people.

Urinary tract infections can cause or worsen OAB symptoms. If you’re experiencing new or worsening urgency, especially with burning or frequent infections, treating the underlying UTI may resolve the problem.

For women, pelvic organ prolapse or atrophic vaginitis (vaginal tissue changes after menopause) can contribute to bladder symptoms. Addressing these conditions may help OAB.

In men, benign prostatic hyperplasia (enlarged prostate) causes lower urinary tract symptoms that overlap significantly with OAB. Treatment approaches differ, so accurate diagnosis matters. See our article on OAB in men for more specific information.

Building a Treatment Plan

Most specialists follow a stepped approach:

Step 1: Lifestyle modifications, bladder training, pelvic floor exercises. Give this a genuine trial—at least six to twelve weeks of consistent effort—before concluding it isn’t working.

Step 2: Add medication if behavioural approaches aren’t sufficient. Your doctor may try several different drugs to find one that works adequately without intolerable side effects.

Step 3: If oral medications fail or cause problems, consider specialist referral for advanced options like Botox or neuromodulation.

Throughout all steps, continue with lifestyle modifications. Medications and procedures work better when combined with behavioural approaches than when used alone.

Finding Help

OAB is undertreated partly because people are embarrassed to discuss it. But doctors and continence nurses deal with bladder problems daily—there’s nothing you can tell them they haven’t heard before.

If lifestyle changes and initial treatments aren’t helping, ask your GP for referral to a urologist (for men) or urogynaecologist (for women). Specialist assessment can confirm the diagnosis and rule out other conditions that mimic OAB. You’ll also get access to advanced therapies not available through general practice.

The COB Foundation offers support and information for people with bladder conditions. Our OAB FAQ addresses common questions, and you can contact us for additional resources.

OAB is a chronic condition, and managing it often requires ongoing attention. But most people can achieve meaningful improvement with the right combination of treatments—it’s about finding what works for you.