If you’re dealing with bladder problems, you’re probably wondering what can actually be done about them. There are more treatment options than most people realise, and with the right approach, significant improvement is common. Your GP or continence adviser can help you work out what’s likely to work best for your situation.

This article covers the main treatment categories: diagnostic tests, lifestyle and dietary changes, bladder training, pelvic floor exercises, and medications. Not everyone needs all of these, and treatment is usually tailored to your specific type of bladder problem.

Getting the Right Diagnosis First

Before starting any treatment, your healthcare provider will want to understand exactly what’s going on. This typically involves some combination of the following tests.

Urinalysis and Culture

A urine sample is tested to check for infection or blood. This is usually the first step, since urinary tract infections can cause or worsen many bladder symptoms. If an infection is found, treating it may resolve your symptoms entirely. For more on UTIs, see our article on urinary tract infections.

Bladder Diary

You may be asked to keep a record of when you urinate, how much comes out, what you drink, and any episodes of leakage. Most clinicians ask for 3 to 5 days of records. This might seem tedious, but it provides genuinely useful information that helps with diagnosis and treatment planning.

Bring your completed diary to your appointment. Patterns in the data often reveal things that aren’t obvious from a conversation alone, like whether you’re drinking too little fluid (which concentrates urine and irritates the bladder) or too much (which naturally increases frequency).

Physical Examination

Your GP may perform an internal examination to assess pelvic floor muscle strength, check for prolapse, or identify other physical factors contributing to your symptoms. This is particularly important for women, but men may also need a prostate examination.

Urodynamics

This test measures the pressure inside your bladder as it fills and empties. Sensors record how your bladder behaves, which helps identify whether the problem is with the bladder muscle itself, the sphincter, or the nerves controlling them. It’s not the most comfortable test, but it provides information that can’t be obtained any other way.

Videocystourethrography

This combines a flow pressure study with X-ray screening, giving a real-time picture of how your bladder and urethra work during filling and emptying. It’s typically reserved for more complex cases.

Uroflowmetry

This measures how quickly urine flows when you urinate. A slow or interrupted stream can indicate an obstruction (like an enlarged prostate in men) or problems with bladder muscle contraction. The test is non-invasive and simply involves urinating into a special toilet.

Residual Urine Test

Using an ultrasound bladder scanner, this test checks whether urine is left behind in the bladder after you’ve finished urinating. Incomplete emptying can contribute to frequency and urgency, and increases the risk of infections. The scan takes only a few seconds and doesn’t involve any needles or catheters.

Cystoscopy

A thin camera is inserted through the urethra to look inside the bladder. This can identify abnormalities like bladder stones, tumours, or inflammation. It’s often done under local anaesthetic, though some people have it under general anaesthetic. If you’re anxious about this procedure, it’s worth discussing the anaesthetic options with your doctor.

Lifestyle and Dietary Changes

For many people, changes to diet and fluid intake can make a real difference, sometimes enough to avoid other treatments entirely. According to NHS guidance, lifestyle modifications should typically be tried before medications 1.

Fluid Management

The standard recommendation is to drink between 1.5 and 2 litres per day. This sounds simple, but getting it right matters more than most people realise.

Too little fluid concentrates your urine, which irritates the bladder lining and can actually make urgency worse. Too much fluid means more trips to the toilet, which is obvious enough, but it can also stretch the bladder over time.

If nighttime urination (nocturia) is a problem, try reducing your fluid intake in the evening, particularly in the 2 to 3 hours before bed. Just make sure you’re still getting enough fluid earlier in the day.

What to Avoid

Certain drinks are known bladder irritants:

Caffeine: Found in coffee, tea, cola, and energy drinks. Caffeine is a diuretic (makes you produce more urine) and also directly irritates the bladder muscle. Many people find that cutting down on caffeine significantly reduces urgency and frequency.
Alcohol: Another diuretic that also interferes with the signals between your bladder and brain.
Carbonated drinks: The bubbles can irritate the bladder lining.
Artificial sweeteners: Some people find these worsen symptoms, though the evidence is mixed.

Foods That May Cause Problems

Acidic and spicy foods can irritate the bladder in some people. Common culprits include citrus fruits, tomatoes, vinegar, and heavily spiced dishes. Chocolate contains caffeine, so dark and milk chocolate may be problematic, though white chocolate is generally fine.

It’s worth keeping a food diary alongside your bladder diary to see if you can identify any personal triggers. What affects one person may not bother another at all.

Bladder Training

Bladder training is a structured programme designed to gradually increase the amount your bladder can hold and reduce urinary frequency. Research published in the Cochrane Database shows that bladder training is effective for urge incontinence and overactive bladder, with improvements maintained at follow-up 2.

The basic principle is straightforward: instead of going to the toilet whenever you feel the urge, you wait a little longer. Over time, you gradually extend these intervals.

How It Works

You’ll typically start by urinating at set intervals, perhaps every hour or every 90 minutes, regardless of whether you feel the need. Then, over several weeks, you gradually extend the time between scheduled toilet visits, aiming for intervals of 3 to 4 hours.

When you feel an urge between scheduled times, you use distraction techniques and pelvic floor exercises to suppress it. The urge usually passes within a few minutes if you can ride it out.

Tips for Success

Keep a bladder diary so you can see your progress
Expect setbacks, especially when you’re tired or stressed
Don’t be discouraged if progress is slow; it typically takes 6 to 12 weeks to see significant improvement
Combine bladder training with pelvic floor exercises for better results

Pelvic Floor Exercises

The pelvic floor muscles support the bladder and help control the sphincter. Weakness in these muscles contributes to both stress incontinence (leaking when you cough, sneeze, or exercise) and urge incontinence. For more information on pelvic floor problems, see our article on pelvic floor dysfunction.

Finding the Right Muscles

The easiest way to identify your pelvic floor muscles is to try stopping the flow of urine midstream. The muscles you use to do this are your pelvic floor muscles. However, don’t practice your exercises this way regularly, as it can interfere with normal bladder emptying.

Another way is to imagine you’re trying to stop yourself passing wind. The tightening sensation you feel is your pelvic floor contracting.

The Exercises

Once you’ve identified the muscles:

Squeeze and lift the pelvic floor muscles
Hold for up to 10 seconds (work up to this gradually)
Relax completely
Repeat 10 times
Do 3 sets per day

You should also practice quick, strong contractions (squeeze and release immediately) to train the muscles for when you cough or sneeze.

Common Mistakes

Holding your breath (keep breathing normally)
Tightening your buttocks or thighs (only the pelvic floor should be working)
Pushing down instead of lifting up
Expecting instant results (it takes 3 to 6 months of consistent practice to see real improvement)

Getting Help

A physiotherapist specialising in women’s health or continence can teach you to do the exercises correctly. They can also use biofeedback devices to show you when you’re contracting the right muscles. Some people find electrical stimulation helpful when they’re having trouble identifying or activating the pelvic floor.

Who Benefits?

Pelvic floor exercises work for both men and women, though they’re more commonly discussed for women. The muscles can be weakened by:

Pregnancy and childbirth
Prostate surgery in men
Chronic constipation and straining
Heavy lifting over many years
Chronic coughing
Being overweight
Hormonal changes during menopause

Medications

When lifestyle changes and exercises aren’t enough, medications can help. The right medication depends on your type of bladder problem. For a detailed look at medication options, see our medications guide.

Antimuscarinics (Anticholinergics)

These medications reduce bladder muscle contractions and are the most commonly prescribed drugs for overactive bladder and urge incontinence. Examples include oxybutynin, tolterodine, and solifenacin. For specific medication options for OAB, see our article on medication for overactive bladder.

Side effects can include dry mouth, constipation, and blurred vision. Extended-release formulations tend to cause fewer side effects than immediate-release versions. Some of these medications are available as patches or gels, which may suit people who can’t tolerate the oral forms.

Beta-3 Agonists

Mirabegron works differently from antimuscarinics, relaxing the bladder muscle during filling. It may be an option if antimuscarinics haven’t worked or cause troublesome side effects. The main side effects are increased blood pressure and urinary tract infections.

Desmopressin

This medication reduces urine production overnight and is sometimes used for nocturia. It’s particularly useful for people with nocturnal polyuria (producing too much urine at night). It requires monitoring, especially in older adults, because it can cause low sodium levels.

Topical Oestrogen

For post-menopausal women, oestrogen cream or pessaries applied locally can improve bladder and urethral tissue health. This may help with urgency, frequency, and recurrent infections. Systemic hormone replacement therapy doesn’t have the same local benefit.

Medications to Avoid

Certain medications can worsen bladder symptoms. Diuretics (water tablets) obviously increase urine production. Some blood pressure medications, antidepressants, and sedatives can also affect bladder function. If you’re taking any regular medications and having bladder problems, it’s worth discussing this with your doctor.

When Other Treatments Aren’t Enough

Most people improve with lifestyle changes, exercises, and medications. But if these approaches haven’t worked, there are additional options.

Botox Injections

Botulinum toxin can be injected into the bladder muscle to reduce overactivity. It typically lasts 6 to 12 months before needing to be repeated. The main risk is that the bladder may become too relaxed, requiring temporary self-catheterisation.

Nerve Stimulation

Sacral nerve stimulation involves implanting a small device that sends electrical impulses to the nerves controlling the bladder. It’s typically considered when other treatments have failed. A trial period is usually done first to see if it’s likely to help before the permanent implant.

Percutaneous tibial nerve stimulation is a less invasive option where a thin needle is inserted near the ankle to stimulate a nerve that connects to the bladder. It requires regular sessions over several weeks.

Surgery

Surgical options exist for specific problems. Stress incontinence may be treated with sling procedures or colposuspension. Severe overactive bladder that hasn’t responded to anything else might be considered for bladder augmentation surgery, though this is rare.

Working With Your Healthcare Team

Bladder problems can feel embarrassing to talk about, but remember that continence nurses and GPs deal with these issues every day. Being open about your symptoms helps them help you.

Treatment often involves some trial and error. What works brilliantly for one person may not suit another. If the first approach doesn’t work, there are usually other options to try.

Keep track of what helps and what doesn’t. Your observations matter to your healthcare team, and patterns often emerge over time that point toward what’s actually going to work for you.

References

NHS. (2024). Treatment - Urinary incontinence. https://www.nhs.uk/conditions/urinary-incontinence/treatment/
Wallace SA, Roe B, Williams K, Palmer M. (2004). Bladder training for urinary incontinence in adults. Cochrane Database of Systematic Reviews. https://pubmed.ncbi.nlm.nih.gov/24899499/
Mayo Clinic. (2023). Urinary incontinence - Diagnosis and treatment. https://www.mayoclinic.org/diseases-conditions/urinary-incontinence/diagnosis-treatment/drc-20352814