Overactive Bladder Self-Care for Relief and Control

While overactive bladder (OAB) can cause distress and affect your quality of life, self-care remedies can help you better control bladder spasms and reduce frequent urination and pain. These “fixes” include lifestyle modifications, pelvic floor exercises, fluid management, and the appropriate use of over-the-counter (OTC) and prescription medications.

By addressing both the physical and emotional aspects of OAB, people with overactive bladder can learn to gain control of a condition that affects up to 33% of females and 16% of males at some point in their lives.

Overactive Bladder Self-Care Suggestions

Overactive bladder is a common condition in which you experience the frequent and often urgent need to urinate (“pee”) along with a loss of bladder control or bladder leakage.

OAB has many possible causes, including diseases like diabetes and multiple sclerosis (MS) that cause bladder nerve dysfunction, hormonal changes during menopause that weaken pelvic floor muscles, obstructive conditions like an enlarged prostate or chronic constipation, or medications and substances (like caffeine) that irritate the bladder or promote urination.

The severity of OAB can be further intensified by anxiety caused by the inability to cope with the daily rigors of living with bladder pain and leakage.

To this end, OAB requires more than just medications; it requires an adjustment of lifestyle and better coping skills to manage this common but often distressing urological condition.

Dietary Changes

One of the primary ways to manage OAB is to adjust your diet. This includes avoiding foods and beverages that irritate the bladder and increasing dietary fiber to alleviate chronic constipation.

While there is not an OAB diet per se, there are certain foods and beverages you should eat and avoid to better control your symptoms.

Lifestyle and Habits

The same lifestyle practices that govern good health can benefit people with OAB. The healthier you are, the better you will be at controlling OAB. This not only includes eating a healthier diet but also changing habits that contribute to bladder spasms and leakage.

Chief among these lifestyle modifications are:

• Losing excess weight: Having obesity, defined as a body mass index (BMI) of 30 or over, increases the risk of OAB by up to 95%. Studies have shown that weight loss of just 10% in women with obesity may reduce the frequency of bladder leakage by up to 60%.
• Quitting cigarettes: Cigarette smoke irritates the bladder and independently increases the risk of OAB by up to twofold. Quitting cigarettes has been shown to significantly decrease the risk of urinary urgency common in people with OAB.

Mental Health

Studies have shown that the stress associated with OAB can severely impact a person’s self-image and quality of life. leading to depression, isolation, and a loss of self-efficacy (the ability to manage your life). This, in turn, can lead to a worsening of OAB symptoms.

According to research published in the journal PeerJ, mental resilience is key to coping and living well with OAB. This involves:

• Education: Educating yourself about OAB, including treatment options and control rates, increases self-efficacy and allows you to participate more fully in your care. People who do so tend to solve problems in a more positive way and have lower rates of recurrence.
• Increasing social support: Joining a support group or engaging with loved ones about your condition can reduce the stress and stigma surrounding OAB. Higher degrees of social support are directly linked to greater degrees of mental resilience.
• Psychotherapy: Cognitive behavioral therapy (CBT) can help people identify and change negative emotional responses to OAB symptoms. Learning not to overreact to flare-ups improves one’s ability to self-manage OAB.

Stress management techniques, including meditation, guided imagery, and deep breathing exercises, may alleviate anxiety and help reduce bladder pain during acute flare-ups.

Pelvic Physical Therapy

OAB is characterized by the loss of bladder control, also known as urinary incontinence. One of its primary causes is the weakening of the pelvic floor muscles that support the pelvic organs, including the bladder and urethra (the tube through which urine exits the body).

When pelvic floor muscles weaken due to age and other reasons, the pelvic organs will drop, causing valves in the bladder and urethra (called urinary sphincters) to become distorted and less able to close tightly.

Pelvic floor exercises—known as Kegel exercises—can quickly and effectively strengthen these muscles, restoring the normal position of pelvic organs and reducing bladder leakage in people of any sex.

Kegel exercises are performed several times daily on an ongoing basis (see Pelvic Floor Exercises below). With consistent practice, you may begin to see improvements within several months.

Bladder Retraining

People with OAB will often become trapped in the habit of rushing to the bathroom every time the urge to pee strikes. This can increase the anxiety and stress that aggravates OAB symptoms.

Bladder retraining is a behavioral therapy used to break this cycle. It teaches you how to gradually hold your urine for longer and longer periods. The only tools you need are a journal and a watch.

Bladder retraining involves the following steps:

1. For the first two days, record when you go to the bathroom, day and night.
2. Next, calculate how many hours you typically go between trips to the bathroom.
3. Add 15 minutes to this calculation. This is the target interval you will aim to hold it in for.
4. At the beginning of each morning, empty your bladder fully.
5. If the urge to pee strikes before the target interval, hold it in for as long as you can.
6. If you reach the target interval without the urge to pee, go anyway.
7. Each week, extend the target by another 15 minutes until you are eventually able to hold your urine for two to four hours.

With consistency, you should start experiencing significant improvements within six weeks.

OTC Medications and Devices

Nonprescription medications, supplements, and devices can be combined with other treatments to manage OAB.

These include:

• AZO Bladder Control: This brand-name supplement made of pumpkin seed extract and soy germ extract is a natural remedy for OAB. A 12-week study suggested that the daily use of the supplement can reduce bladder leakage and urgency without notable side effects.
• Chinese herbs: A small older study among women with OAB reported that Gosha-jinki-gan (GJG), a traditional Chinese remedy composed of 10 different herbs, reduced the frequency of daytime urination by around 30%.
• Oxytrol (oxybutynin) transdermal patch: This is the only OTC medication approved by the Food and Drug Administration (FDA) for treating OAB. The patch is applied to the skin. The antispasmodic drug helps reduce urinary urgency and bladder spasms.
• Toilet stool: Bladder leakage often occurs when the bladder cannot be fully empty. Devices like Squatty Potty can help by elevating your feet while seated on the toilet. The squatting position redirects the urethra so that urine flow is less impeded.
• Vaginal pessary: This is a disc-shaped silicone device inserted into the vagina traditionally used to treat pelvic organ prolapse. A 2018 study from Greece reported that the use of pessaries in women with OAB reduced the number of urinations per day by 24%.
• Vitamin D: Vitamin D contributes to the normal function of the bladder muscle. A five-year study of 10,474 men found that the long-term use of vitamin D3 (cholecalciferol) reduced the risk of OAB by just over 50%.

Following a Prescription Medication Schedule

Two primary classes of drugs are used to treat OAB, called anticholinergic and beta-3 adrenergic agonists.

Antimuscarinic anticholinergics, the most commonly prescribed drugs for OAB, block the action of action of acetylcholine, a chemical messenger that stimulates bladder contractions. Anticholinergics approved by the FDA include.

• Detrol (tolterodine)
• Ditropan XL (oxybutynin)
• Enablex (darifenacin)
• Sanctura (trospium)
• Toviaz (fesoterodine)
• Vesicare (solifenacin)

Beta-3 adrenergic agonists target cells in the bladder known as beta-3 receptors. When activated, these receptors relax the smooth muscles of the bladder. Beta-3 agonists approved by the FDA include:

• Gemtesa (vibegron)
• Myrbetriq (mirabegron)

Except for Sanctura (which is taken twice daily, one hour or more before meals), all other drugs are taken once daily with or without food. The dose should be taken at the same time every day with a full glass of water. Tablets should be swallowed whole and not crushed, chewed, or split.

Beta-3 adrenergic agonists do not have typical side effects of anticholinergics, including dry mouth and constipation. Also, their safety may be better for older people.

Pelvic Floor Exercises

Kegel exercises can help prevent or control urinary incontinence. They are performed on an ongoing basis to help maintain strong pelvic floor muscles.

Kegel exercises help reduce the frequency and embarrassment of bladder leakage and may also reduce the severity of spasms by better supporting the bladder.

While there are several variations of Kegel exercises, the same basic principles that follow are applied to each:

1. Lie on your back on a firm surface.
2. Locate your pelvic floor muscles. These are the muscles you use to stop urine flow while peeing.
3. Tighten your pelvic floor muscles, holding for three to five seconds.
4. Release and relax for three seconds.
5. Repeat for a total of 10 repetitions.

Perform Kegels at least three times per day. Once you’ve mastered them while lying down, you can do them while sitting or standing.

When to Use vs. Avoid Kegels

Kegels are an excellent treatment for urinary incontinence, used on their own for mild cases or in combination with other treatments for severe cases. They are especially beneficial to people who experience incontinence due to:

Kegels are not intended for people with pelvic pain or urinary urgency without leakage. In such cases, strengthening the pelvic floor muscles may make symptoms worse.

If you have OAB, work with your healthcare provider to build a holistic strategy to treat all of your symptoms. You can also ask for a referral to a physical therapist specializing in OAB and urologic dysfunction.

After Provider Visits

Depending on the severity of your symptoms, managing OAB may involve multiple providers and treatments. Specialist treatments may help when conservative treatments fall short.

Examples include:

• Botox injections: Botox (onabotulinumtoxinA) can provide longer-lasting relief from OAB symptoms. It can take up to 12 weeks to feel the effects. Treatment may be needed every six to 12 months to maintain control.
• Intermittent catheterization: This involves using a urinary catheter to help drain the bladder when you cannot do so on your own. If self-catheterization is needed, you will be taught how to insert, remove, and clean catheters to avoid infection and injury.
• Percutaneous tibial nerve stimulation (PTNS): This FDA-authorized treatment delivers a gentle electrical pulse into your ankle to help “silence” the nerve that controls the bladder. This minimally invasive procedure is given once weekly in 12 30-minute sessions.
• Surgeries: Augmentation cystoplasty is a surgery to enlarge the bladder. While effective in stopping incontinence, you’ll need to permanently use catheters afterward to fully empty the bladder.

What to Do During an Overactive Bladder Flare

Even people who are managing their condition consistently and correctly can still experience OAB flares. When these occur, a few fast, simple steps you can take to ease cramping, pain, and urgency are:

1. Stop what you are doing and sit or lie down quietly. Pacing or moving will only make things worse.
2. Squeeze your pelvic floor muscles as you would for Kegels. Keep the muscles tense with conscious contractions, not by holding them with your hands.
3. Try diaphragmatic breathing, also known as belly breathing. This stress-reduction technique can take your mind off your symptoms while relaxing the abdomen.
4. When your body is relaxed and you have a clear shot to the bathroom, get up quietly and walk (not run) to the bathroom. Continue breathing slowly while squeezing your pelvic muscles.

OAB Postoperative Self-Care

Augmentation cystoplasty, which involves the grafting of your own intestinal tissues to enlarge the bladder, is one of the more extreme treatments of OAB. It is reserved for when all other options fail and your ability to function is severely compromised. Even so, it can be highly effective in relieving OAB symptoms.

In properly selected candidates, augmentation cystoplasty has around a 90% success rate in both increasing urinary capacity and fixing incontinence.

Upon completion of the surgery, you would return home with a fixed Foley catheter in your urethra and a tube called a suprapubic tube inserted into your bladder through the abdomen.

You will be shown how to irrigate your bladder via the suprapubic tube and be given low-dose antibiotics to prevent infection until the catheter and tube are removed (usually after three weeks). Your surgeon will then want to check if the bladder is healing properly.

Recovery from the augmentation cystoplasty can take up to three months, though many people return to work or school within six weeks. Heavy lifting and physical exertion are avoided until then.

Because the bladder will have lost its ability to fully contract, you will need to permanently use intermittent catheters to fully drain the bladder.

Summary

Self-care for overactive bladder may involve changes in diet, smoking cessation, weight loss, Kegel exercises, and bladder retraining. Improved mental health with regular social support and stress management techniques can also help.

In addition to OTC drugs like Oxytrol patches, prescription anticholinergics and beta-3 adrenergic agonists can help support self-care treatments. If conservative treatments fail, your healthcare provider may recommend Botox injections, intermittent catheters, electrical stimulation, or surgery to relieve symptoms and improve your quality of life.