What Can Be Done for Overactive Bladder?

When doctors do a full examination, only about 8 percent of patients are diagnosed with overactive bladder, but that still means that the condition is a problem for tens of millions of people. It's relatively easy just to pop a pill so you won't go to the bathroom as often, but medication is just one of several options.

• The first line of treatment is behavioral therapy. Bladder training teaches patients to become aware of the relationship between their eating habits and activity patterns and episodes of incontinence. Typically patients are told to be sure to empty their bladders as soon as they wake up in the morning. They are put on a schedule of bathroom breaks and told not to go to the bathroom when they aren't on a break, and to empty their bladders even if they don't feel an urge when they are on a bathroom break. (There is no schedule at night. If you have to go, you go.) If there is a strong urge to urinate off schedule, then patients are told to use deep breathing and hold-it-in techniques for at least five minutes before they slowly go to the bathroom. Bathroom breaks are scheduled farther and farther apart so that eventually the patient only needs to go every three to four hours. Bladder training alone is enough to cure overactive bladder in about 75 percent of cases.
• Pelvic floor muscle training teaches patients how to contract pelvic floor muscles in ways that relax the detrusor muscle, the round muscle around the urinary canal that keeps the urinary sphincter closed as long as it is relaxed. While these exercises are best learned from a professional, simply stopping and restarting the urine stream at will when urinating approximates their effect. Pelvic floor muscle training exercises need to be done 30 to 80 times a day for six to twelve weeks. They are especially helpful for younger women, but they are not very useful for older men or for patients who have limited mobility.
• A vaginal cone can help women strengthen the pelvic floor muscles that keep the urinary sphincter closed. Holding the cone in place in the vagina for 15 minutes at a time twice a day for six to twelve weeks strengthens muscles enough to prevent urinary incontinence and urgent urination in about 80 percent of women who use it.
• Biofeedback-assisted pelvic floor muscle training incorporates a sensor (placed in the vagina of women or the anus of men) to tell the patient when they are doing their strength exercises correctly. About 15 percent of patients are cured of overactive bladder when they use this technique.

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• The medication oxybutynin (sold under the trade names Ditropan, Gelnique, and Oxytrol) antagonizes the nerves that tell the sphincter of the bladder to open. It can reduce the frequency of urination, but it can also cause dry mouth, constipation, blurred vision, drowsiness, and dizziness. Oxybutynin reduces the frequency of urination in about 65 percent of patients who use it, less than than bladder training or pelvic flood muscle training, but with the added benefit of stopping bladder spasms.
• Doctors often recommend avoiding chocolate, alcoholic beverages, carbonated beverages, spicy foods, and high-potassium fruits and vegetables, but there are no clear data showing that these dietary changes are helpful.

Bringing overactive bladder under complete control may require more than one method, but medication is not necessarily a must. Many people find longer lasting relief with fewer side effects from bladder training and pelvic floor exercises.