Overactive Bladder

Overview

• Overactive bladder (OAB) is a common bladder problem; it means the bladder muscle squeezes (contracts) on its own, even when the bladder is not full
• This causes a sudden, strong urge to pass urine that is hard to hold on to; it can also make you pass urine very often, including at night
• OAB is not simply “part of getting old”; it can affect adults of any age and both men and women

How common is overactive bladder?

• Studies from across the world show that about 1 in 5 adults (20%) live with OAB
• A large United States study found OAB symptoms in about 1 in 6 adults (16.5%), affecting men and women almost equally
• OAB becomes more common with age, especially after 60 years
• It is somewhat more common in women, but a growing number of men are also affected

Who is commonly affected?

• Older adults, especially those above 60 years
• Women, especially after the menopause
• People who are overweight or obese
• People with diabetes, a past stroke, Parkinson’s disease or multiple sclerosis
• Anyone can get OAB, it is not only an “old age” problem

What causes overactive bladder?

• In OAB, the muscle wall of the bladder (called the detrusor muscle) squeezes at the wrong time, even when the bladder is not full; this gives a sudden urge to pass urine
• In most people, doctors cannot find one single, exact cause; this is then called “OAB syndrome”

Some things that can cause or worsen OAB symptoms:

• Urine infection
• Bladder stones or growths
• Nerve-related illness, such as stroke, Parkinson’s disease or multiple sclerosis
• Previous surgery in the pelvic area
• Being overweight
• Caffeine, alcohol and fizzy drinks, which can irritate the bladder

Symptoms of overactive bladder

• Urgency: A sudden, strong need to pass urine that is hard to put off
• Frequency: Passing urine more often than usual, generally more than 7–8 times a day
• Nocturia: Waking up more than once at night to pass urine
• Urge incontinence: Leaking urine before you can reach the toilet (this happens in some, not all, people with OAB)

Warning signs: See a doctor without delay

• Blood in your urine
• Pain or a burning feeling when passing urine
• Fever along with urinary symptoms
• Sudden difficulty passing urine at all

Diagnosis and investigations

• History and examination: Your doctor will ask about your symptoms and may examine your abdomen
• Urine test: To check for infection
• Bladder diary: Note down the times and amounts of urine you pass, usually for 3 days; this is one of the most useful tests
• Post-void residual scan: A simple ultrasound to check if your bladder is emptying fully
• Urodynamic tests: Special tests that measure the pressure inside your bladder; these are only done if the diagnosis is not clear

What to expect

• Most tests for OAB are simple and quick and can usually be done as an outpatient
• Filling in your bladder diary honestly and completely helps your doctor understand your symptoms far better
• Your doctor will go through the results with you and agree a treatment plan together with you

Treatment options

Step 1: Lifestyle changes

• Cut down on caffeine as tea, coffee and cola can irritate the bladder
• Cut down on fizzy drinks and alcohol
• Drink a normal amount of fluid, about 6–8 glasses (1.5–2 litres) a day; do not cut fluids down too much, as this can make symptoms worse
• Cut down spicy and citrus foods if you find they irritate your bladder
• Try to lose weight if you are overweight
• Treat constipation early, as straining can make OAB worse

Step 2: Bladder training

• You slowly increase the time between toilet visits, a little at a time
• This usually needs to be continued for at least 6 weeks
• Over time, it helps your bladder hold more urine and reduces urgency

Step 3: Pelvic floor muscle exercises

• These exercises strengthen the muscles that support your bladder
• Aim for at least 8 squeezes, 3 times a day, continued for at least 3 months

Step 4: Medicines

• Tablets called antimuscarinics or newer medicines such as mirabegron or vibegron, help relax the bladder muscle
• These medicines can take 4–8 weeks to show their full effect
• Common side effects include a dry mouth and constipation

Step 5: Advanced treatments (if the above do not help)

• Botox injection into the bladder wall
• Nerve stimulation, given through the ankle or lower back
• Surgery is rarely needed and only in severe, difficult cases

Living well with overactive bladder

• Keep a bladder diary from time to time to track your progress
• Keep doing your pelvic floor exercises even after your symptoms improve
• Ask your doctor to review your medicines every 6–12 months
• Talk openly with your doctor; OAB is common and very treatable, so there is no need to feel embarrassed

When to contact a doctor

• Your symptoms are affecting your daily life, work or sleep
• You notice blood in your urine
• You have pain or a burning feeling when passing urine
• Your symptoms are getting worse despite lifestyle changes
• You notice new weakness, numbness or other unusual symptoms

References

1. Urology Care Foundation. Overactive Bladder (OAB): Symptoms, Diagnosis & Treatment [online]. Available from: https://www.urologyhealth.org/urology-a-z/o/overactive-bladder-(oab). Accessed on: 16 July 2026.
2. NHS. Urinary incontinence — Symptoms [online]. Available from: https://www.nhs.uk/conditions/urinary-incontinence/symptoms/. Accessed on: 16 July 2026.
3. Patient.info. Overactive Bladder Syndrome (OAB): Symptoms and Treatment [online]. Available from: https://patient.info/womens-health/lower-urinary-tract-symptoms-in-women-luts/overactive-bladder-syndrome-oab. Accessed on: 16 July 2026.
4. Zhang L, Cai N, Mo L, et al. Global prevalence of overactive bladder: a systematic review and meta-analysis. Int Urogynecol J. 2025;36(8):1547–1566.
5. Stewart WF, Van Rooyen JB, Cundiff GW, et al. Prevalence and burden of overactive bladder in the United States. World J Urol. 2003;20(6):327–336.
6. Cheng Y, Chen T, Zheng G, et al. Prevalence and trends in overactive bladder among men in the United States, 2005–2020. Sci Rep. 2024;14(1):16284.
7. National Institute for Health and Care Excellence (NICE). Urinary incontinence and pelvic organ prolapse in women: management. NICE guideline NG123 [online]. Available from: https://www.nice.org.uk/guidance/ng123. Accessed on: 16 July 2026.
8. NHS. Urinary incontinence — Non-surgical treatment [online]. Available from: https://www.nhs.uk/conditions/urinary-incontinence/treatment/. Accessed on: 16 July 2026
9. NHS. Urinary incontinence — 10 ways to stop leaks [online]. Available from: https://www.nhs.uk/conditions/urinary-incontinence/10-ways-to-stop-leaks/. Accessed on: 16 July 2026