Overactive Bladder (OAB) with or without Urinary Incontinence (UI)

Women with OAB commonly experience a sudden and strong desire (urgency) to urinate that cannot be delayed. Some women with OAB lose urine on the way to the bathroom. Others may not actually lose urine but have urinary urgency, frequency (going to the bathroom more than normal), or nocturia (getting up more than once or twice to urinate at night). Involuntary bladder contractions are usually the underlying cause of OAB. Most women control their urinary urgency by deciding when it is convenient to urinate. With OAB, it is difficult to control the urinary urgency when the bladder is full. This appears to be caused by a communication problem between the brain and the bladder but we don't understand this completely. OAB is a chronic condition like diabetes and high blood pressure. The treatment is long term, but good control is achievable. Many women with OAB also have stress urinary incontinence (loss of urine with cough, sneeze, or activity). Treatment options below may help both incontinence subtypes.

Treatment Options

Non-Surgical Treatment

  • Do nothing or live with your condition.
    • It is very rare for OAB to result in any serious medical threat to you. You can choose to live with the symptoms if you feel that they are not too disruptive.
  • Behavioral modification
    • Lose weight: Excess weight puts extra pressure on the bladder and pelvic floor muscles. If you are overweight or obese, losing 10% of your body weight can dramatically improve symptoms.
    • Stop smoking: Smoking can lead to a chronic cough that strains pelvic floor muscles. Smoking may also damage the bladder and urethra. If you are a smoker, quitting smoking will help.
    • Times toileting: Going to the bathroom at regular (not too frequent) intervals, except when asleep, will help empty the bladder better and reduce urine loss.
    • Double voiding: Immediately after you urinate, try leaning forward and gently rocking back and forth, then standing, then sitting again while keeping the pelvic floor muscles relaxed. This will help empty the bladder better and reduce urine loss after you leave the bathroom.
    • Dietary and fluid modifications: Aim for 48-64 oz/fluid a day. Limit caffeine and alcohol consumption (less than 2 servings a day).
    • Other: Maintain regular and predictable bowel habits; avoid constipation; practice urgency suppression techniques.
  • Kegel exercises (pelvic floor exercises)
    • Identify the correct muscles by imagining you are trying to prevent passing of gas.
    • Keep your abdomen, hips and buttocks relaxed. Try to squeeze and hold these muscles for 5 seconds while continuing to breathe and then relax for 5 seconds.
    • Repeat this 10 times in a row, 3 sessions a day.
    • Do not practice kegels during voiding.
    • If unable to do kegels correctly, we can refer you to pelvic floor physical therapists.
    • Medications
  • Medications
    • Commonly used medications for OAB are known as anticholinergics. There are several available by prescription and one, Oxybutynin, is available as a generic. Common side effects of these medications are dry eyes / mouth and constipation.
    • Vaginal estrogen (cream, tab, or ring) can be applied directly to the vagina and that may help with OAB due to its indirect effect on the bladder.
  • Pelvic Floor Physical Therapy
    • This is a specialized form of therapy to help with pelvic floor muscle coordination and bladder habits, and to improve/resolve symptoms of urinary urgency, frequency, and leakage. Pelvic floor physical therapy can also help those who experience pelvic pain, constipation, and difficulty emptying the bladder. A specially trained physical therapist works with the patient on an individual basis after assessing her pelvic floor.
  • Biofeedback/Electrical stimulation
    • These can be used by the physical therapist as part of your pelvic floor physical therapy plan. They can be helpful in improving pelvic floor muscle coordination to help control urgency, frequency, and leakage, as well as increased pelvic floor muscle strength. With proper training you may be able to use these devices at home.
  • PTNS (Percutaneous Tibial Nerve Stimulation)
    • Offered to those patients for whom multiple other interventions have not helped. PTNS is an office treatment requiring 12 weekly sessions, lasting 30 minutes each. A small, thin needle electrode is temporarily placed near the ankle and is connected to a battery-powered stimulator. The stimulator sends an impulse through the leg nerve to the nerves in the sacrum which innervate the bladder. PTNS is designed to treat OAB symptoms by slowing down and softening signals to and from the bladder.

Surgical Treatment

  • Neuromodulation (Interstim)
    • This is a 2-step procedure. In step 1, a very thin wire is placed in the lower back to electrically stimulate the bladder nerves. If this works well the patient proceeds to step 2, when a wire is connected to a ''pacemaker'' placed in the buttocks to electrically stimulate the bladder nerves. Both steps are done as outpatient surgery. Interstim may help patients who have failed nonsurgical treatments.
  • Others (e.g. botox injection in the bladder)


For over a century, a leader in patient care, medical education and research, with expertise in virtually every specialty of medicine and surgery.

About BWH