UTI Information Service
UTI Information Service
Please note: the information below does not constitute medical advice. If you have any concerns at all, speak to your GP or consultant.
Approved: November 2024
Review date: November 2026
Overactive bladder (OAB) is a common condition characterised by urgent and frequent urination, affecting many people across the UK. This can also include urge incontinence where there is involuntary leakage following an urgent need to urinate. These symptoms can significantly disrupt everyday activities, including sleep, work, and social life.
The exact cause of OAB isn’t fully understood, but it’s thought to involve:
A key issue in overactive bladder (OAB) involves the detrusor muscle, which forms the wall of the bladder. In OAB, this muscle contracts involuntarily even when the bladder isn’t full, causing an urgent need to urinate. These involuntary contractions are sometimes referred to as bladder spasms.
Normally, the detrusor muscle should only contract when you’re ready to urinate, and relax to allow the bladder to fill. However, in OAB, these contractions occur unpredictably, leading to symptoms like frequent urination, urgency, and in some cases, urge incontinence. The exact cause of these involuntary contractions is not always clear, but they can be influenced by neurological factors, hormonal changes such as those relating to the menopause, bladder inflammation, or obstructions like an enlarged prostate in males.
Declining levels of oestrogen affect the tissues of the bladder, urethra, vagina and pelvic floor, making them thinner, drier, and more fragile. This group of changes is known as Genito Syndrome of Menopause or GSM. A less stretchy bladder can signal the need to pass urine more often, even when it isn’t full. The urethra can be become less supported so the ‘urgent’ sensation can feel stronger and leaks can happen more easily. Vaginal tissues sit right next to the bladder and urethra and irritation in this area can sensitise the nerves feeding the bladder, contributing to burning and urgency, frequency, and discomfort during sex. The loss of oestrogen also can weaken the pelvic floor muscle, reducing the bladder’s ability to ‘hold on’ Lastly, lower oestrogen affects the vaginal microbiome, making UTI’s more common.
Diuretics: Commonly known as water pills, diuretics are often prescribed to treat high blood pressure and fluid retention. They work by increasing the amount of water and salt expelled from the body as urine. While effective for their intended uses, they can also lead to increased bladder filling and, consequently, more frequent urges to urinate.
Alpha Blockers: Used primarily to treat high blood pressure and prostate enlargement, alpha blockers can relax the muscle fibres in the prostate and bladder neck. This relaxation can improve urine flow but might also lead to greater urinary frequency and urgency as the bladder adapts to easier urine flow.
High fluid intake: Consuming a large amount of liquids can naturally lead to increased urine production, which challenges the bladder’s capacity and can worsen symptoms of OAB, especially if fluid intake is not balanced throughout the day.
Excessive consumption of caffeine or alcohol: Both substances have diuretic effects, promoting increased urine production. Additionally, caffeine can irritate the bladder’s lining, and alcohol can disrupt the neurological signals that control bladder function, both contributing to the urgency and frequency associated with OAB.
Hydration: While it’s important to avoid overhydration, which can increase the frequency of urination, dehydration can also contribute to OAB. Insufficient fluid intake can lead to concentrated urine, which can irritate the bladder lining and exacerbate OAB symptoms. Maintaining a balanced fluid intake is crucial for reducing irritation and preventing constipation, which can also affect bladder function.
Bowel function: Regular bowel function is important in managing OAB. Constipation can put additional pressure on the bladder, which can worsen the symptoms of OAB. Ensuring a diet high in fibre, maintaining hydration, and regular physical activity can help promote healthy bowel movements and alleviate pressure on the bladder.
Smoking: Smoking is a risk factor for many health conditions, including OAB. The irritants in tobacco smoke can aggravate the bladder, leading to increased frequency and urgency of urination. Moreover, chronic coughing associated with smoking can put pressure on the pelvic floor muscles, exacerbating symptoms of urinary incontinence.
Certain foods: Some foods and drinks can trigger OAB symptoms. Common irritants include caffeine, alcohol, spicy foods, artificial sweeteners, and acidic foods such as tomatoes and citrus fruits. Identifying and avoiding personal triggers can be an effective way to manage symptoms.
The experiences of OAB can vary widely but typically include:
An immediate, strong need to urinate that is difficult to control. This urgency can occur even when the bladder is not full, causing frequent and often sudden urges to find a loo.
Needing to use the loo more often than usual, generally more than eight times in 24 hours, including the compelling need to urinate again shortly after passing urine.
Having to wake up several times at night to urinate which disrupts sleep and can impact overall well- being.
Experiencing leaks triggered by a sudden urge to urinate, often before you can reach the loo.
These symptoms can be quite bothersome and may be influenced by your fluid intake, diet, and certain medications.
For females, symptoms might be influenced by menopause due to changes in oestrogen levels which can affect bladder control.
For males symptoms may overlap with conditions like benign prostatic hyperplasia (BPH), complicating the management of urinary functions.
More information on bladder leakage (also known as urinary incontinence) is available on our page HERE.
To diagnose OAB, your GP may undertake the following:
Assessing for symptoms of menopause related bladder symptoms in females, where you may be in terms of perimenopause, transitional stage or post menopause .Understanding your fluid intake, lifestyle, and any medications.
You might be asked to keep a diary noting when you urinate and any incidents of leakage to help identify patterns.
You can download our Bladder Diaries below:
Including checks relevant to your gender, such as a pelvic examination for women or a prostate exam for men.
To rule out infections or other underlying conditions.
If your symptoms are severe, you may be referred to a urologist for further tests, possibly including urodynamic studies. These tests help evaluate the function of the bladder and urethra by measuring urine flow, bladder pressure, and residual urine after voiding. Procedures include measuring the speed and volume of urine flow, assessing bladder capacity and nerve function, and identifying any blockages.
This information is critical for diagnosing the specific causes of urinary symptoms and tailoring effective treatment plans for conditions like Overactive Bladder (OAB).
Your GP, Urologist or healthcare team will recommend a programme for you. This might include the following:
For those who have symptoms of menopause related vaginal and bladder symptoms. This may be recommended in conjunction with vaginal moisturisers and lubricants.
Diet and fluid management: Balancing how much and what you drink can significantly impact symptoms. It’s wise to be mindful of caffeine intake from popular sources like tea, coffee, and energy drinks, which not only increase urine production but may also irritate the bladder lining. This is especially important for younger individuals given that energy drinks are often marketed to them. Making these changes can help manage urgency and frequency.
Bladder training: Techniques to extend the time between trips to the bathroom can improve bladder control. https://www.baus.org.uk/patients/information_leaflets/44/bladder_training
Weight management: Keeping a healthy weight can reduce pressure on the bladder and help alleviate symptoms.
Anticholinergics: These medications work by blocking the action of acetylcholine, a neurotransmitter that induces the bladder muscles to contract. By inhibiting this signal, anticholinergics reduce involuntary bladder contractions and help increase bladder capacity.
Beta-3 Adrenergic Agonists: These drugs activate beta-3 adrenergic receptors on the bladder muscle, helping to relax it and increase the amount of urine it can hold before triggering the urge to urinate.
Sacral Nerve Stimulation (SNS): This therapy involves the implantation of a small device that sends electrical impulses to the sacral nerves, which play a critical role in bladder control. SNS can help modulate the neurological signals when behavioural therapies and medications are insufficient.
Percutaneous Tibial Nerve Stimulation (PTNS): This is a minimally invasive treatment that involves stimulating the tibial nerve through weekly sessions over several months. The electrical impulses help manage the nerve activity that influences bladder behaviour.
Botox injections (Botulinum toxin): Injected directly into the bladder muscle, Botox works by paralysing the muscles, thereby reducing abnormal contractions and alleviating symptoms of urgency and incontinence. The effects of this treatment can last several months, after which the procedure may need to be repeated.
Pelvic floor exercises: Strengthening the muscles of the pelvic floor can significantly help manage symptoms of OAB. These exercises, commonly known as Kegel exercises, involve tightening and releasing the muscles that control urine flow. Regular practice can help improve bladder control and reduce the frequency and urgency of urination. These exercises are often recommended as part of a broader physical therapy program that may also include biofeedback and muscle conditioning techniques.
Acupuncture: Standard acupuncture and tibial acupuncture have shown promise in several studies. Tibial acupuncture, targeting nerves at the ankle, and standard acupuncture, involving specific body points, can help manage symptoms of urgency and frequency by modulating the sensory nerves of the lower urinary tract. These treatments are non-invasive, generally well-tolerated, and can be integrated with other therapies for enhanced effectiveness.
Bladder augmentation: This surgical procedure involves enlarging the bladder’s capacity by adding a piece of the patient’s intestine to the bladder. It’s used to reduce urinary frequency and urgency by increasing the bladder’s ability to store urine more effectively. It’s typically considered when other treatments for urinary frequency and urgency have failed, aiming to increase the bladder’s storage capacity and improve quality of life.
Urinary diversion: Used as a last resort, this surgery reroutes the flow of urine away from the bladder. It may involve creating a new pathway for urine to exit the body, often through a stoma on the abdomen, or constructing a new bladder-like reservoir from a section of the intestine. These procedures ensure urinary function when the bladder can no longer function properly, and may involve using external appliances to collect urine.
Support and education are key.
Maintaining an active dialogue with your healthcare provider, tracking symptoms, and staying active can all contribute to better management of OAB. Reducing caffeine and sugary drink intake, especially among younger people, is recommended to prevent symptoms from developing or worsening.
Each person’s response to medications and treatments for overactive bladder can vary, so it’s important to work closely with your healthcare provider to find the strategy that best fits your individual needs and lifestyle.
Sometimes overactive bladder, painful bladder syndrome (PBS), and urinary tract infection (UTI) symptoms can overlap. See our information on these conditions HERE.
These conditions all share common symptoms such as urinary urgency and frequency, but they have different underlying causes and require distinct treatments.
OAB involves an increased urgency and frequency without pain, primarily due to bladder muscle overactivity.
In contrast, PBS is characterised by chronic pelvic pain, pressure, or discomfort perceived to be related to the urinary bladder, accompanied by other urinary symptoms.
Unlike OAB and PBS, UTIs are mostly caused by bacterial infections.
While PBS is not typically linked to bacterial infections, some medical professionals consider the possibility that a subset of PBS cases might be related to undetected, chronic bacterial infections that standard urine tests fail to identify. This ongoing debate highlights the need for thorough medical evaluations to accurately diagnose the specific cause of urinary symptoms, ensuring that treatments address the actual underlying condition.
Living with conditions like OAB, PBS, or UTIs can be challenging, especially when they sometimes occur together. Understanding how these conditions might interact is key to managing your symptoms.
Your treatment plan may need to address multiple conditions simultaneously. For instance, medications for OAB might be used alongside pain relief strategies for PBS and antibiotics for UTIs. This integrated approach helps ensure that one condition’s treatment doesn’t worsen another.
Personalised strategies: Each person’s experience with these conditions is unique. You may find certain lifestyle adjustments, like dietary changes, fluid management, and pelvic floor exercises, particularly beneficial. Working closely with your healthcare team can help you discover the most effective strategies for you.
Support systems: Living with urinary conditions can be emotionally taxing. Support groups, chat forums or counselling can provide both practical advice and emotional support. Sharing experiences with others facing similar challenges can make a significant difference in how you cope day-to-day.
By actively participating in your treatment and management plans and maintaining open communication with your healthcare team, you can effectively manage your symptoms and improve your quality of life. Remember, you are not alone in this journey, and help is available to guide you through managing these conditions.
You are not alone.