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Overactive Bladder (OAB) in Women

Overactive bladder in women at a glance

  • Overactive bladder (OAB) is a bladder storage problem that causes women to experience the urgent and frequent need to urinate, more than eight times each day.
  • OAB may be associated with urinary incontinence.
  • OAB affects about 40 percent of women in the U.S.
  • OAB may be caused by malfunctioning bladder muscles and nerves that send sensations to the brain, resulting in involuntary contraction of the bladder muscles even when urine volume is low.
  • Treatments for OAB include behavioral changes, pelvic floor strengthening, medications and surgery.

What is overactive bladder?

Overactive bladder (OAB) is a common urologic condition that occurs when bladder muscles begin to act involuntarily, resulting in the frequent and urgent need to urinate. The urge may be very strong and, in some cases, lead to incontinence of urine. OAB affects both men and women with an estimated 40 percent of women in the U.S. experiencing OAB symptoms.

Most adults urinate from four to seven times a day. Patients with OAB may need to use the bathroom up to 30 times a day. Women with OAB often experience urinary incontinence when they are unable to reach the toilet before involuntary urination begins.

The kidneys create urine, which then drains into the bladder. As the bladder fills, nerves in the bladder send signals to the brain that it’s time to urinate, or empty the bladder. Nerve signals cause the muscles of the pelvic floor and urinary sphincter to relax while causing the muscles of the bladder to tighten (contract), pushing out urine through the urethra.

In cases of OAB, the bladder muscles start to contract because they receive a neurological signal to do so, but this is a faulty neurological signal because the bladder is not actually in need of emptying. OAB can also occur because bladder muscles are too active, contracting frequently and creating an urge to urinate.

OAB and its related symptoms cause embarrassment and negatively impact quality of life for many patients.

Causes of overactive bladder in women

Medically linked causes of OAB include strokes, multiple sclerosis or Parkinson’s disease, all of which can cause OAB symptoms. Overweight women also experience OAB more frequently than women at a healthy weight. Factors such as menopause, age and acute urinary tract infections may also increase a woman’s chance of experiencing OAB.

Although OAB is common among the aging population, the condition is not considered a normal part of the aging process. Diuretics such as alcohol and caffeine may exacerbate OAB symptoms.

Symptoms of overactive bladder and diagnosis

The most common symptoms of overactive bladder are urinary frequency and the sudden urge to urinate. If a woman is urinating more than eight times a day, this might be a symptom of OAB. Waking up in the middle of the night to urinate often indicates OAB, as well.

A urologist or urogynecologist may perform a number of tests to diagnosis OAB. These may include:

  • Physical exam, medical history review and symptom questionnaire.
  • Bladder stress test, performed by filling up the bladder and having the patient cough to ascertain how much urine leaks.
  • Postvoid residual volume test checks if the bladder is actually fully emptying by inserting a catheter through the urethra and into the bladder after urination. The catheter measures any remaining urine.
  • Urodynamic testing ­is a series of tests typically reserved for unusual cases and primarily measures urine flow to test for obstruction as well as evaluating urge sensation.
  • Urinalysis ­ screens for the presence of bacteria and may rule out other similar conditions such as a UTI.
  • Cystoscopy examines the inside of the bladder by placing a long thin tube with a magnifying glass up the urethra.

Treatment of overactive bladder in women

Treatments for OAB range from behavioral interventions, medications, injections and nerve stimulation to surgery.

Behavioral and lifestyle changes

Performing pelvic floor exercises, known as Kegels, strengthens the pelvic floor muscles and the sphincter, a urinary muscle. Scheduling toilet trips for every couple of hours, as well as managing and reducing fluid intake, will help women normalize their urine schedule. Bladder training involves delaying urination after the initial sensation hits and building up the intervals between urinating over time.


Medications prescribed for women with OAB are intended to relax the bladder and help mitigate symptoms. Botox bladder injections may stop the muscles of the bladder from contracting involuntarily.

Nerve Stimulation Therapy (InterStim)

Sacral nerve stimulation (SNS), InterStim and peripheral nerve stimulation (also called percutaneous neural stimulation or PTNS) attempt to regulate nerve impulse reactions. The procedure involves using removable, implantable device which can be activated by a patient to send mild electrical pulses to the sacral nerves located near the tailbone. Typically, a doctor will recommend a 1-2 week trial of the device for the patient to determine effectiveness of the implant.

Nerve stimulation has been shown to help people with urinary retention and overactive bladder symptoms including urinary urge incontinence, urgency and frequency.

Surgery for overactive bladder

Treating OAB with surgery is not a common treatment course and is reserved for women whose other treatments plans have failed. Surgery may increase the physical size of the bladder by using portions of bowel to replace and expand a section of the bladder. Completely removing the bladder is always a last resort surgery.