Coping With Overactive Bladder

While overactive bladder (OAB) can be a nuisance to some, there are others for whom the condition is debilitating, undermining their quality of life and ability to function without stress or embarrassment. Contrary to what some people might tell you, OAB is not a normal part of getting older or something you have to “learn to live with.”

As you work with a healthcare provider to seek the appropriate treatment, there are things you can do to better cope with this frustrating and all-too-common condition.

Emotional

One of the most challenging aspects of OAB is the emotional stress it places on a person. People with severe OAB symptoms will often find it easier to isolate themselves than deal with the constant stress and fear of wetting themselves or being unable to hold it when at work or in public.

Anxiety and depression increase the likelihood and severity of urinary incontinence in people with OAB, according to a 2016 study published in BMC Urology. It’s a “Catch-22” situation, wherein stress can serve as both a cause and effect of OAB symptoms.

To this end, it is just as important to manage your emotional health as it is to deal with the physical symptoms if you have OAB.

Stress management, including the use of mindfulness-based therapies, has been shown to improve not only the quality of life of people with OAB but can help them better manage episodes of urinary urgency and incontinence.

Among some of the options:

• Breathing exercises, including controlled slow-paced breathing, are often recommended by healthcare providers as part of bladder retraining to help you hold more urine for longer periods of time.
• Mindfulness meditation and yoga have been shown in smaller studies to reduce urgency incontinence episodes (although they do little to reduce the actual frequency of urination).
• Biofeedback may be useful in bladder retraining by helping you recognize and modify your response to urinary urgency. It can also help improve irregular sleep patterns that contribute to nighttime urination (nocturia).

In addition to mind-body therapies, traditional interventions such as cognitive-behavioral therapy (CBT)—including modalities like rational emotive behavioral therapy (REBT) and problem‐solving therapy—can help treat depression in people in OAB, particularly those with treatment-resistant OAB.

Physical

Your general health influences OAB in the same way it does any chronic medical condition. In the end, OAB cannot be treated in isolation. If you are struggling to manage OAB despite medical treatment, you can make two key physical changes that usually help.

Diet

If you have OAB, certain foods and drinks can irritate the bladder and trigger sudden spasms of the bladder wall. Others are diuretic and actively promote urination. Changes in diet can help.

In addition to restricting fluids, you should limit certain foods and drinks irrespective of the severity of your OAB symptoms. These include:

• Coffee, tea, and other caffeinated beverages
• Alcohol, including beer and wine
• Citrus fruits and drinks
• Sports drinks
• Tomato-based drinks, soups, and condiments
• Carbonated drinks
• Artificial sweeteners
• Spicy foods
• Chocolate
• Raw onions (cooked onions are OK)

Certain preservatives, including monosodium glutamate (MSG), can also increase bladder sensitivity.

A diet rich in vitamin C and vitamin D is associated with reducing urinary frequency and urgency. Good vitamin C sources include broccoli, Brussels sprouts, peppers, dark leafy vegetables, strawberries, papaya, and kiwi fruit. Vitamin D-rich foods include oily fish (such as salmon, tuna, and sardines), eggs, and fortified milk and yogurt.

Weight Loss

Obesity is associated with an increased risk of OAB and an increase in the severity of OAB symptoms.

A 2012 study published in the International Neurourological Journal concluded that a body mass index (BMI) of 30 or greater corresponds to a higher incidence of bladder leakage in women with OAB than all other weight categories. By contrast, a BMI of less than 30 does not appear to increase such risk.

Although obesity places direct pressure on the bladder itself, it also impedes blood flow in the pelvic floor. This indirectly stimulates bladder contractions due to the release of cytokines and other inflammatory compounds.

If you have OAB, achieving and maintaining a normal weight can help mitigate some of the risks. This should involve:

• Healthy balanced eating: Diets should aim to reduce saturated fat and sugar intake while emphasizing fruits, vegetables, whole grains, and fat-free or low-fat dairy, as well as a variety of protein-rich foods such as seafood, lean meats, poultry, eggs, legumes, soy, nuts, and seeds.
• Routine exercise: Workouts should gradually progress from moderate-level activities (such as a brisk 15-minute walk or casual biking) to vigorous-level activities (such as jogging or swimming laps). Core-stabilizing exercises can also help strengthen the pelvic muscles and improve bladder control. Exercise can also improve mood.

Although there are no specific weight-loss plans for people with OAB, any program you embark on should be under a healthcare provider’s supervision. It may also help to engage the services of a nutritionist or dietitian and a personal trainer to set you on the right track.

Social

As much as OAB can cause social isolation and depression, social isolation and depression can increase the risk of obesity and poor lifestyle habits that contribute to OAB. It’s a spiraling cycle that is often hard to break.

Social interaction is key to managing any chronic condition, and OAB is no exception.

Start by educating your trusted friends, family members, and co-workers about what OAB is and how it affects you personally. The more they understand, the more likely they will be to make accommodations when organizing outings or meetings. It can also reduce stress and embarrassment if you do have to rush to the bathroom.

Here are other tips to help manage social or work situations if you have OAB:

• Always plan ahead. If you have an important meeting or social event, stop fluids three to four hours prior and visit the toilet immediately beforehand.
• If going to shops or restaurants, time your fluids carefully and check for bathroom locations as soon as you arrive.
• Ask to be seated close to the restrooms when dining out or at sporting events or concerts to avoid having to walk back and forth through crowds.
• Always have cash or a credit card on hand in case you suddenly need a bathroom and see a “For Customers Only” sign on the door.
• Those assigned female at birth who engage in sports or workouts (or have a hectic work schedule) can use a tampon or pessary to support the pelvic muscles.
• Pre-test incontinence underwear at home before trying them out in public. They need to fit well. If too tight, they may ride up and cause gaps. If too loose, they may slip and create gaps around the leg openings or waistband. (Period panties may not always provide the best protection for people assigned female at birth with OAB.)
• Keep a change of clothes at your desk or in the trunk of your car in the event of an accident.
• Talk to your employer about moving your workstation closer to the restrooms.
• When traveling, stay on your medication schedule, making adjustments based on the time zone.
• It may be well worth paying a few extra dollars to pre-book an airline seat on the aisle closest to the bathroom.
• If taking a car trip, plan your pit stops in advance using Google Maps or a similar app. Be sure to check the hours of operation.
• You can buy a collapsible (and even disposable) travel toilet to store in your car if a bathroom is nowhere in sight. Hospital urine bottles are also great for people assigned male at birth.

OAB and Sex

Sexual relationships also benefit from an open, honest discussion if you have OAB. Doing so allows you to make adjustments to your sex life together rather than trying to manage on your own in silence. If, for example, there is a position that presses on your bladder or makes you feel like peeing, say so and find a new position.

You can also keep towels close at hand or purchase fitted waterproof “play sheets” to keep the bed dry in case of leakage. Urinating before sex and avoiding an alcohol “icebreaker” also helps.

Practical

One of the best ways to cope with OAB is to normalize it. By making few practical adjustments to your life, you can take control of your condition rather than it controlling you.

While this is sometimes easier said than done, planning and preparing for contingencies can usually help see you through the most inopportune moments.

As you and a urologist explore the various treatment options, there are a few tips that can help you better control your OAB symptoms:

• Keep a bladder diary to get a better sense of your urinary patterns and any events that preceded a bathroom visit (such as meals, medication doses, or physical activities). Over time, these insights can help you predict what your daily bathroom schedule will be.
• Schedule regular bathroom breaks throughout the day, even if you don’t have to go. When you are in the toilet, take your time. Never rush things.
• When you are finished urinating, wait for several moments and try again. This is especially helpful if you have urinary retention (difficulty emptying the bladder).
• Avoid fluids at least two hours before bedtime. Before nodding off, go to the bathroom one last time, whether you feel like it or not.
• If the fear of wetting the bed keeps you up at night, incontinence underwear, a protective pad, or waterproof sheets may help you sleep more soundly.
• If you are on diuretic medications, take them in the morning rather than at night to avoid nighttime urination.
• If you need an energy boost at work, skip the caffeine and nibble on nutrient-rich snacks like nuts or carob-covered raisins.
• Practice your Kegel exercises whenever you have a break. The benefits of toning the pelvic muscles extend to all with OAB.

A Word From Verywell

According to the American Urological Society, around 60% of people treated for OAB will experience a complete resolution of symptoms within a year. Others will experience ongoing symptoms despite treatment, albeit less severely in all but a few cases.

Finding the right treatment can take time and patience. If you find it difficult to cope, do not go it alone. Reach out to OAB support groups, many of which can be found on Facebook. These allow you to share your concerns (anonymously if you prefer), seek advice or referrals, or help others who fully understand what you are going through.

You can also access updated news, tips, and personal insights about living with OAB through the blog site managed by the non-profit National Association for Continence (NAFC).