Overactive Bladder (OAB): Is it normal? 5 things to think about.


Overactive bladder (OAB) is defined as urinary urgency with no clearly defined cause that impacts both daytime and nighttime bladder function due to frequent voiding and urinary dysfunction and often includes incontinence. Frequency is when you have to go to the bathroom more than 1 time every 3-5 hours and if you have OAB, you know how disruptive getting up to go to the bathroom at night can be to your sleep. Incontinence is when you lose a little or a lot of urine, you know, you pee yourself some. You’ve seen the commercials “gotta go, gotta go, gotta go” or the adorable little pink bladder that leads her human around by the hand to transmit the message that your bladder is in control of your life. The marketing people for pharmaceuticals or bladder control products are really great at making you think that this is a normal part of aging. Spoiler alert…this is not normal at any age! The really good news, it is treatable at any age.


Although it is treatable, the condition itself can be very complicated and needs to be evaluated carefully. I’ll bet you did not know that the first line of treatment is actually physical therapy! We have many tools in our toolbox to address this problem and get you moving toward bladder independence. We evaluate the muscles of the pelvic floor (yes you have muscles down there) for strength deficits or the inability to lengthen them which is a critical function if you want to open sphincters to allow all of the urine to flow out, not just some of it. That is for you sufferers who feel like you can’t empty your bladders all the way.


We may use biofeedback, posterior tibial nerve stimulation, education, toilet posture training (yes that is a thing), behavior modification and teach you how to coordinate your muscles better so you can store urine and then release it when the time is right. There may be some complications with scar tissue development after surgery so we will assess that and treat if necessary. Of course, there are other things that can be layered on the PT treatment like pharmaceutical support, devices that help put pressure on the urethra to limit the leaking and mental health help.


Managing anxiety is really important because the reflex that controls urination (the micturition reflex) is a complicated nerve event that starts at the autonomic nervous system which is very affected by stress or anxiety, think fight or flight. If your body is always in fight or flight, muscles of the pelvic floor will over-react by tightening so you don’t inadvertently leave a trail of urine as you flee the tiger, boss, etc. Limiting urine flow is great if running from a tiger but not so much when you need to pee.


You are not alone in feeling diminished self-esteem or sexuality, feel isolated, are less productive at work, are gaining weight, have affected sleep or simply feel like so much financial burden exists in the name of buying protective padding or clothing or with time spent cleaning your body or clothes. These are well demonstrated in the research as very common side effects of OAB. Women tend to have more of a problem with this than men, but it exists in both genders. Sadly, people will wait on average 3 years to report this to a medical professional. If this is you, don’t wait any longer. See your doctor, have the conversation and ask to see a qualified physical therapist to help you navigate all of it.


Castro, R. A., Arruda, R. M., & Bortolini, M. A. T. (2015). Female urinary incontinence: effective treatment strategies. Climacteric : The Journal of the International Menopause Society, 18(2), 135–141. doi:10.3109/13697137.2014.94725

Ellsworth, P. (2017). Updated Diagnostic and Individualized Treatment Strategies in the Management of Overactive Bladder. Journal of Managed Care Medicine, 20(2), 32–36

Reynolds, W. S., Fowke, J., & Dmochowski, R. (2016). The Burden of Overactive Bladder on US Public Health. Current bladder dysfunction reports, 11(1), 8–13. https://doi.org/10.1007/s11884-016-0344-9