Overactive bladder in women: symptoms, causes and treatment

The NHS describes urge (urgency) incontinence as urine leaking as you feel a sudden, intense urge to pee, or soon afterwards, and says it is usually the result of overactivity of the detrusor muscles that control the bladder. Overactive bladder syndrome is the frequent urge to urinate, which can happen with or without leaking.

NICE guidance for women classifies urinary incontinence into stress incontinence, mixed incontinence and urgency incontinence or overactive bladder, and starts initial treatment on that basis. Many women have a mixture of stress and urge symptoms, in which case treatment is directed at the predominant symptom.

It can also involve nocturia, which is the frequent need to get up in the night to urinate, and which the NHS lists among the problems that have specific treatments.

Often no single cause is found. The NHS lists factors that increase the chance of urinary incontinence generally: pregnancy and vaginal birth, obesity, a family history of incontinence and increasing age, although it is not an inevitable part of ageing.

Caffeine, which is found in tea, coffee and cola, can increase the amount of urine the body makes, and drinking too much or too little fluid can make incontinence worse. NICE recommends a urine dipstick test for all women who present with urinary incontinence, to detect blood, glucose, protein, leucocytes and nitrites, with a urine culture sent if infection is suspected.

The NHS advises seeing a GP if you have any type of urinary incontinence, and says not to feel embarrassed. Urinary incontinence can usually be diagnosed after a consultation, with questions about symptoms, possibly a pelvic examination and a diary of fluid intake and how often you urinate. Some women are referred to a specialist for more tests.

The assessment aims to identify predisposing factors and other diagnoses that may need referral for further investigation, which is why it is worth having symptoms checked rather than assuming they are simply overactive bladder.

The NHS says conservative treatments are tried first. They include lifestyle changes such as reducing caffeine, adjusting fluid intake and losing weight if overweight, pelvic floor muscle training and bladder training. Pelvic floor programmes should include a minimum of 8 contractions at least 3 times a day for at least 3 months.

Bladder training teaches ways to increase the length of time between feeling the need to urinate and passing urine. The NHS says a course usually lasts at least 6 weeks, and NICE recommends a minimum of 6 weeks as first-line treatment for women with urgency or mixed incontinence. NHS continence services staffed by specialist nurses and physiotherapists can diagnose and start treatment, and in some cases you may refer yourself.

Incontinence products such as pads and handheld urinals are not a treatment but can help manage the condition while waiting for assessment or while treatment takes effect. NICE advises against complementary therapies for urinary incontinence or overactive bladder.

If bladder training is not effective, a GP may prescribe an antimuscarinic (also called anticholinergic) medicine. The NHS lists oxybutynin, tolterodine and darifenacin as common examples, taken as tablets 2 or 3 times a day, with oxybutynin also available as a patch. You are assessed after 4 weeks, and then every 6 to 12 months if it continues to work.

Side effects include dry mouth, constipation, blurred vision and tiredness, and in rare cases angle-closure glaucoma. NICE says to explain that dry mouth and constipation may mean the medicine is starting to work, that substantial benefit may take at least 4 weeks and that long-term effects on cognitive function are uncertain. It advises taking account of coexisting conditions such as poor bladder emptying, cognitive impairment or dementia, and not offering immediate-release oxybutynin to older women at higher risk of sudden deterioration.

If antimuscarinics are unsuitable, have not helped or have unpleasant side effects, the NHS says mirabegron or vibegron may be offered, which relax the bladder muscle to help it fill and store urine. A low-dose desmopressin may be used for troublesome nocturia, and NICE advises particular caution in some groups of women.

When non-surgical treatment including medicines has not worked adequately, NICE guidance describes review by a local multidisciplinary team and options including botulinum toxin type A and sacral nerve stimulation. The NHS also mentions surgery to enlarge the bladder or to implant a device that stimulates the nerve controlling the detrusor muscles as options for urge incontinence. These are specialist decisions with real risks and benefits, so the team should explain what is likely to help in your situation.

Practical steps include keeping a bladder diary, spacing drinks sensibly, cutting down on caffeine and alcohol and maintaining a healthy weight. The NHS lists healthy weight, changing drinking habits and pelvic floor exercises as steps that may reduce the chance of incontinence developing. Support from continence services can be valuable when symptoms affect work, sleep or social life.

First-line care, continence assessment, pelvic floor physiotherapy and medicines are available through GP and NHS continence services. Private urogynaecology and physiotherapy are available for faster assessment or specialist procedures. NICE-based pathways are broadly the same: conservative measures first, then medicines, then specialist options.