What to Do About Overactive Bladder Symptoms in Midlife

By Claire Gillespie
Reviewed by Alyssa Quimby, M.D.
July 12, 2024

A change in bladder control is one of the many possible symptoms of perimenopause—the years leading up to menopause—and this can increase your risk of developing an overactive bladder in midlife.

“Overactive bladder” (OAB) is actually something of a catchall term for a collection of symptoms relating to bladder control, such as urinating more often, experiencing sudden urges to urinate, and needing to urinate two or more times at night. According to the National Association for Continence (NAFC), overactive bladder affects an estimated 33 million people in the United States alone, with the prevalence being the same in men and women.

Causes of Overactive Bladder in Middle-Aged Women

For women in midlife, the NAFC lists the hormonal changes that can occur during perimenopause and menopause as a factor. “The bladder itself has thousands of estrogen receptors, and as the estrogen level changes—which happens during perimenopause—this can cause many issues with the bladder, including overactive bladder,” explains Jennifer Linehan, M.D., a urologist and associate professor of urologic oncology at the Saint John’s Cancer Institute at Providence Saint John’s Health Center, in Santa Monica, California.

While the hormonal changes of perimenopause can cause overactive bladder, it isn’t the only factor. Many causes of OAB can come with the process of aging, such as changes in the body’s cells or in the nervous system (which helps the bladder and brain communicate), says Meredith Metcalf, M.D., a urologist at NYU Langone Hospital – Brooklyn and director at Urologic Oncology Brooklyn. “This is why it’s common for women to develop urinary symptoms or overactive bladder in the years leading up to menopause,” she says.

Childbirth can also lead to urinary incontinence later in midlife. “Pregnancy and delivery can definitely impact bladder function later in life,” says Aleece Fosnight, a physician assistant and sexual health counselor and educator based in Asheville, North Carolina. “Pregnancy causes strain on the pelvic floor muscles, which can lead to less bladder support as well as damage to the bladder nerves that can cause OAB,” she explains. This can occur regardless of the type of delivery: cesarean section or vaginal.

But even though overactive bladder commonly affects women as they age, it shouldn’t be just accepted. There are treatments.

What Is a “Normal” Bladder?

Officially, there’s no such thing as “normal” bladder function. It might be normal for you to urinate only a few times a day, while someone else might go every three hours like clockwork. That said, a healthy bladder signals the brain when it’s getting full, but the person can wait to urinate. When they’re ready to go, the brain signals the bladder to squeeze and empty itself.

As a general rule, most women should be able to hold urine for at least two hours before needing to empty their bladder, Linehan says. Of course, how much and how often you drink is a factor. But if you’re urinating small amounts more frequently than that, it could be a sign of a problem.

Signs of an Overactive Bladder

The current definition of overactive bladder is based on symptoms, Metcalf says. A person with OAB can’t wait and feels the need to urinate urgently. “With urgency incontinence, the bladder may squeeze and leak urine with the ‘gotta go’ feeling,” explains Metcalf. “With overactive bladder, these symptoms of needing to urinate urgently can happen before the bladder is even full. In this case, the bladder is squeezing and trying to empty—it is ‘overactive’—rather than relaxing and filling with urine.”

The 5 Types of Urinary Incontinence

According to the Mayo Clinic, there are five types of urinary incontinence

  1. Stress incontinence. Exertion such as sneezing, coughing, jumping, etc. leads to leakage.
  2. Urge incontinence. This is when you get an overpowering urge to urinate (even when your bladder isn’t really full) that’s followed by involuntary loss of urine.
  3. Mixed incontinence. You experience more than one type of urinary incontinence—most commonly stress and urge.
  4. Overflow incontinence. The bladder never empties completely and dribbles small amounts of urine.
  5. Functional incontinence. This is usually related to some kind of mental or physical impairment that leads to an inability to make it to the toilet following the urge to go.

What to Do If You Think You Have an Overactive Bladder

If you think you have an overactive bladder, the first step is to talk to your healthcare provider, who will ask you about your symptoms and may refer you to a specialist for evaluation or management, says Metcalf. You may be asked to complete a bladder diary before or after the visit, to record how much and what fluids you drink in a day, and how much and with what symptoms you urinate in a day.

Work to Retrain Your Bladder

While there’s not a cure for overactive bladder, you may be able to relieve symptoms by taking steps to “retrain” your bladder, Metcalf says. By relearning how to hold on instead of rushing to the bathroom every time you feel the need to urinate, you’ll help to make your bladder less sensitive.

The key is to do it in small stages. For instance, if you’re going to the bathroom every hour, try to extend the time for 10 minutes for a week. The following week, extend it for 20 minutes, and so on.

Different techniques may help you suppress your urgency (and it’s worth trying them all until you find the one that works best for you). For example, you can try distracting yourself by reading a book, doing a crossword or jigsaw puzzle, or counting backward from 200.

Engage Your Pelvic Floor

Contracting your pelvic floor muscles may also help with overactive bladder, says Metcalf. “This is thought to happen because the communication between the brain and bladder is improved,” she explains. However, she recommends an exercise similar to Kegels (exercises that contract the same pelvic muscles used to stop the flow of urine) that she calls “quick flicks,” where you quickly squeeze and release your pelvic floor muscles repeatedly.

You can try this at home initially, but if you worry you aren’t doing it correctly, or if you aren’t seeing results, an evaluation with a pelvic floor physical therapist may be a great next step. Pelvic floor physical therapists specialize in helping women strengthen the muscles of the pelvic floor.

Explore Prescription Options for OAB

If these initial steps don’t help, Fosnight recommends asking your doctor about prescription medication for overactive bladder. A group of drugs called anticholinergics, including oxybutynin (Ditropan), darifenacin (Enablex) and solifenacin (VESIcare), work by blocking the nerve signals involved in bladder muscle contractions.

There are other options for women dealing with urinary incontinence, too, including electrical stimulation, inserts, and other interventions, according to the Mayo Clinic. You can try one treatment or several at the same time and, with the support of a trusted medical professional, find the best plan to help you manage your overactive bladder. Because it can be managed—to let you live your best life, during perimenopause and beyond.

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