About a year ago, I began noticing I was getting up several times a night to pee. Once I thought about it, I realized I was peeing a lot during the day, too. The problem escalated and escalated until I was getting up three to five times a night, leading to severe sleep deprivation. Desperate for a solution, I got tested for interstitial cystitis, ovarian cysts, diabetes, kidney stones, you name it. But with all the results negative, I instead got the frustrating diagnosis of overactive bladder (OAB).
I describe an OAB diagnosis as frustrating because it doesn't have a simple cure. Your options are to go on medication, to see a physical therapist who can teach you helpful exercises or an osteopath who can manipulate your nerves, to try a more drastic treatment like Bladder Botox injections or electrical bladder stimulation, or to make a bunch of small changes to your lifestyle that can gradually alleviate the problem. "Even though treatment options exist, many patients opt for natural and homeopathic remedies, since no single treatment has been proven to be most effective," Caleb Backe, Health and Wellness Expert for Maple Holistics, tells Bustle.
There are two main symptoms of OAB, Los Angeles-based urologist S. Adam Ramin, MD tells Bustle: urgency frequency (feeling like you have to pee a lot) and urgency incontinence (not being able to hold it in). Some people with OAB (like me) only have the first symptom, while others have both.
"Whether it’s that sense of urgency when you laugh or the incessant fear of not making it to the bathroom in time, women who suffer from an overactive bladder or urinary incontinence are often embarrassed by their condition and sometimes feel like the only people on the planet who must endure it," says Ramin. "In reality, nothing could be further from the truth. While urinary incontinence does affect women more often than men, millions of women deal with some type of bladder control issue at some point in their lives. And the truth is this: If you suffer from an overactive bladder, it doesn't have to be a condition that puts you in adult diapers for the rest of your life. In fact, there are some simple diet and lifestyle changes that can put you back on the road to bladder control."
I know this is true because when I make it through the day without caffeine and alcohol, avoid sugar in the evening, relax before bed, and refrain from drinking anything a few hours before bedtime, I only get up to pee once or twice. I initially discounted this advice because, hey, I don't want to give up alcohol or caffeine or sugar or *gasp* stop working at night. But after I tried a few medications that all had undesirable side effects, I realized lifestyle changes were worth it — and would probably make me healthier in the process.
If you're experiencing symptoms of overactive bladder, like an urge to pee eight or more times a day, urinary leaks, or the need to wake up to pee twice or more per night, see a urologist. There are a lot of underlying conditions it could be related to, and you can learn more about treatment options. Whether there is some underlying cause or it's just plain old OAB, though, these strategies should improve the condition.
1. Cut Back On These Bladder Irritants
Just this evening, I realized my bladder was feeling much more irritated than usual. Then, I thought back to what I'd just eaten: Thai curry and a smoothie containing orange juice. Curry, oranges, and juice are all on Urology San Antonio's list of bladder irritants. "Studies show that spicy foods can sometimes be an irritant to the lining of the bladder," says Ramin. "Fare like spicy chili, chili peppers, or horseradish are examples of foods that can cause such irritation. Likewise, highly acidic foods can trigger a similar response."
It may not be realistic for you to give up all foods that could irritate your bladder, but you can start to take note of which foods are worst for you, and avoid those when you can (especially before bed).
And a word to the wise: People often say you should drink cranberry juice for bladder health, but that's to ward off UTIs. When it comes to bladder irritation, cranberry juice — along with most kinds of juice — could have the opposite effect you want. "Due to its high acidity, it can actually worsen the condition," says Ramin.
2. Cut Back On Diuretics Like Caffeine and Alcohol
Caffeine and alcohol are both double trouble, says Ramin. They're diuretics (they make you pee) and they stimulate bladder function. "If you suffer from urinary incontinence, one of your worst enemies can be caffeinated beverages," he says. "Though it can be much easier said than done, limiting or eliminating caffeine altogether has been known to be successful in diminishing and resolving issues of urinary incontinence in some women."
Similarly, he adds, "alcoholic beverages act as bladder stimulants and diuretics in most people. So when you have a problem with urinary continence, consuming even slight amounts of alcohol can make matters worse."
If you can't function without your daily cup of coffee, try to keep it to the morning so you're not getting up to pee at night. And if you like having a glass of wine to wind down, at least limit it to one and keep it as far from bedtime as possible. Or, just take a break from caffeine or alcohol for a week or two, and see if the benefits you notice are worth it.
3. Stay Hydrated
So what should you drink, then? When you're already a peeing machine, drinking water may be the last thing you want to do. According to a 1,000-person survey by Poise, almost half of women believe that limiting water intake will limit their bladder leakage. The problem with this is, dehydration dilutes your urine, making it more concentrated and consequently more irritating to your bladder, Poise partner and OB/GYN Dr. Jessica Shepherd tells Bustle.
However, you have to balance this information with the knowledge that drinking before bed will increase your chances of waking up to pee. So, Shepherd recommends drinking eight eight-ounce glasses during the day and then cutting off fluids four hours before bedtime.
4. Do Kegel Exercises
Kegel exercises — when you repeatedly squeeze and relax your PC muscles (the ones you use to hold in pee) — have a ton of benefits, two of which are reducing urinary incontinence and urinary urgency, Brent Reider, an author and referee for medical and scientific peer review journals and designer of several FDA-cleared medical devices including the Yarlap, tells Bustle.
"Exercise therapy to tone and re-educate the pelvic floor muscles is an essential aspect of pelvic care and often recommended by physicians as the first line of overactive bladder treatment," he says. "The muscle contractions that cause urge/OAB (and can be the cause of nocturia) are like spasms caused from inactivity and where the muscle needs respiration. Blood flow from the workout gets the muscle respirated."
How do you do them, then? "One of the most promising techniques is for patients to trigger their pelvic floor muscles (kegels) as soon as they sense the urge to urinate and engage these muscles for around 10 seconds," says Backe. "Alternatively, you can do five to seven rapid contractions until the urgency diminishes, and then go to the toilet."
If you can't find the energy to do Kegel exercises or want to make sure you're doing them right, a device called the Yarlap will do them for you by delivering electric pulses to your vagina that cause it to contract. As an added bonus, many Yarlap users also find that they start having better sex, says Reider.
5. Try Physical Therapy
Regular sessions with a pelvic floor physical therapist can help retrain your bladder muscles and nerves through kegels and other exercises. "Although this modern form of physiotherapy can be extremely time-consuming and frustrating, it offers patients the best chance of regaining control of their bladder," says Backe. "These bladder drills function to retrain the brain to retain the power of the bladder’s muscle contractions."
The exercise program to help with overactive bladder is called "bladder retraining," Rachel Gelman, DPT, PT, Branch Director at the Pelvic Health and Rehabilitation Center, tells Bustle. "Many people have developed habits over time, like going just in case, so then the bladder starts to send a signal that it is full when it really isn't," she says.
"Sometimes, the pelvic floor muscles can become restricted or hypertonic/spasmotic, which can lead to urinary urgency and frequency," Gelman says. "Working on the myofascial restrictions with manual therapy and exercises to help relax the muscles may be beneficial can help address these symptoms as well. Many times, patients actually have poor bowel habits and suffer from constipation, which can lead to pelvic floor dysfunction and bladder issues, so working on bowel mechanics can actually improve bladder symptoms." Since the problems are different for each person, the exercises will be, too, so a physical therapist can recommend the right ones for you.
6. Reduce Stress
When my bladder issues first started, a psychic and a spiritual intuitive both told me the main cause was anxiety. I didn't listen until my urologist, a Yale Medical School graduate, said the same thing. The nerves in your brain connect to the nerves in your bladder, he explained, so anxiety can lead to hypersensitive bladder nerves.
After learning this, I think I figured out what happened to me. I was dealing with crippling insomnia when my bladder issues started, and I'd become obsessive about everything that could keep me up, my bladder included. I'd lie in bed for a few minutes then get up to pee again and again out of fear that if I didn't, I wouldn't sleep. By thinking about my bladder so much, I must have built up the connections between it and my brain, developing a hyper-awareness. That's my theory, at least.
This is just one way that anxiety can lead to bladder issues. Whatever the mechanism, it's pretty clear that it does. One 2016 study in Urology found that overactive bladder patients had more anxiety than controls. "Mental stress can cause increase autonomic nervous system activity," says Ramin. "This leads to increased bowel and bladder activity. Increased bowel leads to irritable bowel syndrome (aka IBS). Increased bladder activity leads to overactive bladder."
Stress reduction can mean many different things, from seeing a therapist to spending time doing things you enjoy. If you have issues with peeing at night, doing something relaxing before bed can be a huge help (taking a bath helps for me).
7. Get Acupuncture
Acupuncture — a Chinese healing technique where someone places tiny needles in your skin near pressure points — can help with all sorts of physical ailments, and research suggests overactive bladder is one of them.
One study by Whipps Cross University Hospital and University College of London Hospital found that 79 percent of overactive bladder patients saw significant improvement after 10 weeks of weekly 30-minute sessions. These patients had already tried typical treatments like behavioral changes and medications. An advantage to acupuncture is that unlike medications, it doesn't tend to cause many side effects (though there are a few rare ones).
8. Get Visceral Manipulation
For a fairly new technique called Visceral Manipulation, an osteopath uses their hands to move around the nerves in your pelvis and abdomen. "Visceral manipulation refers to manual therapy techniques that work directly with organs and their surrounding connective tissues to restore normal motility, structure, and function," OB/GYN Eden Fromberg, DO tells Bustle. Connective tissue is the scaffolding that connects different parts of the body, from the surface of the skin to the internal organs.
"Removing stuck stress from the tissues, literally hydrating and unsticking dry connective tissue, restores the sensitivity of the core and neurofascial system and kicks in repair and healing processes," Fromberg says. Visceral manipulation can help alleviate overactive bladder by changing the way your bladder nerves communicate with the rest of your body.
Living with OAB is truly awful. I would know — with all the sleep mine has lost me, I don't remember what it's like to not be exhausted. But I try to think of it this way: Discomfort is your body's way of telling you something's wrong. And maybe if you fix whatever's wrong by making the changes needed for a healthier bladder, your whole body and mind will also become healthier in the process. At least that's what I'm hoping.