Urinary incontinence and overactive bladder

A lot of people have laughed or sneezed so hard they peed a little, but when urine leakage starts happening regularly, it can be a sign of a bigger issue. Frequent urination, loss of bladder control or sudden, extreme urges to go to the bathroom could point to urinary incontinence or overactive bladder.

While it might feel embarrassing to struggle with bladder and incontinence issues – much less talk about it – our urogynecology team is here to help treat overactive bladder problems with compassion and understanding. Together, we’ll find a treatment option that helps you feel in control again.

What is overactive bladder?

Overactive bladder is a condition marked by sudden urges to urinate that are difficult to control. It often involves frequent trips to the bathroom, including waking up at night, and sometimes includes urine leakage.

More specifically, an overactive bladder is related to how the bladder muscles and nerves work together. When signals between the bladder and brain are out of sync, the bladder may contract before it’s full, leading to urgency and other symptoms.

How common is overactive bladder?

An overactive bladder is more common than many people realize. It affects adults of all ages and genders, though symptoms tend to become more frequent with age. Hormonal changes, underlying health conditions and bladder muscle changes can all play a role.

Because symptoms aren’t always discussed openly, overactive bladder is often underreported and untreated.

Types of incontinence

Incontinence isn’t one-size-fits-all. There are different types, each linked to specific symptoms, triggers and causes. Understanding which type you’re experiencing can help guide treatment and clarify why certain approaches may work better than others.

Urinary incontinence

• Urinary stress incontinence: Urine leakage caused by coughing, sneezing, laughing, bending or lifting
• Urinary urge incontinence: General increase in urinary urgency or frequency or an uncontrollable flow of urine
• Urinary overflow incontinence: Extremely frequent urination and inability to completely empty the bladder
• Mixed urinary incontinence: A combination of symptoms from other incontinence types

Fecal incontinence

• Obstetrical anal sphincter injury (OASIS): The most common cause of fecal incontinence in women usually caused by trauma during natural childbirth.
• Rectovaginal fistulas: An abnormal connection between the rectum and the vagina causing stool leakage because of injury during childbirth.

Overactive bladder vs. urinary incontinence

Overactive bladder and urinary incontinence are closely related, but they aren’t identical. Overactive bladder refers to a collection of symptoms, most often frequent urination, strong urges to go and difficulty holding urine long enough to reach a bathroom. Urinary incontinence, on the other hand, describes the actual leakage of urine.

Some people have overactive bladder without leaking, while others experience leakage as part of their symptoms. In many cases, overactive bladder can lead to urge-related incontinence, which is why the two terms are often mentioned together.

What are the key symptoms of overactive bladder with incontinence?

Overactive bladder and urinary incontinence often share symptoms, which can make them hard to tell apart. Common symptoms include:

• A sudden, strong urge to urinate that’s difficult to delay
• Frequent urination, including needing to go more than usual during the day
• Waking up at night to urinate (nocturia)
• Urine leakage that happens before reaching a bathroom
• Leaking urine during activities like coughing, sneezing, laughing or exercising
• A feeling that the bladder doesn’t fully empty
• Needing to plan activities around bathroom access

These symptoms can range from mild to disruptive, and not everyone experiences them the same way.

Should you worry if you can’t hold your pee?

Occasional urine leakage can happen, but ongoing issues with bladder control shouldn’t be ignored. Trouble holding urine may be linked to overactive bladder, urinary incontinence or another underlying condition that can often be treated.

If symptoms are frequent, worsening or affecting your daily routine, it may be time to talk with your doctor about what’s causing them and what treatment options are available.

Causes of incontinence and overactive bladder

Incontinence and overactive bladder can be caused by a variety of factors. While they often overlap, they aren’t the same condition and not everyone will experience both. Causes can include physical changes, lifestyle factors or underlying health conditions.

What is the main cause of overactive bladder?

In many cases, symptoms are linked to abnormal bladder muscle activity, where the bladder contracts too often or at the wrong time, even when it isn’t full. This can lead to sudden urges to urinate, frequent bathroom trips and difficulty holding urine. Other factors, including changes in nerve signaling between the bladder and brain, can also contribute.

Other possible causes include:

• High fluid intake
• Certain foods or beverages
• Certain medications
• Urinary tract infections
• Weakened pelvic floor muscles
• Childbirth or pregnancy
• Age
• Menopause
• Tumors or other obstruction
• Select neurological disorders

Conditions linked to overactive bladder

Overactive bladder is often associated with other conditions that affect how the bladder muscles and nerves work together. These conditions don’t always cause overactive bladder, but they can increase the likelihood of symptoms or make them more noticeable.

Conditions commonly linked to overactive bladder include:

• Urinary tract infections, which can irritate the bladder and trigger urgency
• Neurological conditions that interfere with bladder-brain communication
• Bladder outlet obstruction, such as tumors or other blockages
• Pelvic floor dysfunction, which can affect bladder control and coordination
• Hormonal changes, including those related to menopause
• Aging, which can alter bladder capacity and muscle control

Having one or more of these conditions doesn’t mean overactive bladder is inevitable, but it could help explain why symptoms develop and guide next steps for care.

How is overactive bladder diagnosed?

Diagnosing overactive bladder involves looking at symptoms, medical history and how the bladder and urinary tract are working. Tests may be recommended to better understand what’s causing urgency, leakage or other bladder concerns.

What tests will be done to diagnose overactive bladder?

Urinary incontinence can be diagnosed by performing urodynamic testing to assess how well the bladder and urethra are storing and releasing urine. This helps identify what’s contributing to symptoms like urgency, leakage or difficulty emptying the bladder.

During the tests, measurements are taken to see how the bladder muscles and nerves respond as the bladder fills and empties. The tests are not usually painful, though they can sometimes cause mild discomfort. The results help determine whether symptoms are related to overactive bladder, weakened muscles or other bladder control problems.

Other diagnostic overactive bladder or incontinence testing may include:

• Cystoscopy, where a scope is used to look inside your bladder
• Radiology/imaging scans
• Endoscopic procedures of the bladder or bowel

What are the treatment options for urinary incontinence and overactive bladder?

There’s no single incontinence or overactive bladder treatment that works for everyone, but there are a variety of medical and surgical options that can be tailored to you.

From medical management and pelvic floor physical therapy to state-of-the-art urogynecologic surgery, our team at Aurora Health Care helps you regain health, confidence, comfort and quality of life.

Botox^® and other nonsurgical overactive bladder treatments

For people with persistent overactive bladder symptoms, nonsurgical treatments can help calm bladder activity and reduce urgency and urine leakage. Botox injections are one of the most commonly used treatment options to help with this, but there are several other therapy options designed to improve bladder control without surgery.

• Botox injections: Botox is injected into the bladder muscle to help relax overactive contractions. This outpatient treatment can reduce urgency, improve bladder capacity and decrease leakage.
• Percutaneous tibial nerve stimulation (PTNS): A minimally invasive therapy that stimulates nerves in the lower leg connected to bladder control. This stimulation can help reduce urgency, frequency and urge incontinence.
• Urethral bulking injections: Materials such as collagen are injected around the urethra to help it close more effectively, reducing urine leakage, especially with activities like coughing or lifting.
• Medical devices: In cases where the bladder doesn’t empty fully, self-catheterization may help drain urine safely and reduce discomfort or infections.
• Biofeedback: This therapy uses sensors to help you become more aware of bladder and pelvic floor muscle activity, supporting better control and coordination.

Overactive bladder medications

Medication may help reduce overactive bladder symptoms by calming bladder muscle activity or improving communication between the bladder and nervous system. These treatments are often used alone or alongside other therapies.

Your doctor can help determine whether medication is appropriate based on symptoms, overall health and other treatments being considered.

Bladder training therapy

Bladder training focuses on gradually improving bladder control through scheduled bathroom visits, urge-delay techniques and behavioral strategies. Over time, this approach can help increase the time between urination and reduce sudden urges.

Bladder training is often combined with pelvic floor exercises or physical therapy for added benefit.

Surgical treatments for urinary incontinence

Surgical options are sometimes recommended when other nonsurgical options and therapies aren’t successful. These procedures aim to support bladder control, restore anatomy or improve nerve signaling involved in urination.

Surgical treatment options may include:

• InterStim^® therapy or sacral nerve stimulation: A neurotransmitter device placed under your skin gives mild electrical pulses that stimulate the nerve that controls the bladder and surrounding muscles. The stimulation reduces symptoms of overactive bladder and urinary retention.
• Sling procedure: This procedure treats urinary stress incontinence. The sling restores and supports the correct anatomical positioning of pelvic organs.
• Vaginal surgery: This minimally invasive procedure is performed through small vaginal incisions to correct structural issues contributing to incontinence.
• Laparoscopic and robotic surgery: These advanced, minimally invasive techniques offer faster healing and smaller scars.
• Pelvic reconstructive surgery: This procedure can be used to treat pelvic floor dysfunction, which can cause incontinence.

Pelvic floor therapy

For fecal or urinary incontinence, pelvic floor physical therapy, including pelvic floor muscle exercises like Kegels, can be an effective treatment option to strengthen the pelvic floor muscles. If pelvic floor muscles are causing bladder problems, this therapy is often one of the first treatments. Successful pelvic floor therapy can prevent the need for surgery.

Research and innovations in overactive bladder treatment

Care for overactive bladder continues to evolve, with research focused on making treatments more effective, less invasive and better tailored to each person’s symptoms. Many of today’s treatment options, including Botox injections, nerve-based therapies and pelvic floor rehabilitation, are the result of ongoing research aimed at improving bladder control and quality of life.

Urinary incontinence, overactive bladder and aging

Urinary incontinence and overactive bladder can happen to anyone, but it’s more common in older adults, especially women. In men, urinary continence is usually related to issues with the prostate gland.

Some causes of urinary incontinence in older adults include:

• Loss of elasticity in the bladder and pelvic floor muscles, reducing the amount of urine the bladder can hold
• Arthritic or other pain that limits the ability to move quickly enough to get to the bathroom in time
• Congestive heart failure and other conditions that cause excessive fluid buildup in the body
• Deterioration in how the nerves and muscles signal the bladder, causing the need to urinate more often or unexpectedly
• The need to urinate more frequently during the night
• Dementia or Alzheimer’s disease causing you to forget to go to the bathroom or where to find the toilet
• Greater risk for urinary tract infections in women after menopause

Tips for managing an overactive bladder

Managing an overactive bladder often involves more than one approach. Small adjustments to daily habits and routines can help reduce symptoms, improve confidence and make it easier to stay active and comfortable.

• Avoid caffeinated drinks such as coffee, tea and soda, which can increase urination.
• Keep hallways and bathrooms well-lit and clutter-free to make it safer and easier to get to the bathroom during the night.
• Use underwear that’s easy to get on and off.
• Wear absorbent briefs when necessary to avoid soiling clothing.
• Consider weight loss, if needed, to increase your mobility and reduce pressure on your bladder.
• Limit fluids before bedtime.
• Avoid smoking, which can irritate the bladder.

Locations

Aurora Health Care offers overactive bladder and incontinence treatment in Milwaukee, Green Bay and throughout eastern Wisconsin. Call the location nearest you to set up an appointment today:

Aurora Medical Center West Allis
Aurora Women's Pavilion
8901 W. Lincoln Ave.
Suite 405
West Allis, WI 53227
414-329-5650

Aurora Medical Center – Grafton
Medical Office Building
975 Port Washington Rd.
Grafton, WI 53024
262-329-8100

Aurora Medical Center – Summit
Medical Office Building
36500 Aurora Dr.
Summit, WI 53066
262-434-5000

Aurora BayCare Medical Center
Women's Center
2845 Greenbrier Rd.
4th Floor
Green Bay, WI 54311
920-288-8510

Aurora Health Center
4202 W. Oakwood Park Ct.
Suite 200
Franklin, WI 53132
414-649-1280