Bothered By Urgent Urination? You’re Not Alone

March 20, 2025

Bladder problems such as overactive bladder and urgency incontinence – a frequent, immediate urge to urinate, sometimes leading to leaked urine – are incredibly common. In fact, up to 30 percent of men and 40 percent of women are impacted by overactive bladder. Yet many people live with untreated symptoms that significantly impact their quality of life.

Fortunately, if you struggle with frequent urination, there’s a good chance one of a handful of approved treatments could help restore bladder control.

The Bladder-Brain Connection

Anatomically speaking, overactive bladder results from a mix-up in signals between your brain and your bladder. “The bladder is as much a part of your nervous system as your brain,” explains urogynecologist David Sheyn, MD.

Unlike stress incontinence, which is caused by physical changes that result from pregnancy and childbirth, trauma or surgery, the precise cause of overactive bladder is unknown in up to 70 percent of cases.

Evaluation for overactive bladder typically begins with a review of symptoms and testing to identify any underlying causes. For example, a neurological or heart condition may be found in a small percentage of patients. “Sometimes bladder symptoms offer a window to other health problems,” says Dr. Sheyn.

The good news? “Regardless of what specifically is causing the signaling problem between the bladder and the brain, we’re able to help the vast majority of people improve their symptoms,” he adds.

A Menu of Treatment Options

When it comes to treatment for overactive bladder, there are several options including:

Diet modifications, including limiting certain foods and liquids.
Physical therapy, using pelvic floor exercises to strengthen muscles for better control.
Several FDA-approved oral medications that help to relax the bladder as it fills.
Botulinum toxin (Botox) injections to relax the bladder, which typically last 6 – 12 months.
Sacral neuromodulation, a small device implanted in the lower back to modulate nerve signals to the bladder.
Nerve stimulation, using a needle in the foot to stimulate a nerve and block abnormal bladder signals.

Typically, doctors will recommend beginning with noninvasive approaches like physical therapy or medication, which can provide symptom relief for up to three-quarters of patients, before moving to neuromodulation and nerve stimulation.

Although there has been some connection reported between overactive bladder medications and dementia, Dr. Sheyn stresses that more research needs to be done to better understand the link.

“It may be that people with overactive bladder are more likely to have dementia,” he says. “The overall risk of memory problems with these medications is low, so it’s best to talk to your doctor and to weigh that risk with the potential to meaningfully improve your symptoms.”

An Individualized Approach

In addition to examining the association between dementia and overactive bladder, Dr. Sheyn is exploring research to use artificial intelligence (AI) to match patients with the treatment most likely to work for them. The AI model would take information from CT scans and other imaging to help predict which patients will respond to a certain medication, for example. “Our goal is to gather information from a patient and then we can recommend the best medication for them,’” he says.

Even without next-generation tools like AI, Dr. Sheyn stresses that he can help the vast majority of patients overcome their bothersome overactive bladder symptoms. “Most patients we treat say they wish they’d spoken up and gotten treatment sooner,” he adds.