What is the bladder?

The bladder is the organ which stores urine produced by the kidneys. It is a muscle in the shape of a bag which can hold around 400 millilitres of urine (Fig. 1a and 1b).

Most people become aware their bladder is filling when it is half full. In order to empty the bladder, you have to be able to relax. This usually means being in a socially convenient environment, such as a toilet or a private space. The brain will then send a signal to the bladder to start squeezing out the urine.

How often you urinate depends on many factors, but one in particular is how much you drink. Most people urinate less than 8 times during the day, and either not at all or once during the night.

Fig. 1a: The male lower urinary tract.

Fig. 1a: The male lower urinary tract.

Fig. 1b: The female lower urinary tract.

Fig. 1b: The female lower urinary tract.

Symptoms of overactive bladder syndrome

Overactive bladder syndrome (OAB) is a common condition and can affect both men and women. Between 10 and 20% of people suffer from it at some stage in their lives. This syndrome is characterised by the presence of urinary symptoms that include:

The sudden need to urinate and having trouble postponing it, also called urgency, that can be followed by an involuntary loss of urine

The need to urinate more often than usual, called increased daytime frequency

The need to wake up at night to urinate, also called nocturia

Diagnosis of overactive bladder syndrome

When OAB symptoms are present, your doctor might need to rule out other possible explanations for the symptoms, such as urinary infection or diabetes.

First, the doctor or nurse might take your medical history and do a physical examination. If needed, other tests will be performed.

This section offers general information about the diagnosis of OAB and situations can vary from country to country.

Medical history

The doctor might take a detailed medical history and ask questions about your symptoms. You can help your doctor by preparing for the consultation:

Describe your current symptoms

Note how long you have had the symptoms for

Make a list of the medication you are taking

Make a list of previous surgical procedures

Mention other diseases or conditions you suffer from

Describe your lifestyle (exercising, smoking, alcohol, and diet)

Physical examination

Your doctor or nurse will do a general physical examination focussing on:

Your abdomen

Your genitals

The nerves in your back

Urine test

You will need to give some of your urine for testing. The test will show if you have a urinary tract infection and if there are traces of blood or sugar in the urine.

Bladder diary

Your doctor may ask you to keep a bladder diary. Here you can note down how much you drink, how often you urinate, and how much urine you produce. The bladder diary is important because it helps your doctor to understand your symptoms better.


Uroflowmetry is a simple test that electronically records the rate of urine flow. It is easily done in privacy at the hospital or clinic. You will urinate into a container, called a uroflowmeter. This test helps your doctor to check whether there is any obstruction to the flow of urine.

Imaging of the bladder

You might get an ultrasonography (also known as ultrasound), which uses high-frequency sounds to create an image of your bladder. The doctor or nurse will scan your bladder to check how much urine is left in the bladder after urinating. This information helps to see if your symptoms are caused by urine retention in the bladder after urinating.


With a cystoscopy, the doctor can look inside the urethra and the bladder with the help of a small camera, usually under local anaesthesia. It may be needed when you suffer from other symptoms, such as blood in the urine.

Urodynamic evaluation

A urodynamic test is done to get more information about your urination cycle and how your bladder muscles work.

During the test, your doctor or nurse inserts small catheters in your urethra and rectum to measure the pressure in your bladder and abdomen. The bladder is slowly filled with sterile water through the catheter in the urethra. This is done to simulate the filling of the bladder with urine. When your bladder is full, you will urinate into a uroflowmeter. The test results are shown on a screen which is connected to the catheters.

Treatment of overactive bladder syndrome

Drug treatment for overactive bladder

Botulinum toxin

Nerve stimulation

Bladder surgery

In case your symptoms have not improved with drug or other treatments, you may need surgery on your bladder. The goal of the procedure is to increase the capacity of the bladder. This will reduce the pressure in the bladder as it fills so that it can hold more urine.

The doctor makes an incision in your lower abdomen and uses a piece of your bowel to increase the size of the bladder. This procedure is called bladder augmentation or clam cystoplasty, and is rarely performed nowadays. If this surgery is recommended you will need to discuss its implications and side effects with your doctor because they can be significant.

Cause overactive bladder syndrome

The precise cause of overactive bladder syndrome is not well understood and is still under investigation. Several factors may be involved and the main one may vary from individual to individual. Some people experience sudden and spontaneous contractions of the bladder muscle

Some people are more sensitive to the feeling of their bladder filling

Some people have a smaller bladder which is filled to capacity more quickly

Self-management overactive bladder symptoms

The symptoms of overactive bladder are often bothersome but not life-threatening. OAB symptoms can last for a long time and there is no simple cure. There are various treatment options available. In most cases, self-management is offered as the first step of treatment. It is common to try different treatment options to figure out which one works best in your individual situation. You can discuss this with your doctor.

You can actively manage your symptoms. The following self-management measures may help you:

Together with your doctor you can discuss adapting when, what, and how much you drink

If urine leakage is a problem, your doctor may recommend wearing an absorbent pad to prevent wetting your clothes

If recommended by your doctor, encourage yourself to “hold it” longer when you feel the urgency to urinate. This will train your bladder and gradually increase the time between toilet visits

Pelvic muscles can weaken with age. Different exercises can help to regain muscle strength and suppress the urgent desire to urinate. A physiotherapist can help you do these exercises the right way.

Read more about continence products, such as different types of pads, at the Continence Product Advisor website

Lifestyle advice

In addition, general lifestyle changes can help manage your symptoms and improve your quality of life.

Discuss with your doctor how much you should drink

Drink less before and during long trips

Drink less in the evening to avoid getting up at night to urinate

Reduce alcohol and caffeine because they increase urine production and irritate the bladder

Certain foods can irritate the bladder and worsen OAB symptoms. It may be helpful to reduce artificial sweeteners, spicy foods, citrus fruits and juices, caffeine and soft drinks in your diet

Maintain a healthy weight (your Body Mass Index should be between 18-25 kg/m2). Reducing your weight may lead to improvement in urine leakage symptoms