Your bladder is a balloon-shaped organ in your pelvis. Like a balloon, it expands as it fills. When your bladder works as it should, it’s a temporary storage place for urine.

The average bladder can hold as much as 2 cups of urine. Normally, the more urine in your bladder, the more you feel that you need to pee.

If your bladder becomes irritated, it can make you feel like you need to go more often. Your bladder can also start to squeeze out urine at the wrong time. Sometimes, urine can leak out when you don’t want it to.

For women, bladder issues are often due to weakening muscles in the pelvic floor. For men, having an enlarged prostate is often part of the problem.

Bladder problems are highly treatable, sometimes with minimal intervention.

People usually mention bladder problems to their care team when they’re having trouble with urinating. This can mean you’re peeing too much or at the wrong time. Or perhaps urinating is painful.

These are the bladder and urination issues we see most often:

• Stress incontinence: Urine leaks during activities that put pressure on the bladder, such as coughing, sneezing, laughing, or lifting. It’s more common in women, especially after childbirth or menopause.
• Urge incontinence: A sudden, strong urge to pee that may make it hard to reach the bathroom in time.
• Overactive bladder: Frequent urges to pee, even when the bladder isn’t full. This often means going more than 8 times a day or waking more than twice at night.
• Urinary retention: Difficulty fully emptying the bladder. This problem happens more often in men, often because of prostate issues.
• Bladder infections: Pain or burning when you pee, or pressure in the lower belly. Urinary tract and bladder infections happen more often in women but can also affect men.
• Bladder stones: Hard clumps of minerals form in the bladder. They can cause pain, burning, or trouble urinating. Bladder stones are more common in men.

Who should I see for incontinence?

When you’re dealing with bladder problems, your first stop should be your primary care team, gynecologist, or midwife. If your urinary issues aren’t getting better, your care team may refer you to a urologist or urogynecologist.

• Urogynecologists: Experts in treating women. A blend of urology and gynecology, urogynecology focuses on helping women with pelvic floor problems.
• Urologists: Experts in urinary issues for both men and women. Urologists treat many of the same conditions as urogynecologists.

We may ask you to keep a bladder record when you’re having bladder problems. You’ll note what you drink, how often you urinate, how it feels, and if or when you leak.

Your doctor will ask about symptoms, as well as your overall health and habits. 

The exam may include: 

• A pelvic exam (for women)
• A rectal exam
• Urine and blood tests
• Bladder function tests
• Imaging

Your primary care or women’s health team can usually clear up bladder infections with medicine. For overactive bladder and incontinence, we have several treatment options. 

Treatments include:

• Making lifestyle changes, like reducing caffeine, avoiding constipation, and quitting smoking
• Exercises to strengthen bladder muscles, including pelvic floor physical therapy
• Medicine that relaxes bladder muscles to treat overactive bladder or urge incontinence
• Treatments, including medicine, to shrink an enlarged prostate, which can cause urinary symptoms in older men

If your bladder problems aren’t resolving with these treatments, a urologist or urogynecologist may see you to discuss other care options.

These may include:

• Devices that help control the flow of urine, like a catheter
• Procedures, including urology surgery, when other treatments haven’t worked