Bladder issues get more common as you age. For men, an enlarged prostate is a common cause. In women, the weakening pelvic floor muscles can cause bladder issues.

They can include:

• Incontinence: You struggle to control when and if you pee. Sneezing or exercising can make you leak urine. You might also get the urge to pee randomly and not be able to make it to the bathroom.
• Overactive bladder: You constantly feel like you have to go. Your bladder squeezes out urine, and you’re constantly making trips to the bathroom.

You should seek bladder treatment from your primary care or women’s health team if you have:

• Frequent urges to pee
• To get up to pee multiple times a night or throughout the day
• Accidental leaking, including during daily activities or when at rest
• Trouble emptying your bladder, meaning that your bladder feels full even after peeing
• Pain and discomfort, either while peeing or in your abdomen or pelvic area

The most crucial factor might be its impact on your daily life. If your bladder issues interfere with work, relationships, exercise, school, or other routines, seek care.

Everyone responds differently to bladder treatments. Your primary care team may try more than one. For many people, a combination of behavioral and medical treatments works best.

Behavior-based bladder treatments

Depending on your symptoms and what might be causing them, your doctor might suggest some lifestyle changes.

This includes:

• Keeping a strict bladder schedule 
• Peeing twice in a row, or “double voiding,” when you pee, wait a few seconds, and try again
• Doing bladder exercises to help control the feeling of having to go
• Paying attention to what you eat and drink, including avoiding certain foods and drinks that affect the bladder
• Getting plenty of fiber helps avoid constipation, which can make bladder problems worse

Medicine for bladder issues

Medicines include hormone-based therapy and incontinence treatments.

These medicines can:

• Relax the prostate, bladder, and bladder neck muscles
• Increase the amount of urine your bladder can hold
• Block the signals to your brain that trigger bladder contractions
• Lower certain hormone levels to shrink the prostate, reducing pressure on the bladder

Your doctor will discuss which medicines might be best for you. Some have side effects and work best for certain bladder conditions.

Physical therapy

Your primary care team or gynecologist can refer you to our pelvic floor physical therapy specialists, who can improve bladder issues. It’s a special type of physical therapy focused on the pelvic floor muscles.

Your bladder is part of your pelvic floor. If you can strengthen the muscles that support it, it can help with bladder control. This therapy includes exercises and manual techniques.

Pessary devices

A pessary is a removable device that helps stop urine leakage. It’s a plastic or silicone ring that fits into the vagina. A gynecologist or urogynecologist can help fit a pessary.

A pessary is a good option for people with stress incontinence, which occurs when urine leaks when coughing, sneezing, or jumping.

If your incontinence or overactive bladder isn’t responding to more conservative treatments, you may need to seek the help of a urologist or urogynecologist. Your primary care or gynecologist can refer you to our team.

Botox as a bladder treatment

You may have heard of Botox to smooth out wrinkles. But it can also help with incontinence and overactive bladder.

Urologists and urogynecologists who have special training can inject Botox into the muscles of your bladder to stop them from contracting. This is usually an outpatient procedure that requires local anesthesia. The effects can last up to a year, but the average is about 6 months.

Nerve stimulation

Nerve stimulation with a device that sends electrical pulses to help control bladder muscles better. It also tries to improve communication between the brain and bladder nerves.

Neuromodulation is an option for:

• Patients with neurogenic bladder due to spinal cord injury, multiple sclerosis, Parkinson’s, or other conditions
• People with severe overactive bladder that doesn't respond to medicine
• People with chronic urinary retention not caused by an obstruction

We use different types of nerve therapy. We can start with outpatient therapy using an electrode on your ankle. This is called posterior tibial nerve stimulation. It sends a pulse that runs up your leg, reaching your bladder.

Other people may need sacral nerve stimulation, which is like a pacemaker for the bladder. The doctor implants the device during a small surgery.

Catheter

A catheter drains urine from your bladder if you’re having trouble peeing. A catheter is never the first treatment for bladder issues. But if other options haven’t worked, a catheter might help.

For most patients, a catheter is a temporary option that leads to a more permanent solution. But for some patients, intermittent use of a catheter can be a good long-term solution to a difficult problem.

Surgery for bladder problems

Most people will not need surgery for bladder problems. If other treatments haven’t worked, surgery may be able to bring relief. Urologists and urogynecologists both perform bladder surgeries. 

Common procedures include:

• Sling surgery: This procedure supports the urethra and bladder neck to help prevent leaks. It’s more common in women but is also used in men, especially after prostate surgery.
• Bladder neck suspension surgery: This surgery supports the bladder neck and urethra using stitches and nearby tissue.
• Artificial urinary sphincter: A small device placed inside the body that helps men control urine, often after prostate surgery.
• Prostate procedures: For some men, surgery can relieve bladder symptoms caused by an enlarged prostate.