First-Line Treatments for Overactive Bladder

Overactive bladder (urgency urinary incontinence) can feel overwhelming, emotionally and physically. Many women silently cycle through denial, frustration, and finally, acceptance. But living with constant urgency or leaking before reaching the bathroom doesn’t have to be your “new normal.”

In this episode, I break down first-line treatments for urgency incontinence, the practical, foundational steps every woman should try before turning to medications or procedures.

You’ll learn:

• How to keep a bladder diary to identify your personal triggers (from sparkling water to coffee).
• Why pelvic floor strengthening is key—and the difference between doing Kegels on your own vs. with support.
• How to practice urge suppression—the 5 quick contractions + calming breath technique that really works.
• The power of bladder retraining to teach your body to hold more comfortably over time.

These tools don’t just improve symptoms; they put you back in control, helping you feel less isolated and more hopeful.

Additional resource,  BLADDER DIARY.

Take this first step toward confidence and freedom from urgency.

Transcript

Okay. Leaking urine can be so overwhelming. There are so many stages that women go through denial, depression, and then acceptance. So many women have urinary incontinence, but we still don't talk about it, and so many women just don't know where to start. I'm gonna break this down for you and tell you how to get started if you are struggling with overactive bladder or urgency incontinence.

This is from a podcast that I did a couple years ago, but the information on it is great. So listen and learn. Hi there. Today I am gonna be talking to you about first line treatments for urgency urinary incontinence. So again, urgency urinary incontinence, also known as overactive bladder. Is that gotta go feeling where you're going to the bathroom all the time.

You're worried about getting there on time and sometimes you might even be leaking before you can get there. Different types of leaking are treated in different ways, and today we're going to be focusing on first line treatments for overactive bladder. So with overactive bladder or urgency urinary incontinence.

We talk a lot about first-line therapy, second line therapy, and third line therapy. So first line therapy really focuses on behavioral changes and pelvic floor muscle strengthening. Second line therapy includes medications and supplements that you can take. And then third line therapy includes procedures and surgeries, um, more interventional techniques.

And today we're really just gonna be talking about this first line therapy. So for many women, the first line therapy is all they need to do to treat their urgency. Urinary incontinence. You've developed some behaviors that have made your bladder behave more poorly, and there are things that you can do to counteract this.

Different techniques you can use, things you can change. This is always the first thing that we recommend. It's a lot of hard work for you, but even if you go on to second and third line therapy, this hard work will really help you and help you maintain the benefits. People always do better when they do this initial homework.

So the first thing that we usually have you do is we have you keep a bladder diary and I'll include a link to a bladder diary in the show notes. So a bladder diary really is just journaling your symptoms. You're gonna be writing down the day and during that day. At what time you're drinking things, what you're eating, and then how your bladder is behaving.

And we have you document the symptoms that are bothering you, so you could write down how many times you're leaking. You could write down how often you're going. You could just document when it feels really urgent. You're gonna write this down. You can use a formal bladder diary. You can just write it down on a piece of paper.

There are different apps that are out there that can help you with this. It, it doesn't really matter how you do it, it's just important that you do the exercise. Sometimes we'll have you do it for one day. Sometimes we'll have you do it for three days in a row. I. I think the thing that's the most important is that you really document a day where you have symptoms that are bothersome to you.

So if you journal your symptoms and it's a day where everything is perfect, then you need to do it again because it is not. Giving you the information that you need. Once you've done this, look at your results and you're looking to see if you can see any patterns. Does your bladder act up after that second cup of coffee?

Is it worse when you drink carbonated beverages or sparkling water? Do drinks with artificial sweeteners, make things worse. Or maybe tomato-based foods we have you add up the number of leaks that you're having per day and the number of times that you're going, and then this'll give you a baseline. A lot of what we eat and drink is a habit, and we don't really pay close attention.

When I have my patients do avoiding diary, they frequently see the problem before they even talk to me, and they realize that they're drinking too much. Or maybe there's a specific food that's bothering them. Once you write it down, it can be pretty easy to figure out what the problem is. There are a lot of bladder irritants that are out there, and I think some of these are well known to us.

I think everyone knows that coffee is a bladder irritant, but there are lots of other things that you may not realize. The big one that I see a lot these days is sparkling water. So the carbonation is a bladder irritant, and then some of the flavors can also be a bladder irritant. So going through a list of bladder irritants and figuring out if you are.

Using any of them and if they bother you because they don't bother everybody is important information for you. If you do have some bladder irritants in your diet, I usually recommend removing one at a time. And once you identify your list. Of bladder irritants, you can use that information in the way that works for you.

So, for example, if coffee is an irritant for you, you may give up coffee or you could decide that you're just gonna have coffee on days where you're at home and you can go to the bathroom much more easily. You can use that information in a way that works for you, but identifying your triggers is the most important step.

The second thing that we have you do is work on your pelvic floor strength. Women with urgency, urinary incontinence need to have a strong pelvic floor because pelvic floor strengthening will help urgency incontinence. So. I've said this before, but the pelvic floor muscles are a mystery to a lot of us.

So again, they're shaped like a bowl. They go from one hip to the other hip, and then from your pubic bone to your tailbone. They hold up all your pelvic organs, they're connected to your sphincters, and they help keep you dry. And when you contract these muscles or do a Kegel exercise, you're strengthening them.

In order to strengthen your pelvic floor muscles, you need to be able to do a contraction correctly. If you can do a contraction correctly, then you can exercise these muscles on your own. If not, you're probably gonna need to see a pelvic floor physical therapist. There's good data that tells us that pelvic floor strengthening with a pelvic floor therapist is the gold standard, and for urge incontinence, it will treat about 70% of women.

There's more and more data coming out about strengthening on your own, and this is because more and more women wanna do this on their own. Pelvic floor strengthening on your own will work if you can do a pelvic floor contraction correctly, and you continue to do the exercises for three to six months because this is how long it can take to see an improvement in your symptoms.

So again, you can strengthen the pelvic floor on your own if you can do a contraction correctly, and the exercises are most likely to work for you if you continue to do them for three to six months. There are lots of different ways that you can strengthen your pelvic floor. So one, you can do Kegel exercises on your own.

Two, you could get vaginal weights and do the exercises on your own. So the weights provide some biofeedback and it can make it easier for you to feel the muscles working. Three, you can get a peri trainer. So a peri trainer is a vaginal insert. That insert measures the pressure associated with a contraction.

It tells you how strong your muscles are. The vaginal insert is connected usually to your smartphone into an app, and so it will give you different exercises to do over time. It will monitor your progress. It will give you. Often, not always, but it will often give you different exercise routines to do to vary it up.

There are lots of different pelvic floor trainers on the market and none, not one has been shown to be better than another. So you can pick the one that appeals the most to you. And I would also say the one that's on sale because they are of different prices and because one hasn't been shown to be better than the other, it's totally okay to pick the cheapest one.

Per trainers can't tell the difference between a contraction or if you're pushing. Um, so that's something to be aware of because you could be pushing, generating a high pressure, it would be recognizing it as a strong contraction, and you would be doing it incorrectly. So you wanna make sure that you are doing your exercises correctly before you start using a peri trainer.

The fourth thing that you can do is you can always work out with an athletic train trainer, or you can use an online physical therapist or an online program or a group class. There are lots of programs out there that are designed to strengthen the pelvic floor. There are lots of social benefits to doing this with other people.

If you're working with an athletic trainer. Or an online pt, they're gonna make sure that you continue to do it. But again, they're not gonna be assessing your muscle strength directly, and so you need to make sure that you can do a contraction correctly. And then the fifth thing is physical therapy.

Physical therapy is really the gold standard here. Lots of insurances will allow you to go to a physical therapist without a referral, and I'll include a link to a pt. Finder. Um, in, in the show notes, there are also some devices that will contract the pelvic floor without your actually doing anything, and they do them by different mechanisms.

There's some that work by electrically stimulating the muscle. There's one that works by a magnetic wave. Um. These devices come in different forms. So there's a patch that you can put on that will, um, stimulate the pelvic floor. There are shorts you can wear. There's the ELLA chair that you can sit on.

These devices all strengthen the pelvic floor, but they don't teach you how to use the muscles. And so they may not work quite as well as the other techniques, um, because they're not teaching you to use the muscles and then you're not over time using them in a reflexive manner. So something to consider.

These devices tend to be much more expensive, and so that is another consideration as well. Okay, once you have a strong pelvic floor, the number one technique recommended by physical therapy for overactive bladder is urge suppression. So with urge suppression, you do five quick pelvic floor contractions.

The minute you start feeling an urge, contracting the pelvic floor like this reflexively tells the bladder to stop contracting and will make the urge go away. So there are lots of different reflexes in our body, and using them can be to your advantage. You get that urge sensation because the bladder starts contracting when you don't want it to, and you want it to stop doing that while you're waiting for the urge to go away.

Stand still and do 5, 4, 2, 8 breaths. So you breathe into the count of four. Hold it for two and then exhale to the count of eight. And while you're doing this, you try to think of something relaxing, like swinging in a hammock on a beach, something to distract yourself. When you're done with that breathing, the urge should have gone away and you can walk quietly to the bathroom.

The stronger. Your pelvic floor is the better This technique works. Urge suppression works very well, but it does take some practice and you should try it at home before you try it out in public. The last technique that we recommend for overactive bladder is bladder retraining. This slowly teaches your bladder to want to hold more over time and teaches you to ignore your bladder.

In this technique, you go to the bathroom based on time and not when you feel the urge. So you may start emptying every 90 minutes. You do this for three days, and then increase the time by 15 minutes. So if you start at 90 minutes after three days, you would go up to 105 minutes. You empty every 105 minutes for three days, and then you keep upping the time interval until you get to an interval that works for you.

And one thing I would say about this is that we want you to do this while you're awake. I, I don't want you to be waking up in the middle of the night to go to the bathroom that frequently. So these fundamentals help many women with overactive bladder. And this is the place that we really think all women should start.

Okay. Women who go on to additional treatment do better when they have mastered these techniques. So the first is recognizing your triggers and journaling your symptoms and minimizing bladder irritants. Two, strengthening your pelvic floor and mastering urge suppression. And then three is bladder retraining.

I'll have lots of information. And resources in the show notes, so check that out. If you're interested in learning more about bladder irritants and foods that you might consider avoiding, I've included some resources for you in the show notes, so take a look there.