Bladder Problems: What’s Normal and the Risks and Benefits of Treatment (2024)

There are many reasons you might feel pelvic pain, experience powerful urges to urinate, or have an overactive bladder, including infections, nerve damage, an enlarged prostate, pelvic organ prolapse or side effects of other medications you’ve been prescribed.

Seth Cohen, MD, a urologist at City of Hope in California, says the idea that there are very few options to treat bladder symptoms without surgery is a common misconception. In addition to surgical procedures, “there are alternative treatment options for bladder management, including physical therapy, behavioral interventions, and medicinal interventions,” he added.

Here’s what you need to know about your bladder and how you and your healthcare provider might address your bladder-related symptoms.

Your Urinary Tract

Your urinary tractis made up of your kidneys, ureters, bladder, and urethra. Your kidneys filter your blood to create urine.1That urine then travels from each kidney down through thin muscular tubes called ureters into your bladder, where it is stored. Sensory nerves in your bladder send signals to your brainwhen the organ is getting full, and your brain then signals back to your bladder when it’s time to release the urine through your urethra, the tube connecting your bladder to the outside.2You also have two sets of sphincter muscles that prevent urine from exiting through your urethra at inconvenient times. When nerves signal to those muscles to relax, your bladder contracts and pushes the urine out through the urethra.

Signs of Bladder Problems

There are a variety of conditions that can affect your bladder. Hereare some common bladder-related symptoms3:

• Leaking at inconvenient times, during sexual activity, exercising, coughing, or sleeping
• Blood in your urine
• Pelvic pain
• Pain during urination
• Difficulty urinating
• Urinating more frequently than usual or many times at night

Preparing to See Your Doctor

The options for treating any bladder issue depend on the cause. The available treatments include physical therapy, behavioral modifications, medications and surgery. Cohen emphasizes that you should be prepared to share the following informationwith your healthcare provider so the two of you can discuss the best treatment plan for you.

• When your symptoms started
• How often you experience symptoms
• How often you are you going to the bathroom
• Whether you are experiencing urinary incontinence
• What medicines you are presently taking and when you started taking them (include supplements, herbal remedies, and vitamins)
• Whether there is visible blood in your urine

Bladder Conditions

Some common conditions that can impact your bladder and its function include the following:

Urinary Tract Infections (UTIs)

A bacterial infectionin your urinary tract can make you feel like you need to rush to the bathroom and may often cause pelvic pain or burning when you urinate.4

These infections are typically treated with antibiotics. Read more about how UTIs are treated and the side effects of antibiotics in this article: How to Handle UTIs.

Enlarged Prostate

Benign prostatic hyperplasia (BPH), a noncancerous enlargement of prostate tissue, is a common condition among older men.5By age 60, about half of all men have an enlarged prostate gland, and the prevalence increases with age.

As the gland increases in size, prostate tissue can press on your urethra, which can make it difficult to fully empty your bladder of urine. If your enlarged prostate isn’t causing symptoms, doctors may recommend watchful waiting.

However, if you are unable to empty your bladder, you may need a urinary catheter or a surgical procedure, or doctors may prescribe one of the following medications:

Alpha-Blockers

Alpha-blockers,often prescribed to treat high blood pressure, can also be used to help improve urine flow.6They don’t change the size of the prostate, but they relax the muscles around the prostate and bladder, making it easier to pee and allowing men to sleep through the night, Alex Shteynshlyuger,MD, director of urology at New York Urology Specialists, told MedShadow.

People who have had cataract surgery should use caution when taking these drugs because they can cause problems with their eyes and irises.

Other side effectscan include symptoms like these7:

• Dizziness
• Fainting
• Falls
• Low blood pressure
• Rapid heart rate

Flomax (tamsulosin) is an alpha-blocker that was the first treatment James Huber, a retired human services director in Woodbury, MN, tried when he sought help for BPH. “I took that for the better part of a year but still had frequent urination.” After talking to his friends and conducting some internet research, he told his doctor he’d like to try Avodart (dutasteride), a 5-alpha reductase inhibitor.

5-alpha reductase inhibitors

Avodart (dutasteride) and Proscar (finasteride) are commonly prescribed 5-alpha reductase inhibitors that can be used to gradually reduce the size of your prostate gland over several months.

Because they block the activity of the hormone dihydrotestosterone (DHT), 5-alpha reductase inhibitors can cause side effectssuch as8:

• Erectile dysfunction
• Reduced volume of sperm upon ejacul*tion
• Lower sex drive
• Increased breast tissue

Phosphodiesterase 5 (PDE5) inhibitors

It’s not completely clear how PDE5 inhibitors work on the bladder, but scientists believethey may help relax smooth muscle, modulate the activity of your nerves or reduce prostate growth.9Cialis (tadalafil) is an erectile dysfunction drug that can also be used to treat BPH.

Side effectsof Cialisfor BPH include10:

• Headache
• Nasal congestion
• Flushing
• Back pain
• Indigestion

Antimuscarinics11

These drugs, discussed in more detail under the header “Medications for Bladder Conditions,”treat symptoms of an overactive bladder, which you may experience as a result of an enlarged prostate.

Bladder Stones

Bladder stonesare small, hardened clumps—often made up of calcium—that can form in your bladder.12They are not commonly seen in the Western world but can be caused when urine sits in the bladder for longer periods. This can result from the effects of a spinal cord injury or obstruction by an enlarged prostate or if a foreign object, such as surgical staples or a piece of a catheter, gets stuck in your bladder.

These stones can cause pain or make it difficult for you to fully empty your bladder when they block some of the outflow of urine. Your doctor may prescribe alkalinizingmedications that can help dissolve the stones, or you might need surgery to remove them.

Side effectsof alkalinizing agents include13:

• Gastrointestinal discomfort, including nausea, vomiting, and diarrhea
• High potassium levels in some people with kidney disease

Bladder Pain Syndrome (Interstitial Cystitis)

Bladder pain syndrome, also known as interstitial cystitis, is a condition that causes pelvic pain and urinary incontinence for six weeks or longer.14It’s characterized by inflammation in the lower urinary tract without any obvious cause, such as an infection. Your treatment will depend on your precise symptoms and may include trial and error with a variety of lifestyle changes or medications.

Bladder Cancer

Bladder cancer is a type of cancer that can causeblood in the urine (which is the hallmark symptom), frequent urination, a feeling that you need to urinate even if your bladder isn’t full, and pain or burning during urination. Smoking is one of the well-known risk factors for bladder cancer.15

Treatment options are similar to those for other cancers, such as radiation, chemotherapy, immunotherapy, and targeted therapies.15

Neurogenic Bladder16

Nerves carry signals from your brain that tell the muscles around your bladder to relax and allow you to urinate or to contract and hold your urine in. Injuries or diseases that damage these nerve cells interrupt the communication between your brain and bladder. This can cause the muscles around the bladder and its opening to be less active or overactive, and they no longer work together to regulate bladder emptying.

Your treatment will depend on the cause of your nerve damage and can include lifestyle changes, medications, urinary catheters, or surgery.Some conditionsthat can lead to neurogenic bladder include the following17:

• Diabetes
• Giving vagin*l birth
• BPH
• Parkinson’s disease
• Multiple sclerosis
• Cerebral palsy
• Stroke or brain injury
• Spinal cord injury, infection, or tumor
• Herniated disc
• Congenital conditions (e.g., spina bifida)
• Aging
• Pelvic tumor, bladder cancer
• Pelvic surgery

Your treatment will depend on the cause of the nerve damage.

Pelvic Organ Prolapse

Pelvic organ prolapse(POP) is a condition in which pelvic organs (such as your uterus, rectum or bladder) push into the vagin*.18It’s especially common in women who have given birth. Often, it doesn’t cause any symptoms, but for some, it can cause pain or incontinence.

Kari Adamek spent two decades with severe pelvic pain and waking up repeatedly during the night to urinate. “I thought I was doomed,” she says. “Or I’d have to have surgery.” She believed that her pain and the urge to urinate throughout the night were just symptoms she’d have to live with forever. However, after she talked to her primary care physician and a urogynecologist, she discovered she had pelvic organ prolapse. Adamek has a son who is now in his 20s.

Instead of medications or surgery, the urogynecologist recommended that she try pelvic floor physical therapy. The therapy was “amazing,” according to Adamek. She is relieved that she no longer has to get up so often at night.

Depending on the severity of the prolapse, doctors may recommend pelvic floor physical therapy, devices like a pessary that support your pelvic muscles or surgery. There’s some evidence that topical estrogen could help improve symptoms, but a 2023 Cochrane reviewof 14 studies found that there wasn’t enough positive outcomes data to recommend this treatment.19

Incontinence

Urinary incontinence means an inability to control the passage of urine. There are four broad categories of incontinence symptoms, including20:

Stress incontinence

Urine leaks out when you laugh, cough, lift heavy weights or exercise.

Urge incontinence

You feel a sudden urge to use the restroom, and you aren’t able to hold the urine in long enough to make it to the toilet.

Overflow incontinence

Your bladder is never fully emptied and often leaks. This is usually caused by a neurogenic bladder. It can also occur when the flow of urine is obstructed, like with an enlarged prostate gland that blocks the urethra.

Functional incontinence

Your bladder control is healthy, but you have trouble getting to the bathroom in time to urinate due to limitations in function or movement, such as arthritis, neurologic conditions or muscle disorders.

Is Incontinence Normal as You Age?

Urinary incontinence becomes more common as we age, but scientists say that it is not just a normal part of aging.21It is typically related to an underlying problem, such as those described above, including20

• Weak bladder muscles
• Overactive bladder muscles
• An enlarged prostate
• Pelvic organ prolapse
• Neurogenic bladder
• Conditions that affect mobility

Your treatment options will depend on the cause of your symptoms.

Medications That Impact Bladder Control

In some cases, bladder symptoms may be a side effect of medications you’re taking.22Some medications, like diuretics, make you produce more urine. Other medications can change the way you sense your need to urinate. Still other drugs can weaken your sphincter muscles or make them more prone to spasms that can cause leaks.

Hereare some medications that can impact your bladder control:

• Antihistamines (Benadryl, Claritin)
• Decongestants (Afrin, Sudafed PE)
• Opioids (morphine, oxycodone)
• Benzodiazepines (Xanax, Valium)
• Antispasmodics (Bentyl, Levsin)
• Parkinson’s medications (Duopa, Sinemet)
• Angiotensin-converting enzyme (ACE) inhibitors (Lotensin, Vasotec)
• Alpha-agonists (methyldopa)
• Alpha1-blockers (Uroxatral)
• Antiarrhythmics (Amiodorone, Propranolol)
• Diuretics (Aldactone, Diuril)
• Antidepressants, specifically, selective norepinephrine reuptake inhibitors (Cymbalta) and tricyclic antidepressants (amitriptyline)
• Antipsychotics (Rexulti, Abilify)
• Skeletal muscle relaxants (Lorzone, Zanaflex)
• Estrogen (Premarin, Estrace)
• Beta-3 agonists (Mirabegron)

Do Caffeine and Alcohol Cause an Overactive Bladder?

Initially, researchers suspected caffeine and alcohol might increase your riskof experiencing overactive bladder23because they are known to have a diureticeffect, but more recent studies have provided mixedresults.24, 25, 26, 27

Drug-Free Treatment for Overactive Bladder andUrinary Incontinence

Since there are many causes for incontinence, your treatment will need to be personalized. The therapies discussedbelow may help you control when and where you urinate. But choosing the best one for you depends on the reason for your bladder disorder. If you have a UTI that is causing incontinence, for example, you’ll need to treat the underlying infection.

Bladder Training

Bladder traininguses a set of strategies to help you practice holding your urine. You’ll start by keeping a journal of how often you urinate and when, along with how much and when you drank fluids.28Over time, you’ll practice urinating on a regular schedule and resisting the urge to go for longer periods. Gradually, you’ll be able to increase the interval between bathroom trips.

A recent review of 15 studiessuggested that bladder training may be more effective than certain medications, such as anticholinergics, for reducing symptoms of overactive bladder while minimizing side effects.29

Pelvic Floor Physical Therapy

This therapy consists of exercises that help strengthen the muscles around your pelvis. It often includes exercises such as Kegels, which you can try on your own or with the help of a specially trained physical therapist. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) offers a guideto trying Kegels.30These exercises can be used to prevent the progression of problems like urinary incontinence and vagin*l prolapse.

A pelvic floor physical therapist can help make sure you’re doing the exercises correctly. They may recommend other exercises specific to your condition or tools such as biofeedback, an internal wand or vagin*l weightsthat might help you strengthen and better control these muscles.

Research suggeststhe techniques can help relieve symptoms of stress incontinence, overactive bladder, and pelvic organ prolapse.31

Pelvic floor muscle training during pregnancy was found to help prevent stress urinary incontinence in a recent review of seven studies.32

Electrical Stimulation

A healthcare provider may suggest using electrical stimulation to reduce symptoms of overactive or underactive bladder.There are several waysto deliver electrical stimulation, including vagin*l or anal probes or through an electrode inserted into a nerve above the ankle that sends signals to the nerves in your lower back or pelvis that control bladder function.33

How the stimulation works is not completely clear, but it may stimulate nerve cells that help your bladder communicate with your brain.34

A 2016 review of 63 studiessuggested that the techniques may have promise, but there was not yet enough evidence to suggest that they are more effective than pelvic floor muscle training.33A 2019 reviewcame to a similar conclusion, showing that different techniques for electrical stimulation appeared to be effective in animal studies or in small human studies, but it’s not yet clear which therapies work best for which patients and how they compare to each other and the other available options.34

Acupuncture

You can use acupuncture, with or without medications, to help manage overactive bladder. A review of 30 studiesfound that acupuncture was as effective as medications in reducing symptoms, though the certainty of the evidence was still low, according to the researchers.35

Medications for Incontinence

Alongside any treatments you need for underlying conditions, such as antibiotics for UTIs or chemotherapy for bladder cancer, your healthcare provider may prescribe medications specifically to manage your bladder symptoms.

These medications“have a very wide range of possible adverse effects, including dry eyes, dry mouth, and constipation,” says Cohen.

Beta-3 Adrenergic Agonists

These drugs include mirabegron (Myrbetriq) and vibegron(Gemtesa), which relax the smooth muscle of your bladder, making the urge to urinate less intense.36

Side Effects of Beta-3 Adrenergic Agonists

The most common side effects of these drugs include:

• Headache
• Nausea, diarrhea or constipation
• Runny nose
• Increased blood pressure (specifically with mirabegron)

On AskAPatient.com, self-selected patients who chose to report their experiences wrote that mirabegron caused headaches, increased heart rate and hair loss.37

“Losing a ton of hair every time I wash it, every time I brush it, and it’s just falling out all over the place,” wrote one 44-year-old woman. “I cannot believe hair loss isn’t listed as a side effect. Just read these reviews and Google[d] ‘does Myrbetriq (mirabegron) cause hair loss’ and it is so obvious it does. It’s too bad because it hasn’t caused any other side effects for me. I’d try increasing the dose to see if, but the medication hasn’t really worked much at all in 6 weeks and I’d probably go bald if I increased my dose to 50 mg.”

Antimuscarinic Drugs

Antimuscarinicsare a type of anticholinergic drug.38They block acetylcholine, a chemical that helps constrict muscles, from binding to its receptors on the smooth muscle of your bladder. Like with beta-3 adrenergic agonists, this action relaxes these muscles and leads to less urinary urgency. Sometimes drugs from the two classes are prescribed together.

Antimuscarinic drugs include:

• darifenacin
• fesoterodine (Toviaz)
• oxybutynin
• solifenacin (VESIcare)
• tolterodine (Detrol)
• trospium

Side Effects of Antimuscarinic Drugs

Drugs that block acetylcholine are also used to treat a variety of conditions, such as allergies. That’s because the neurotransmitter acetylcholine has receptors throughout your body that regulate different functions.

However, researchers have found that anticholinergic drug use in later life is associated with cognitive decline.The higher your dose and the longer you take these types of drugs, the higher your risk.39You can ask your doctor to help you review your anticholinergic burden, and determine your level of risk.40If you’re taking too many anticholinergic medications, you and your provider might consider deprescribing, which means stopping certain medications or lowering their doses.

Other side effectsof antimuscarinic drugs include:41

• Dry mouth
• Urinary retention
• Constipation
• Dizziness
• Blurry vision
• Gastrointestinal discomfort

Botox

If other treatments don’t help, your healthcare provider may recommendinjections of botulinum toxinto relax the muscles that control your bladder.42

However, a very small 2024 studyfound that the medication mirabegron was more effective than botulinum toxin injections for managing symptoms of an overactive bladder.43

Side effectsof Botox for an overactive bladder include:44

• Increased risk of UTIs
• Blood in the urine
• Inability to fully empty the bladder

How to Keep Your Bladder Healthy

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) recommends the following tipsto keep your bladder healthy.1

• Drink enough water(the amount you need depends on your current health, the ambient temperature and your level of physical activity).
• Urinate when you need to and fully empty your bladder.
• Avoid and treat constipation.
• Urinate after sex.
• Eat plenty of fruits, vegetables, and whole grains.
• Get regular exercise.
• Do pelvic floor exercises.
• Avoid cigarette and pipe smoking.