Overactive Bladder

What it is

Overactive bladder is characterized by a sudden, hard-to-defer need to urinate (urgency), usually accompanied by increased daytime urinary frequency, the need to get up at night to urinate and, in some cases, leakage of urine before reaching the bathroom. It occurs when the bladder muscle contracts involuntarily, and it is more common with advancing age and after menopause. It affects quality of life, sleep and social life, and many women start mapping out bathrooms and reducing their fluid intake. The assessment includes the clinical history, a voiding diary, a urine test to rule out infection and, when necessary, additional tests. Treatment begins with lifestyle changes and bladder training, pelvic floor physical therapy and, if necessary, medication that relaxes the bladder; vaginal estrogen helps during menopause. Resistant cases have other options, evaluated individually.

Most common symptoms

• Sudden, hard-to-defer urge to urinate
• Frequent bathroom trips during the day
• Need to get up at night to urinate
• Urine leakage before reaching the bathroom
• Urgency triggered by running water, cold or arriving home
• Reduced fluid intake for fear of leaks

Causes and risk factors

• Involuntary contractions of the bladder muscle
• Aging and the drop in estrogen after menopause
• Weakening of the pelvic floor after pregnancy and childbirth
• Excess caffeine, alcohol and carbonated drinks
• Constipation and being overweight
• Neurological conditions and diabetes, in some cases

How it is diagnosed

Diagnosis is clinical. Your gynecologist discusses the urgency, how often you go to the bathroom, urine leaks and the impact on daily life, and may ask you to fill out a voiding diary for a few days, recording what you drink and how often you urinate. The gynecological exam assesses the pelvic floor, the presence of prolapse and signs of atrophy. A urine test rules out infection and, when necessary, ultrasound to measure post-void residual and urodynamic testing complement the investigation.

How we treat it at Femi Saúde

Treatment starts with conservative measures: adjusting fluid intake, reducing caffeine and alcohol, treating constipation, and bladder training, in which the patient learns to gradually increase the interval between urinations. Pelvic floor physical therapy is a central resource, with exercises and techniques to control urgency. When necessary, Femi Saúde's gynecology team prescribes medications that relax the bladder, and vaginal estrogen helps during menopause; CO₂ laser may be considered in selected cases. For cases that do not respond, options such as botulinum toxin injections into the bladder and neuromodulation are available, evaluated individually. The plan is reviewed as it progresses.

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