You can have a weak (or overactive) bladder due to aging, pregnancy, menopause, diet, or an underlying condition. A doctor can help identify the cause and recommend the appropriate treatment.

If you find yourself having to urinate urgently and often, you may have a weak bladder, also known as an overactive bladder (OAB).

OAB is a condition that becomes more common as people age. Lots of things can cause OAB. Symptoms usually go away or are manageable with treatment or lifestyle changes.

In this article, we’ll review the symptoms of OAB and what can cause it. We’ll also discuss what you can do to manage it.

Who’s most likely to get an overactive bladder?

Anyone of any age can get OAB, but it’s more common and more severe in people 65 years of age or older.

People assigned female at birth may be more likely to get OAB than those assigned male at birth. People who have gone through pregnancy and vaginal childbirth may also have stretched or weakened pelvic muscles, making them more likely to experience OAB symptoms. Declining estrogen in people who have gone through menopause can also have an impact.

Having obesity or overweight is also a risk factor for OAB.

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OAB symptoms can be challenging. You may find yourself avoiding social situations and long trips in cars or airplanes. You may also be fatigued from dealing with nighttime trips to the bathroom.

The main symptoms of having an overactive or weak bladder are:

Urinary urgency

Urinary urgency refers to a strong, sudden need to urinate (pee). The symptoms may also include urge incontinence: the unintentional leakage of urine. People with urge incontinence typically have only a few seconds between feeling a strong need to pee and accidental urination.

Urinary frequency

There’s no specific number of trips to the restroom that defines frequent urination. Rather, the term “frequent urination” refers to feeling a need to pee more often than what’s typical for you on a daily basis.


Nocturia is the need to wake up from sleep to urinate regularly. The sensation of needing to pee will often wake you up one or more times per night. Nocturia can also cause sleep deprivation and daytime fatigue.

How does a healthy bladder work?

Your brain and bladder are meant to work together. As your bladder starts to become full, it sends messages to your central nervous system (CNS): where your brain is. Your CNS then sends out messages to the muscles in your bladder and pelvic region, letting you know it’s time to go.

Your bladder muscles squeeze to push urine out of your body through the urethra. The urethra’s sphincter muscle opens, and urine comes out.

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OAB symptoms may come on gradually or rapidly, based on the underlying cause. Common causes of OAB include:

Urinary tract infections

Urinary tract infections (UTIs) are usually caused by bacteria. Anyone can get a UTI, but they’re much more common in people assigned female at birth. Urinary urgency and frequency are symptoms of this condition.


Certain medications may cause increased urination and OAB symptoms, such as urgency and frequency. These medications include:


Caffeine is a diuretic that increases urine production. Drinking caffeinated beverages such as coffee and soda may make you need to urinate frequently. Caffeine may also cause loose stool.


Alcohol is also a diuretic. It holds back the production of vasopressin, which is a hormone designed to regulate urine excretion from the kidneys. The suppression of this hormone makes you urinate more often.


Frequent urination is typical during pregnancy. The physical and hormonal changes that occur in each trimester can affect how often and how urgently you need to go.

Your body produces more fluids during pregnancy. Your uterus also enlarges to accommodate a growing fetus. Since the uterus is directly behind your bladder, you may feel more urgency and pressure even when your bladder isn’t full.

UTIs are also common during pregnancy. Even though you can expect OAB symptoms with a UTI, talk with a healthcare professional about your symptoms. You’ll need treatment if you have a UTI.

Hormonal changes

Hormonal changes can cause OAB symptoms to occur gradually.

A reduction in estrogen production is a natural part of aging in people assigned female at birth. Estrogen starts to decline in perimenopause and continues to diminish during menopause and afterward.

Reduced estrogen causes the tissues that line the vagina to become thin, which decreases the strength and elasticity of your vagina and the muscles around it. These weakened muscles reduce support for your bladder and urethra, often resulting in urinary urgency and frequency.

If you were assigned male at birth, changes in testosterone and estrogen can affect the size of your prostate. An enlarged prostate may cause frequent urination, difficulty with urination, or urinary incontinence.

Nerve damage (neurogenic bladder)

Physical trauma, such as accidents or herniated discs, can damage the nerves that transmit messages between your CNS and bladder. Conditions such as Parkinson’s disease, stroke, and multiple sclerosis can also cause similar damage.

Doctors and specialists refer to this type of nerve damage as “neurogenic bladder.” This condition can cause your brain to signal to your bladder that it’s full, even when it’s empty or nearly empty.

Excess weight

Extra weight can put pressure on your bladder, generating urge incontinence and other OAB symptoms.


If you have diabetes, you’re at risk of an enlarged bladder, which can cause OAB symptoms.

Bladder stones

If you have trouble emptying your bladder, hard masses of crystalized minerals called bladder stones may form.

Bladder stones can irritate your bladder wall or block urine flow from your urethra. OAB symptoms, such as urgency, may sometimes indicate the presence of bladder stones.

Bladder cancer

Changes in urination, such as urgency, frequency, and nocturia, can be early symptoms of bladder cancer. Pain or burning during urination may also occur.

Hematuria, or blood in your urine, is usually the first obvious symptom of this disease.

Any of these symptoms warrant an examination by a healthcare professional.

Will a weak bladder resolve on its own?

An overactive bladder won’t usually resolve without treatment. You typically need medical treatment or lifestyle changes to resolve OAB symptoms. Getting a diagnosis and addressing the underlying cause is the best way to eliminate or manage OAB.

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A healthcare professional will run several tests to determine what’s causing your symptoms. They may also ask you to keep a bladder diary. The diary may help pinpoint patterns, such as drinking too much coffee, which you can easily change.

The underlying cause of your condition will determine the recommended treatment.


A healthcare professional may prescribe medication to address the cause of OAB. For example, if you were assigned female at birth and have low estrogen, a clinician may prescribe a vaginal estrogen cream or suppository.

Other medications may help directly treat OAB symptoms. These medications help relax your bladder muscle and stop your bladder from squeezing when it isn’t full.


If you have ongoing OAB symptoms after pregnancy, a clinician may recommend exercises such as Kegel exercises that strengthen your pelvic floor.


If medication and recommended changes don’t provide relief, a clinician may recommend bladder Botox. For this treatment, Botox is directly injected into the muscle that lines the bladder (detrusor muscle).

Nerve stimulation

Doctors can also treat nerve damage with sacral nerve stimulation, a type of neuromodulation therapy. An electrode will be implanted under your skin that sends electrical pulses to nerves located along the path between the CNS and bladder. These electrical pulses work to improve communication between the brain and bladder, reducing OAB symptoms.

Another treatment, percutaneous tibial nerve stimulation, is also a form of neuromodulation therapy. A small electrode is positioned in your lower leg near the ankle. The electrode sends pulsed electricity to the tibial nerve, which runs from your leg to your lower back. You may need up to 12 treatments before OAB symptoms resolve.


Doctors rarely use surgery to treat a weak bladder. But if your case is severe, they may recommend bladder reconstruction or urinary diversion surgery.

Who can diagnose and treat overactive bladder?

Doctors who can help identify the cause of your OAB and recommend treatment include:

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OAB, or a weak bladder, is a common condition that can affect anyone. There are several causes, and susceptibility to OAB can become more likely as you age. Treatment will depend on the underlying cause.

Lifestyle changes and medication are often enough to control OAB. Other treatments include Botox and nerve stimulation therapies. In very rare cases, a doctor might recommend surgery.