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Bladder Problems

Leaks, urgent trips to the bathroom, bladder infections, bladder pain and waking at night to urinate are common — but they are not a normal part of aging, and most can be treated. Bladder training and pelvic floor exercises are proven first steps.

Get medical care right away if you have any of these:

  • You can’t urinate at all, or you have severe pain or swelling in your lower belly. Sudden inability to urinate (acute urinary retention) can be life-threatening (NIDDK).
  • Bladder infection symptoms plus fever, chills, nausea or vomiting, or pain in your back, side or groin. These can mean the infection has reached the kidneys, which needs quick treatment (NIDDK, MedlinePlus).
  • Blood in your urine — pink, red or brown urine (NIDDK). It often has a harmless cause, but it can also be a sign of a more serious problem, including cancer of the bladder, kidney or prostate (NIDDK).
  • New confusion in an older adult. In older people, mental changes or confusion are often the only signs of a urinary tract infection (MedlinePlus). Call their health care provider the same day.

Call 911 or go to the emergency room if you suddenly lose control of your bladder along with sudden weakness, numbness or tingling in an arm or leg, trouble walking or talking, loss of vision, confusion or loss of bowel control (MedlinePlus). Bladder problems together with back or leg pain, leg weakness, or numbness around the genitals, buttocks and inner thighs can be signs of cauda equina syndrome — pressure on the nerves at the base of the spine — which needs immediate medical attention (American Association of Neurological Surgeons). See our Back Pain guide.

What are bladder problems?

Bladder control problems affect how you hold or release urine. The most common is urinary incontinence — accidentally leaking urine. It is not a disease in itself, but a condition that can be linked to another health problem or life event, such as pregnancy or prostate problems (NIDDK). This guide also covers bladder infections, bladder pain and waking at night to urinate.

Types of incontinence

  • Stress incontinence: urine leaks when coughing, sneezing, laughing or exercise puts pressure on the bladder (NIDDK).
  • Urgency incontinence (overactive bladder): a sudden, strong need to go, with urine leaking before you reach a toilet. It happens when the nerves and muscles of the bladder don’t work together to hold urine. Having both stress and urgency leaks is called mixed incontinence (NIDDK).
  • Overflow incontinence: the bladder doesn’t empty all the way, so it gets too full and leaks (NIDDK).
  • Other types include reflex incontinence from nerve damage (for example after a spinal cord injury or with multiple sclerosis), functional incontinence when a disability or a problem with thinking makes it hard to reach the toilet in time, and temporary incontinence from a medicine, an infection or a bad cough (NIDDK).

How common is it?

Very common, especially in women. Researchers estimate that about half of all women experience urinary incontinence, and as many as 1 in 3 men over age 65 may lose urine by accident (NIDDK). But it is not a routine part of being a woman or of getting older (NIDDK). Proper treatment can improve your quality of life, and the sooner you get help, the sooner it may improve (NIDDK).

What causes it?

  • Pregnancy, childbirth and menopause can weaken the pelvic floor muscles that help hold urine in (NIDDK).
  • Prostate problems in men. An enlarged prostate can make it hard to start urinating or to empty the bladder, and surgery or radiation for prostate cancer can lead to short- or long-term leaks (NIDDK).
  • Nerve problems, from diabetes, stroke, Parkinson’s disease, multiple sclerosis, Alzheimer’s disease or a brain or spinal cord injury (NIDDK).
  • Other health factors: aging, constipation, a long-lasting cough, being overweight, and bladder infections (NIDDK).
  • Medicines, such as water pills (diuretics), antidepressants, tranquilizers, some cough and cold remedies and antihistamines (MedlinePlus).
  • Daily habits: alcohol, caffeinated or carbonated drinks, smoking, physical inactivity and foods that cause constipation (NIDDK).

Bladder infections (UTIs)

A bladder infection is usually caused by bacteria that get into the bladder and multiply. It is the most common kind of urinary tract infection (UTI), and if it isn’t treated it can spread to the kidneys (NIDDK). Signs include burning when you urinate, frequent or intense urges to go even when little comes out, pain low in the belly, and cloudy, bloody or strong-smelling urine (NIDDK). About half of all women will have a bladder infection in their lifetime, and about a quarter of them will have repeat infections; men under 50 rarely get them (NIDDK). Being sexually active, menopause, a diaphragm or spermicide, trouble emptying the bladder, a catheter, a blockage such as a kidney stone or enlarged prostate, and diabetes all raise the risk (NIDDK).

Interstitial cystitis / bladder pain syndrome

Interstitial cystitis (IC), also called bladder pain syndrome, is a long-lasting condition with pain in the bladder that usually gets worse as the bladder fills and eases after urinating. Some people feel mild pressure or tenderness; others have intense pain, urgency or frequency (NIDDK). Between 4 and 12 million people in the United States may have it, more women than men (NIDDK). Researchers aren’t sure what causes it, and symptoms can come and go (NIDDK). It is often confused with repeated urinary tract infections, so mention it to your provider if you suspect it (MedlinePlus).

Waking at night to urinate

Getting up at night to urinate (nocturia) can come from drinking a lot in the evening, caffeine or alcohol with or after dinner, a bladder infection, an enlarged prostate or pregnancy. Less often it is linked to diabetes, heart failure, kidney disease, swollen legs, certain medicines such as water pills, or sleep apnea and other sleep problems (MedlinePlus). See a provider if it goes on for several days, bothers you, or comes with burning or blood in the urine (MedlinePlus).

Men: prostate-related symptoms

An enlarged prostate (benign prostatic hyperplasia, BPH) is the most common prostate problem in men over 50; experts estimate it affects 29% to 33% of men 65 and older. It can cause trouble starting or emptying, a weak or dribbling stream, urgency, frequency and waking at night (NIDDK). Because these symptoms can also come from infections, prostatitis or prostate cancer, talk them over with a health care professional (NIDDK). MBHA’s separate guide on prostate problems is being written.

Bedwetting

Adults can wet the bed too. Some medicines, caffeine or alcohol at night, or a bladder that can’t hold enough overnight can play a part, and so can health problems such as a urinary tract infection, diabetes insipidus, heart failure, kidney disease, prostate enlargement or sleep apnea (NIDDK). For children, see our Bedwetting guide.

How it is diagnosed

Your provider will ask about your health history and examine you, and may ask you to cough with a full bladder to check for stress leaks. A bladder diary — what and how much you drink, when you urinate, when you leak and what you were doing — kept for 2 to 3 days before the visit helps show patterns (NIDDK). A urinalysis (urine test) checks for infection, a kidney problem or diabetes; some people need blood tests, bladder-function (urodynamic) tests, a look inside the bladder (cystoscopy) or imaging (NIDDK). For a suspected infection, a urine culture shows which bacteria are present and helps guide treatment (NIDDK).

You don’t have to just live with it

Many people feel too embarrassed to bring up bladder problems, but gynecologists, urologists and geriatricians talk with people about them often (NIDDK). Left untreated, leaks can lead people to give up activities they enjoy, which can feed depression or social anxiety (NIDDK). Raising it with your provider is the first step toward help.

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Bladder training and pelvic floor exercises (often with a pelvic floor physical therapist) first; then medicines for overactive bladder, devices, Botox injections, nerve stimulation or surgery such as a sling. Antibiotics for infections; a stepwise plan for bladder pain. Physical therapy about $50–$350+ a session without insurance; Medicare Part B covers medically necessary outpatient PT (20% after the deductible). Original Medicare doesn’t cover incontinence supplies or adult diapers. Medicine prices: cost estimate being researched. Strong evidence: pelvic floor training helps many women with stress leaks, and guidelines recommend bladder training for urgency. Medicines and procedures help many people when first steps aren’t enough.
Chiropractic Being researched — coming soon.
Acupuncture Acupuncture or electroacupuncture (needles with a mild electrical current), usually in a series of sessions. About $125–$230 for a first private visit and $90–$185 for follow-ups; community clinics about $50–$90. Medicare covers acupuncture only for chronic low back pain. One large trial found less leaking in women with stress incontinence than sham treatment; evidence for overactive bladder is low quality or uncertain. Not a replacement for pelvic floor training.
Herbal medicine Cranberry products to help prevent repeat bladder infections. We found no good evidence that any herb treats incontinence. Cost estimate being researched. Cranberry probably lowers the risk of repeat UTIs in women who get them often, but does not treat an infection you already have. Check with your provider if you take warfarin.
Massage therapy Being researched — coming soon.
MBHA Wellness Coach Bladder diary, timed bathroom trips, the right amount of fluid, cutting back on caffeine, alcohol and fizzy drinks, avoiding constipation, weight loss, quitting smoking, a daily pelvic floor routine and comfortable protective products. Cost estimate being researched. Habit changes can mean fewer leaks and urgent trips; in one trial, women who lost weight had markedly fewer leaks. They support — not replace — a check-up.

Approach 1 of 6

Conventional medicine (AMA)

For most bladder control problems, care starts with simple steps you can do yourself, guided by your provider; medicines, devices and surgery come next if those aren’t enough (NIDDK).

1. Bladder training and pelvic floor exercises — the first step

  • Bladder training: urinating on a schedule (timed voiding), then slowly lengthening the time between trips so the bladder learns to hold more (NIDDK). The American College of Physicians strongly recommends bladder training for women with urgency incontinence (ACP guideline, 2014), and the American Urological Association’s 2024 guideline says it should be offered to everyone with overactive bladder (AUA/SUFU guideline, 2024).
  • Pelvic floor muscle training (Kegel exercises): the ACP recommends it as the first treatment for women with stress incontinence (a strong recommendation based on high-quality evidence), and pelvic floor training plus bladder training for mixed incontinence (ACP guideline, 2014). Men can benefit too (NIDDK). See the pelvic floor section below for the research.
  • Pelvic floor physical therapy: a physical therapist trained in pelvic floor therapy can help you get the most from the exercises and build core strength; biofeedback or electrical stimulation can help you find the right muscles (NIDDK). Many women don’t do Kegels correctly even when they think they do, and many people benefit from formal training with a pelvic floor specialist (MedlinePlus).
  • Calming a sudden urge: holding still, slow relaxing breaths, distraction, or a few quick, strong pelvic floor squeezes can help you get to the toilet in time (NIDDK).

2. Medicines for overactive bladder

If bladder training hasn’t worked, medicine is the next option for urgency incontinence; the ACP advises choosing among medicines by side effects, ease of use and cost, and recommends against pills for stress incontinence (ACP guideline, 2014). The main types relax the bladder:

Side effects can include dry mouth, dizziness and constipation (MedlinePlus, NIDDK). Memory and thinking: the American Urological Association’s guideline asks clinicians to discuss the potential risk of dementia and cognitive impairment with patients who take, or are offered, antimuscarinic medicines (AUA/SUFU guideline, 2024) — ask about this, especially if you or a family member already have memory concerns. Your provider chooses the medicine and dose; we don’t list doses here.

3. When medicines aren’t enough

  • Botox injections into the bladder relax it so it holds more and leaks less (NIDDK); this is usually done in the provider’s office (MedlinePlus).
  • Nerve stimulation uses mild electrical pulses to change the bladder’s reflexes — either through a fine needle near a nerve at the ankle, done weekly in the office, or with a small implanted device in the lower back (MedlinePlus). The AUA guideline lists these and Botox as options when earlier treatment hasn’t helped enough or caused side effects you can’t tolerate (AUA/SUFU guideline, 2024).
  • For stress incontinence: a pessary (a soft device worn in the vagina), bulking injections near the urethra, or surgery. Sling surgery is the most common operation for stress incontinence in women; men may have a male sling or an artificial urinary sphincter. Complications can occur, so ask about risks and expected results (NIDDK).
  • Overflow incontinence may need a catheter to empty the bladder, or surgery to remove a blockage (NIDDK).
  • Men with an enlarged prostate may also be offered alpha-blockers, 5-alpha reductase inhibitors or phosphodiesterase-5 inhibitors (NIDDK).

4. Bladder infections

Bacterial bladder infections are usually treated with antibiotics, chosen with the type of bacteria and any allergies in mind; drinking more fluids helps flush bacteria out, and a heating pad may ease pain (NIDDK). Take the antibiotic exactly as prescribed and finish it even if you feel better — stopping early can help bacteria become resistant (NIDDK). Men may need a longer course because bacteria can reach the prostate (NIDDK). Bladder infection symptoms most often ease within 24 to 48 hours of starting treatment (MedlinePlus). For repeat infections, a provider may suggest changing birth control or, after menopause, vaginal estrogen (NIDDK), or a preventive antibiotic plan (MedlinePlus).

5. Interstitial cystitis / bladder pain syndrome

There is no standard treatment; finding what helps takes some trial and error (MedlinePlus). Care usually moves step by step: finding and avoiding food triggers, bladder training, and physical therapy with a therapist who specializes in the pelvic floor to stretch and relax tight muscles. With IC, avoid strengthening exercises such as Kegels unless a physical therapist is guiding you (NIDDK). Medicines may include pentosan polysulfate sodium (the only pill approved for IC), amitriptyline or hydroxyzine, and medicines placed directly into the bladder (MedlinePlus). Other options include bladder stretching, nerve stimulation, Botox and, for Hunner lesions, cauterization; surgery is rarely needed (NIDDK).

Eye safety with pentosan (Elmiron): long-term use has been linked to pigment changes in the retina that may continue even after stopping. Tell your provider and eye doctor right away about trouble reading, slow adjustment to dim light or blurred vision; regular eye exams are suggested during treatment (FDA-approved label).

What it costs

  • Pelvic floor physical therapy: a cost guide puts physical therapy at about $50–$350 or more a session without insurance; with insurance, typically a $10–$75 copay or 10%–50% coinsurance (CostHelper). Medicare Part B covers medically necessary outpatient physical therapy when your provider certifies you need it; you pay 20% of the Medicare-approved amount after the deductible, with no yearly cap (Medicare.gov).
  • Pads, briefs and other supplies: Original Medicare doesn’t cover incontinence supplies or adult diapers, so you pay the full cost; some Medicare Advantage plans offer extra benefits — ask your plan (Medicare.gov).
  • Prescription medicines, procedures and surgery: cost estimate being researched.

What to expect

Many people need to try more than one treatment, sometimes together, and improvement takes time (MedlinePlus). Even after treatment, some leaks can happen, and protective products can help you stay active and confident (NIDDK).

Find a medical doctor in our directory

Approach 3 of 6

Acupuncture

Acupuncture has been studied for incontinence; the largest trials so far were done in China. The best evidence is for stress incontinence in women; for overactive bladder it is weaker.

What the research says

  • Stress incontinence: a 2017 trial at 12 hospitals in China (504 women) compared 18 sessions of electroacupuncture to the lower back over 6 weeks with a sham version that didn’t pierce the skin. After 6 weeks the real treatment group leaked less urine on a one-hour pad test and had somewhat fewer leaks in their bladder diaries, with differences still seen months later. Side effects were few and mild. The authors said more research is needed on long-term results (Liu et al., JAMA, 2017).
  • An earlier Cochrane review (2013) found only one small, high-risk-of-bias trial and called the effect of acupuncture for stress incontinence uncertain (Cochrane review, 2013).
  • Mixed incontinence: a 2019 trial in China (500 women) found electroacupuncture was not worse than pelvic floor training plus a bladder medicine at reducing leaks over 12 weeks (Liu et al., 2019).
  • Overactive bladder: a 2022 Cochrane review of 15 studies (1,395 adults) found it uncertain whether acupuncture works better than sham acupuncture, and only low-certainty evidence that it may help slightly more than medicine, with fewer minor side effects. The reviewers said conclusions must stay tentative until larger, better studies are done (Cochrane review, 2022).

If you want to try it, use it alongside — not instead of — pelvic floor and bladder training, and see a provider first to rule out infection or another cause.

Safety

Relatively few complications have been reported, but improperly delivered acupuncture can cause serious harm such as infections. The FDA requires needles to be sterile and single-use, and most states license acupuncturists (NCCIH).

What it costs

Private sessions run about $125–$230 for a first visit and $90–$185 for follow-ups; community clinics charge about $50–$90 (The Pricer). Medicare Part B covers acupuncture only for chronic low back pain, so it won’t pay for bladder treatment (Medicare.gov).

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

We found no good-quality evidence that any herb treats incontinence or overactive bladder. The one plant product with real research behind it is cranberry, for preventing repeat bladder infections. We don’t list doses or brands.

Cranberry and bladder infections

  • A 2023 Cochrane review of 50 studies (8,857 people) found cranberry products probably lower the risk of symptomatic bladder infections in women with repeat infections, in children, and in people at risk after a medical procedure. They may offer little or no benefit for older people living in care facilities, pregnant women, or people whose bladders don’t empty fully (Cochrane review, 2023).
  • NCCIH notes that results have been inconsistent and that the FDA allows only a “limited” evidence claim on cranberry supplement labels (NCCIH).
  • Cranberry does not treat an infection you already have. If you think you have a UTI, see a provider instead of relying on cranberry (NCCIH, NIDDK).

Safety

  • Cranberry by mouth is generally thought to be safe, though very large amounts can upset the stomach (NCCIH).
  • Blood thinners: evidence conflicts on whether cranberry interacts with warfarin — if you take warfarin or any other medicine, talk with your provider first (NCCIH).
  • Supplements can interact with medicines, and “natural” doesn’t always mean safe (NCCIH). Talk with your provider before using any supplement for your bladder (NIDDK).

Approach 6 of 6

MBHA Wellness Coach

An MBHA Wellness Coach can help you turn your provider’s advice into daily habits, keep track of progress, and talk about something many people find hard to raise. These steps support — but don’t replace — a check-up, especially if any warning signs appear.

Know your bladder

  • Keep a bladder diary for a few days: drinks, bathroom trips, leaks, urges and what you were doing. It helps you and your provider see patterns (NIDDK).
  • Timed bathroom trips: go on a regular schedule and, as your provider suggests, slowly stretch the time between trips (NIDDK).
  • Don’t regularly hold urine for a long time; it can wear out bladder muscles and raises the chance of infection. Take your time and empty fully — sitting rather than hovering over the seat helps women relax the right muscles (NIDDK).

Drinks: not too little, not too much

  • Drink enough that you urinate every few hours and your urine is pale yellow — water is best. Cutting back too much can dehydrate you; people with heart or kidney failure need their provider’s advice on how much to drink (NIDDK, NIDDK).
  • To cut nighttime trips, you might stop drinking a few hours before bed — if your provider agrees (NIDDK).
  • Cut back on caffeine, alcohol and fizzy drinks. Limiting coffee, tea, chocolate and carbonated drinks may reduce leaks, and alcohol makes your body produce more urine (NIDDK). Spicy foods, artificial sweeteners and citrus may irritate the bladder for some people — try leaving them out for a while to see (NIDDK).
  • With bladder pain (IC), a food diary can help pinpoint triggers such as citrus, coffee, tea, soda, alcohol, tomatoes or spicy food; a registered dietitian can help (NIDDK).

Whole-body habits that help

Lowering the chance of bladder infections

Drink enough fluids, wipe front to back, urinate when you feel the urge and empty fully, and choose cotton underwear and loose clothing (NIDDK).

Comfort, dignity and support

  • Washable absorbent underwear, pads, disposable briefs, bed and chair pads, skin cleansers and barrier creams can keep you dry and comfortable; men can use external catheters (NIDDK). Many well-designed products aren’t noticeable to others (MedlinePlus).
  • Bladder problems are common, yet many people feel too embarrassed to mention them. Talk with your provider, and consider telling family or friends — you may find they have had bladder problems too (NIDDK). A coach can help you prepare for that conversation and your bladder diary for the visit.

Another approach

Pelvic floor muscle training (Kegels)

The pelvic floor muscles stretch like a hammock across the bottom of the pelvis and help hold in urine, stool and gas. Pregnancy, childbirth, surgery and aging can weaken them; Kegel exercises strengthen them, and they can help both women and men (NIDDK).

What the research says

  • A 2018 Cochrane review of 31 trials (1,817 women) compared pelvic floor training with no treatment or inactive treatment. Women with stress incontinence who trained were about eight times as likely to report being free of leaks at the end of treatment (56% vs 6%; high-quality evidence) and had about one fewer leak a day. Benefits were also seen across all types of incontinence, side effects were rare and minor, and the reviewers said it could be part of first-line care (Cochrane review, 2018).
  • The American College of Physicians recommends it as the first treatment for stress incontinence in women, based on high-quality evidence (ACP guideline, 2014).
  • Most trials were small to moderate in size with less than a year of follow-up, so long-term results need more study (Cochrane review, 2018).

Getting started

  • Find the muscles you would use to stop passing gas. Squeeze, hold briefly, then fully relax — without tightening your stomach, thighs or other muscles (NIDDK).
  • Don’t make a habit of stopping your urine midstream to practice; not emptying fully could raise the risk of a bladder infection (NIDDK).
  • Practice lying down, sitting and standing, a few times a day, and be patient: you may not feel a difference for 3 to 6 weeks. Don’t overdo it — too much can lead to straining (NIDDK).
  • Many people have trouble finding the right muscles. A doctor, nurse or pelvic floor therapist can check your technique and suggest biofeedback or other aids, and give you a plan suited to you (NIDDK).
  • Check with your provider before you start (NIDDK) — and if you have bladder pain (IC), work with a physical therapist instead of doing strengthening exercises on your own (NIDDK).

Still being researched: Chiropractic, Massage therapy. We add each approach once its costs and results are sourced. Are you a practitioner with experience treating Bladder Problems? Tell us.

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This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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