Some women who are in perimenopause or menopause find they need to pee more often than they used to and that they feel more of an urgency to do so than in the past. What’s going on? One possibility is the presence of overactive bladder. 

You may be thinking: oh no, along with hot flashes, headache, fatigue, and indigestion, now I have to deal with needing to pee all the time.” Indeed, overactive bladder can be a challenge and disrupt your daily routine at times. You may have some urine leakage, which can be embarrassing, or you might curtail your social or exercise activities because you are afraid of not finding a bathroom in time and wetting yourself. Stress and anxiety over these fears can impact your life as well as exacerbate menopausal symptoms.

Although there are medications that may provide some relief from symptoms of an overactive bladder, taking a holistic approach and integrating natural remedies and management tools are effective ways to help bring this condition under control. 

Read about menopause and urinary incontinence

Understanding overactive bladder in perimenopause and menopause

First of all, overactive bladder is not a disease. Nor is it a normal part of aging or part of being a woman. Rather, it is the term used to describe a group of urinary symptoms that can affect both women and men. In fact, about 30 percent of men and 40 percent of women experience the symptoms. 

Be sure to rule out other possible causes like a urinary tract infection. UTIs can often be mistaken for overactive bladder (OAB) and visa versa. 

Estrogen plays many roles in the body, and one of them is helping maintain muscle strength around the pelvic organs and bladder. As estrogen levels decline, the urethra and bladder weaken and the urethral and vaginal tissues grow thinner, which can lead to symptoms of overactive bladder. 

The main symptom of an overactive bladder is a sudden, uncontrolled urge to pee, and sometimes urine does leak out before you can reach a bathroom. Other symptoms include the need to pee multiple times during the day and waking up often during the night to pee. Generally, if you need to pee more than eight times during a 24 hours period, you have frequent urination.

These symptoms are not the same as those experienced by someone who has stress urinary incontinence. In those cases, people leak urine when they laugh, sneeze, cough, or do other physical activities or movements. 

Living with an overactive bladder has the potential to limit your daily activities and therefore affect all aspects of your life, including your daily activities, work, travel, social life, and sex life. It can disrupt your ability to get adequate sleep and leave you feeling depressed and fatigued. Urine leakage may result in infections or skin problems. Fortunately, there are many lifestyle changes you can make that can help you relieve, better manage, and even eliminate overactive bladder symptoms.

Use nutrition to manage overactive bladder

Your food and liquid choices are important in helping you best manage symptoms of overactive bladder in perimenopause and menopause. Here are a few tips.

Fluid intake. In a 2018 study appearing in the Journal of Urology, the investigators reviewed articles from a 45-year period and reported that excessive water intake (more than 8 glasses daily) can worsen symptoms of overactive bladder. However, it’s also critical for everyone to maintain adequate fluid intake because the body requires water for overall function and health. It can be helpful for women in perimenopause and menopause who are experiencing overactive bladder to keep a diary of fluid intake, note how often they are urinating, and discussing their findings with their physician. 

Ways to maximize the benefits of your fluid intake and minimize excessive urination include:

• Taking small sips rather than gulping down large amounts of water
• Avoid or minimize fluid intake two hours before bedtime
• Avoid beverages that are sugary or contain caffeine

Optimal food choices: To help minimize overactive bladder symptoms, it helps to avoid foods and beverages that can irritate the bladder, such as coffee, tea, tomatoes and foods made with tomatoes, spicy foods, soda, raw onions, sports drinks, chocolate, alcohol, items that contain additives and preservatives, and citrus fruits. Keeping a diary of your food and drink intake and your need to pee can give you insight into which items may be contributing to your symptoms. The list of foods that are soothing to the bladder is long and includes natural or minimally processed foods, such as non-acidic fruits that are rich in water (e.g., apples, apricots, pears, berries, bananas, plums, peaches, cantaloupe, honeydew, watermelon, pomegranates), vegetables (asparagus, carrots, cucumbers, celery, lettuce, green beans, squash, cruciferous veggies, sweet potatoes), lean protein, whole grains, plant-based beverages, eggs, nuts, legumes, and herbal teas. 

Fiber-rich foods. What does fiber have to do with your bladder health? An adequate intake of fiber (25-35 grams daily) helps maintain both healthy digestion and bowel movements. Constipation and other bowel disturbances can exacerbate bladder symptoms. Some high-fiber foods to include in your daily diet include oats and other whole grains and cereals, fruits, vegetables, beans, seeds, and legumes. Adequate fluid intake is also essential for avoiding constipation. Also consider a prebiotic fiber supplement like Morphus Fiberus to add extra fiber to your diet.

Read about menopause and soluble fiber

Lifestyle tips for overactive bladder management

In addition to paying close attention to food and beverage choices and intake, women in perimenopause and menopause can take a variety of other measures to manage overactive bladder. Including at least one and preferably more of these activities can lead to better results. Be sure to talk with your healthcare provider about incorporating exercise into your lifestyle, especially if you have been inactive.

Pelvic floor exercises. The walls of the bladder are composed of smooth muscles known as detrusor muscles. These muscles are interwoven throughout the organ and allow it to expand and contract depending on the amount of urine in it. Strengthening those muscles and the muscles adjacent to the bladder (pelvic floor muscles) can go a long way toward improving bladder control. 

Several factors can weaken your pelvic floor muscles. These include pregnancy, childbirth, aging, surgery, being overweight, excessive straining from constipation, and declining estrogen levels as occurs in perimenopause and menopause. Pelvic floor exercises (Kegel exercises) can help strengthen those muscles and thus improve bladder control.

Research has shown that women who engage in Kegel exercises experience an improvement in bladder control. In a 2022 pilot study, investigators also found another approach that worked well called diaphragmatic breathing exercise. In the study, two groups of 20 women who had urinary incontinence practiced either Kegel exercises or diaphragmatic breathing daily, one set of 30 contractions, for six weeks. Women in both groups had significant improvement in symptoms. 

Kegel exercises are easy to do and can be done without the need for any equipment. Here are the steps:

• Identify the correct muscles you need to work. Imagine you are trying to stop peeing in midstream. The muscles you contract to achieve this are the ones you will be exercising. (They are called the pubococcygeus (PC) muscles.) 
• Kegels can be done standing, sitting, or lying down, although the latter is best when you are first learning. Do not contract the muscles in your buttocks, thighs, or abdomen when doing Kegels. Also be sure to breathe normally; do not hold your breath.
• To begin, contract your PC muscles and hold the contraction for 3 to 10 seconds.
• Release and relax for 3 to 5 seconds.
• Repeat these two steps 10 to 15 times, three times a day.

For best results, do Kegels three times a day every day. You can do them while watching TV, driving, sitting at your desk, waiting in line at the grocery store, or while lying in bed. Two convenient times to do Kegels is when you lie down to sleep at night and when you first wake up in the morning. After several weeks to several months, you should begin to notice some improvement in the ability to control your bladder. 

Some women use a weighted vaginal cone to help train their pelvic floor muscles. A cone is inserted into the vagina and women use their pelvic muscles to hold the cone in place. Some research has shown that cones may help some women and can be offered as a treatment option. 

Pelvis floor therapy. This type of therapy is a specialized area within physical therapy that focuses on the used to address issues such as muscle weakness or tightness, pain, and dysfunction in the pelvic area that can lead to issues like urinary incontinence, overactive bladder and painful intercourse.

Regular exercise. It’s important to engage in regular physical activity not only for overall health but to keep your bladder functioning optimally as well. Regular physical activity is especially critical for preventing constipation, which can have a negative impact on bladder function. Exercise also helps you maintain a healthy weight, as being overweight puts you at greater risk for urine leakage. Choose physical activities that you enjoy so you will be more likely to put them into your schedule daily. Some low-impact options include walking with friends, spinning/biking, swimming, tai chi, yoga, rowing, elliptical machines, and Pilates. 

Stress management. Experts have shown that stress, anxiety, and depression are associated with frequent urination and overactive bladder, and there’s research to back it up. For example, in one study in which more than 16,000 women participated, the investigators found a 1.5- to two-fold increase in the risk of developing bladder leakage among participants with anxiety or depression. 

In another study in which 51 patients with overactive bladder were compared with 30 age-matched controls without this issue, nearly half of the subjects with overactive bladder has anxiety symptoms. Participants with overactive bladder reported significantly higher anxiety symptoms than the age-matched controls. 

The exact reason why stress and overactive bladder are associated is not clear. One theory is that stress triggers the fight-or-flight response, which in turn turns up the nervous system and may stimulate the bladder. Individuals with overactive may experience stress about their symptoms, which in turn can keep triggering the fight-or-flight response and thus their anxiety increases. Another theory is that muscle tension increases as anxiety and stress increase, which in turn impacts the need to urinate. Yet another link can be seen between waking up frequently to pee during the night and anxiety.

Read about menopause and stress

Stress reduction techniques may help individuals who experience overactive bladder. One small study reported that mindfulness provided some improvement in bladder symptoms. Other stress management approaches that may help include deep breathing (for example, box breathing), progressive relaxation, yoga, tai chi, and meditation.

Scheduled voiding. One management technique that has been successful is following a voiding schedule, which is also sometimes called bladder drills. Following a voiding schedule can help you pee less often, increase the amount of urine your bladder can hold, and reduce your sense of urinary urgency. Here is a brief look at how it works. Remember: always consume 6 to 8 glasses of fluid/water daily.

• Days 1-3: Immediately after you get up in the morning, void your bladder. Wait one hour and urinate again, whether you feel the need to do so or not. Repeat every hour throughout the day. Use the bathroom at night as needed.
• Days 4-6: Empty your bladder when you wake up and then repeat every 90 minutes throughout the day. Pee at night as needed.
• Days 7-9: Void your bladder every two hours.
• Days 10-12: Void your bladder every 2 ½ hours.
• Days 13-18: Continue to increase the time between voiding from 3 to 3 ½ hours. 

You may need to make adjustments to this suggested voiding schedule to fit your lifestyle and urges. However, it’s important to be consistent with whatever schedule you choose to follow and to increase the amount of time between voiding gradually over time. It can help if you use a timer on your watch or phone to remind you to go to the bathroom. To help you extend the time between your voiding visits, you might distract yourself by concentrating on complex tasks such as remembering all the words to favorite songs or doing a challenging crossword puzzle. Some people find that visualization—intensely visualizing you are on vacation or in a favorite location—can be helpful.

Supplements for overactive bladder management

Several natural supplements can help you manage an overactive bladder.

Cranberry: Cranberries contain several active ingredients that may be helpful in managing overactive bladder. They include anthocyanins, flavonols, tannins, terpenes, and phenolic acid derivatives. The potential benefits of cranberries for overactive bladder have been seen in several studies, including one published in the Journal of Urology. The researchers found that women with overactive bladder who took 500 mg dried cranberry powder experienced a 16.4 percent reduction in peeing episodes and a 57.3 percent reduction in urgency episodes when compared with before the study. 

You can purchase cranberry pills or capsules, or you can drink unsweetened cranberry juice. Talk with a knowledgeable healthcare professional to determine the best dose for you. Doses of 250 to 1,500 mg of cranberry dried powder for up to six months and 120 to 1,600 mg of cranberry extract for 12 weeks have been suggested. If using unsweetened cranberry juice, doses of 120 to 750 milliliters daily are suggested. 

[Editor's Note: Utiva has a line of cranberry supplements and a Bladder Health Supplement. Learn more here.]

Magnesium: This mineral helps regulate the normal function of the central nervous system, including nerve cell activity in the brain. It also plays a significant role in muscle contraction and strength. Since an estimated 50 percent of the US population is deficient in magnesium and low intake of the mineral is a global phenomenon, taking magnesium supplements is often recommended. Some research has shown that taking magnesium may help with urinary incontinence in women. A magnesium supplement in the form of magnesium bisglycinate chelate is one option.

Herbal remedies: Herbs such as pumpkin seed extract, saw palmetto, and horsetail have been studied for their effectiveness in managing urinary issues. You should consult a knowledgeable healthcare provider before using any of these or other herbal remedies for overactive bladder. 

Probiotics: Although you can get beneficial bacteria (probiotics) in some foods, taking a probiotic supplement as well can better help you populate your gut with helpful microorganisms to support gastrointestinal health and bladder function. As noted earlier, making wise food choices—foods rich in fiber, foods that do not irritate the bladder, getting sufficient fluids—helps support healthy bladder function. 

According to a study in the American Journal of Obstetrics and Gynecology, women with urinary incontinence have different microbiomes in their urinary tract than women without urinary problems. The probiotics believed to be most helpful for urinary problems include the Lactobacillus species.  

Fiberus and Sleepus: Two natural supplements designed especially for perimenopausal and menopausal women that may provide some relief of overactive bladder symptoms are Fiberus and Sleepus. 

Fiberus is a prebiotic fiber supplement that supports healthy digestion and bowel movements, which in turn help with urinary health. Sleepus contains Lactium®, which helps regulate levels of the stress hormone cortisol so you can sleep better and can decrease nighttime bathroom visits. It also contains magnesium bisglycinate chelate, which promotes muscle relaxation. Both supplements can be a part of a plan to improve urinary health and overactive bladder symptoms.

Talk with a professional

Every woman has a unique lifestyle and needs, so it’s important to discuss your symptoms and concerns about overactive bladder with a qualified healthcare provider. Such a consultation can result in you getting a personalized treatment plan and more effective results. Be sure to be prepared for your consultation by discussing your symptoms, diet, supplements, and any medications you may be taking.

Bottom line

Resolving your overactive bladder symptoms will likely take a combination of dietary, lifestyle, and supplement changes. Review all of the options discussed here and take proactive steps to improve your bladder health. Discuss any questions and concerns with a qualified healthcare provider.

Recommended Morphus Products to help:

Morphus Magnesium

Morphus Sleepus

Morphus Fiberus