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Overactive Bladder

Overactive bladder (OAB) is urinary frequency during the day or night, urgency and even leakage of urine without an apparent reason or warning.

We identify treatable causes of overactive bladder (frequency, urgency with urine leakage) using holistic approaches. When medication or procedures are needed, we offer the full spectrum of options.

Treatment Options

Overactive bladder is often treatable with simple, noninvasive measures.

For example, women and girls receive multiple messages that we should drink more water. A common problem is that, without realizing it, you are consuming too much. We can help you determine if that’s the cause of your overactive bladder.

Simple pelvic floor rehabilitation can also be instrumental in treating OAB.

In some cases pelvic floor strengthening is needed and in other cases you should avoid Kegel exercises entirely. We can help create a treatment plan that is unique for you.

Ultimately, our goal is to avoid unnecessary medication and procedures if other holistic issues can be identified.

What to Expect


If you have OAB symptoms, we’ll start out with a full exam to look for contributing issues such as pelvic floor tone, menopause changes or prolapse.

We’ll also take a full urinary, sexual and bowel history so we can understand the full spectrum of your pelvic symptoms.

As part of the initial evaluation, cultures (including atypical bacteria that can go undetected in routine urine testing) are done as well as a voiding diary.  A good diary should include measurement of the urine volumes (we provide materials for this) as well as your fluid intake.

The voiding diary is the most important part of the evaluation, so we do not begin treatment for overactive bladder until this has been completed.  Lack of this information can lead to unnecessary medication or even procedures.

You may also have a pelvic or renal ultrasound if uterine/ovarian issues are suspected.

Cystoscopy (minor office procedure lasting about one minute) may be utilized in cases where we suspect a bladder tumor, inflammation or stones.


In keeping with best practice guidelines, we always start treatment with pelvic floor rehabilitation. This may mean strengthening for some women and relaxation with avoidance of Kegel exercises for others.

This is accompanied by behavioral changes that are tailored to findings in your own diary.

We may also utilize bladder relaxation medications like Detrol or Vesicare to help.

For women who do not respond to an initial course of conservative therapy, we may offer bladder Botox therapy. Our injectors are among the most experienced in the Pacific Northwest.

We also offer the full spectrum of neuromodulation options ranging from office treatment (Percutaneous Tibial Nerve Stimulation) to implant placement in a minor procedure (InterStim).



A cystoscopy is a procedure that is used to visually inspect the bladder.

Overactive Bladder (OAB)

Overactive bladder or OAB refers to the feeling of needing to urinate much more often than the average person. Since the medical name for the bladder muscle is detrusor, you may hear this condition called names like “detrusor over-activity” or "detrusor instability".

Pelvic Floor Muscle Rehabilitation (PFMR)

The goal of PFMR is to teach you how to contract the pelvic floor muscles to strengthen them and in turn alleviate associated symptoms. This helps reset the nerves and muscles governing bowel and bladder function to give you better control. 

Percutaneous Nerve Stimulation (PTNS)

Percutaneous Nerve Stimulation is sacral nerve stimulation accomplished percutaneously (through the skin) to modulate the neural reflexes that influence the bladder and pelvic floor. This is a form of "electro acupuncture."


In medicine, prolapse is a condition where organs, such as the uterus, fall down or slip out of place. It is used for organs protruding through the vagina or the rectum.

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