Urogynecologic Condition
Overactive bladder (OAB) is a syndrome — not a single condition — defined by urinary urgency, frequency, and sometimes leakage. The bladder muscle contracts when it should be resting. The result: a sudden, hard-to-defer urge to urinate, often with little warning.
It is extraordinarily common — affecting an estimated 33 million Americans — and frequently dismissed as “just a small bladder.” It is not. It is a treatable medical condition, and there is a tiered, well-studied set of treatments that resolves it for the vast majority of patients.
Most patients tell us they assumed the symptom was minor — or just something they would have to live with. Neither is usually true.
Treatment Approach
Most patients with overactive bladder improve significantly with behavioral, physical, and minimally invasive treatments — long before surgery enters the conversation. Here is the full toolbox, in the order we typically work through it.
Surgery is one tool in a much larger toolbox. When we do recommend a procedure, it is because we have a specific reason — and we will explain exactly what it does, what it doesn't do, and what recovery actually looks like.
What to Expect
A comprehensive first evaluation with Dr. Johnson. Time to be listened to. In-office diagnostics when possible.
Dr. Johnson has read your intake before you walk in. The conversation starts with the impact on your life — not the textbook.
Performed with explanation at every step. Nothing happens without your full awareness and consent.
Diagnostics are performed in-office where possible to avoid extra appointments.
Every option explained. Pros, cons, and what each one would mean for your week, your work, and your life.
A Patient Story
I was waking up four times a night and planning every meeting around the nearest bathroom. Two months of behavioral retraining and one medication later, I sleep through the night. I wish I had brought it up ten years earlier.
— B.L., treated for overactive bladder
Frequently Asked
A “small bladder” is rarely the actual issue. The bladder capacity is usually normal; the problem is that the bladder muscle contracts when it shouldn't, generating a sense of urgency long before the bladder is actually full. The difference matters because the treatments are entirely different — and effective.
— Lisa L. Johnson, M.D., U.R.P.S.
The β3-agonist class has an excellent long-term safety profile and is my usual first-line medication choice. Older anticholinergics have a more nuanced profile — particularly in older adults — and we make those decisions with care. I will not put you on a medication you don't need, and I will not keep you on one that isn't working.
— Lisa L. Johnson, M.D., U.R.P.S.
Yes — in the right patients, very well. It is an in-office procedure, takes about ten minutes, lasts six to nine months, and is one of the most reliable treatments I have for medication-refractory urge incontinence. We discuss the small risks (temporary need for self-catheterization in a minority of patients) openly before deciding.
— Lisa L. Johnson, M.D., U.R.P.S.
For many patients, dramatically. Caffeine, carbonation, citrus, and artificial sweeteners are the most common dietary contributors. I never ask anyone to give all of them up forever — but a structured elimination and reintroduction usually identifies the one or two that matter most to your specific bladder.
— Lisa L. Johnson, M.D., U.R.P.S.
I would rather say durable resolution than cure. Most of my OAB patients reach a point where symptoms are minimal and self-managed with a combination of habits and, where needed, one tool from the toolbox. The goal is not to depend on medication forever — and for most patients, we don't.
— Lisa L. Johnson, M.D., U.R.P.S.
A thorough, unhurried evaluation with Dr. Johnson. You will leave with a written plan — and clarity on what overactive bladder is doing in your body, and what to do about it.
