How to manage bladder symptoms that fluctuate with your cycle

In this interview, Aleece Fosnight, MSPAS, PA-C, CSC-S, CSE, IF, MSCP, HAES, the founder of the Fosnight Center for Sexual Health and a medical advisor for Aeroflow Urology, outlines a stepwise, clinician-endorsed approach to managing bladder control issues that fluctuate across the menstrual cycle, emphasizing individualized, multidisciplinary care.

She explains that first-line management should focus on behavioral strategies, particularly hydration and dietary habits. Many patients mistakenly reduce fluid intake because of frequent urination, but Fosnight notes that concentrated urine can irritate the bladder and worsen urgency. Instead, patients should maintain adequate hydration and spread fluid intake evenly throughout the day to avoid overwhelming the kidneys and triggering large urine volumes at once.

Targeted pelvic floor physical therapy is another cornerstone of treatment and one of Fosnight’s most frequently recommended interventions. She emphasizes that pelvic floor therapy is beneficial for people of all genders and helps patients better understand pelvic anatomy, muscle coordination, and relaxation. By addressing pelvic floor dysfunction, therapy can significantly improve bladder symptoms.

When symptoms appear tied to the menstrual cycle, pharmacologic options can be used as short-term support. Fosnight highlights NSAIDs to reduce inflammation driven by menstrual cytokines. Antihistamines may help patients with a suspected histamine or mast cell component, such as those with interstitial cystitis. Short courses of anticholinergic medications like oxybutynin, flavoxate, or hyoscyamine (which can be dissolved sublingually for quick relief) may serve as “bridging therapies” rather than long-term solutions. Beta-3 agonists such as mirabegron (Myrbetriq) or vibegron (Gemtesa) are additional options.

Bladder training techniques are also valuable. Gradually delaying voiding helps retrain bladder signaling, calm the nervous system, and reduce anxiety-driven urgency. Fosnight notes that sympathetic nervous system activation can worsen symptoms and create a cycle of fear and pelvic floor tension.

For persistent symptoms, more advanced interventions—including nerve stimulation, bladder onabotulinumtoxinA, pelvic floor botulinum toxin injections, or sacral neuromodulation—may be considered. Overall, Fosnight advocates for layered, patient-centered strategies that address both physiologic and nervous system contributors to cyclical bladder symptoms.