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Background: Overactive bladder (OAB) results in symptoms of urinary urgency, frequency, nocturia, and incontinence, and is often associated with other health conditions. OAB symptoms may increase fall risk, and thus increase the likelihood of morbidity, particularly in the elderly population. The first line treatment for overactive symptoms is behavioral therapies. This includes approaches to improve bladder function by changing voiding habits, and pelvic floor muscle training to improve strength and coordination of the pelvic floor to help with the urethral closure mechanism. Because this approach has been shown to be effective in treating these symptoms, it may significantly reduce the chance of falls in this population. The purpose of this report is to bring awareness to issues of pelvic health and the available treatment options. Case description: A healthy, active 82-year-old female reported to outpatient physical therapy with progressively worsening symptoms of urinary frequency, urgency, and nocturia 5 times a night for two years. Her main goal was to decrease the need to urinate throughout the night. Outcomes: A pelvic floor CareConnections survey was used to track the patient’s perceived functional improvement, with pelvic floor coordination, strength, global rating of change, and patient self-reported nighttime micturition number as secondary outcomes. The patient had the same CareConnections score after five treatments, but demonstrated improved pelvic floor coordination and strength and reduced nocturia symptoms. Discussion: The patient showed improvement in nocturia symptoms following behavioral therapies and pelvic pyramid training. Frequently, patients with OAB symptoms have other contributing co-morbidities, requiring more significant lifestyle changes, but these intervention strategies may be enough to effect change in otherwise healthy, elderly individuals.