Overactive bladder (OAB) is considered a lower urinary tract symptom (LUTS), affecting a patient’s quality of life. One of the most widely accepted theories explaining the pathophysiology of OAB is the irregular stimulation of sensory pathways and detrusor overactivity. This causes bladder hypersensitivity at low urine volumes (urinary urgency; UU). Our recent cross-sectional study demonstrated dysbiosis in OAB subjects with severe UU. However, the impact of the gut microbiome on the exacerbation of OAB symptoms such as UU and urge urinary incontinence (UUI) remains unknown. Herein, we longitudinally assessed the relationship of gut microbiome with OAB symptoms in community residents.