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Overactive Bladder


Overactive bladder is a problem with bladder-storage function that causes a sudden urge to urinate. The urge may be difficult to stop, and overactive bladder may lead to the involuntary loss of urine (incontinence).

Formerly called detrusor instability, is a symptom-based clinical diagnosis.

It is characterised by urinary urgency, frequency and nocturia, with or without urge urinary incontinence. These symptoms should initially be managed in the primary care setting and possibly referral and assessment by Community Continence Clinic

Ensure there is no haematuria on dipstick and that any UTI has been treated.

Haematuria should be referred urgently to Urology

Consider chronic retention if palpable bladder or nocturnal enuresis.

Consider nocturnal polyuria if isolated nocturia.

Initial management includes:

Medical therapy involves antimuscarinic agents, or secondly Mirabegron (only where antimuscarinics are contraindicated, ineffective, or not tolerated [NICE Guidance] )

Failure of medical management is an indication for urology referral if the patient wishes to consider more invasive secondary care therapies are which include:

  • Intravesical injections of botulinum toxin
  • Neuromodulation
  • Surgical interventions (very rarely) e.g. augmentation cystoplasty or urinary diversion.
  • Before urology referral, GPs should request MSU, treat any infection, and commence on anticholinergic or antimuscarinic


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