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:
- Reducing caffeine, or too much fluids
- Pelvic floor exercises – pelvic floor exercises
- Completion of a frequency/volume chart or alternative chart
- Bladder training – bladder training leaflet
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
- 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