Urge Incontinence (Overactive Bladder)

Question 1

What is this describing?

Involuntary leakage of urine with a strong desire to pass urine. Symptoms suggest detrusor overactivity.

Answer 1

Overactive bladder (urge incontinence)

Question 2

What are the causes of overactive bladder?

Answer 2

1. Idiopathic
2. Can follow surgery for stress incontinence
3. Neuropathy - MS, spinal cord injury

Question 3

What is this a presentation of?
Urgency, frequency, nocturia, leakage at night. Symptoms provoked by cold weather, opening front door, running tap, coughing, sneezing.

Answer 3

Overactive bladder

Question 4

How is overactive bladder investigated?

Answer 4

1. Urine dipstick to exclude UTI
2. Urinary diary
3. Urodynamic cytometry if diagnostic uncertainty, or surgery planned, or medical treatment fails.

Question 5

What is the management for overactive bladder?

Answer 5

1. Avoid excess fluid intake/caffeinated drinks
2. Review diuretics
3. Bladder retraining for 6 months (often combined with medications)
4. Oxybutynin or tolterodine
5. Refer to specialist if oral therapy fails after 2 months
6. Intravesical botox, neuromodulation of S3 nerve