Overactive bladder in womenBMJ 2021; 375 doi: https://doi.org/10.1136/bmj-2020-063526 (Published 01 December 2021) Cite this as: BMJ 2021;375:e063526
- Daniel Beder, specialist trainee in urology1,
- Pamela Ashton, general practitioner2,
- Vibhash Mishra, consultant urologist1
- 1Urology Department, Royal Free Hospital, London NW3 2QG, UK
- 2Clapham Family Practice, London, UK
- Correspondence to: D Beder
What you need to know
Assess potential underlying causes of overactive bladder syndrome, which is characterised by urinary urgency usually with accompanying frequency and nocturia
Avoid anticholinergic medication in elderly, frail patients or those with a high anticholinergic burden
Solifenacin and mirabegron can be safely combined to improve symptoms if a single agent is ineffective
A 65 year old woman presents to her general practitioner complaining of knee pain. She reports that this makes it difficult for her to get to the toilet in time. On further questioning, she describes urinary frequency and urgency with occasional incontinence episodes, and explains that she knows where all the toilets are on her regular commutes.
The collection of urinary symptoms described above typically constitute the overactive bladder syndrome (OAB), which has a prevalence of more than 20%, and affects women more commonly than men.12 Prevalence increases with age, and it is common for patients to seek help late because of embarrassment or the belief that it is a normal part of ageing.34 In our experience, discussion of urinary symptoms in primary care is often brought up tangentially or as a “door handle conversation.” Over and above its own morbidity, delayed diagnosis of OAB can be a contributing factor to many other mental and physical health issues such as depression, stress, and falls and fractures.56 This article offers an approach to an initial consultation with a patient experiencing OAB symptoms. We refer to women, but this article may also apply to some transgender and non-binary people.
What you should cover
The International Continence Society defines OAB as “urinary urgency, usually accompanied by urinary frequency and nocturia, with or without urgency urinary incontinence, in the absence of urinary tract infection or other obvious pathology.”7 The diagnostic process therefore aims to characterise the lower urinary tract symptoms experienced …