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Case History

image A 68-year-old retired social worker has found that recently she has been incontinent of urine. It has happened when out shopping and she felt she wanted to go, but was unable to control her bladder long enough to find a public toilet in time. This has since got worse and she is passing urine in her pants 3–4 times a day. She is mortified, and wants to stay with her married daughter over Christmas, but is too ashamed to accept the invitation in case she wets the bed.

What are relevant questions and what should you examine for?

What are the drug options?

How are the drug options tolerated?


image About 50–100 million people are estimated to be affected by an overactive bladder (OAB),1 which has a prevalence of about 16% in people aged over 40 years.2 OAB is a chronic condition defined urodynamically as detrusor overactivity, and characterized by involuntary bladder contractions during the filling phase of the micturition cycle.3 However, clinically in primary care without access to a urodynamic laboratory, a few key questions can define the constellation of symptoms, as long as other factors such as metabolic abnormalities (e.g. diabetes, hypercalcaemia) or urinary pathology (e.g. urinary tract infections, interstitial cystitis, stones) have been excluded.

From a study of 16 776 subjects in six different European countries, the prevalence of OAB symptoms was 16.6% in people (men and women) of age 40 years and over.2 The prevalence increased with age: in men, increasing slowly to age 69 years, then increasing sharply after 75 years; in women, increasing slowly to age 59 years, then levelling in the 60s and increasing sharply at age 70 and above. Of those that reported symptoms, 85% had urinary frequency, 54% urgency and 36% urge incontinence. Rather surprisingly, 60% had consulted a doctor about their symptoms, but only 27% were currently being treated. The commonest reason for not consulting was the belief that no help was available.

An OAB has a severe impact on quality of life.4 Sleep disturbance may result in daytime somnolence, reduced cognitive function, and impaired concentration causing errors at work and driving. The relentless restrictions on lifestyle cause high depression scores and low self-esteem. Untreated OAB is associated with an increased risk of urinary tract infections, skin infections from constant wet and chafing pads, and injury from falls in the elderly when people attempt to rush to the toilet and trip. In all, 65% of OAB patients said that their symptoms adversely affected their daily lives.2

What are relevant questions and what should you examine for?

It takes a lot of courage for people to seek help. Although an OAB profoundly affects quality of life,4 people do not even discuss these issues with their partner. Patients need to feel confident they are taken seriously, ...

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