Things to note:
- Detrusor overactivity: bladder training, fluid restriction and physiotherapy.
- Stress incontinence: pelvic floor exercises.
- Surgical procedures as dictated by the diagnosis at specialist care.
- Treat urinary tract infections and underlying conditions, as appropriate.
For detrusor overactivity as demonstrated on urodynamic studies:
- Oxybutynin, oral, 2.5 mg 12 hourly, increasing to 5 mg 6 hourly. Specialist initiated.
When to refer:
- Dry mouth is a common side effect of treatment.
- All patients with prolapse.
- Patients not responding to therapy.
- Stress incontinence as surgical repair will be likely.
- Total incontinence as a fistula has to be excluded.
- Urge incontinence resistant to 3 months Medicine.
- Mixed incontinence (both stress and urge incontinence present) as surgery will play a role.