Primary care management of overactive bladder symptoms: evaluation and treatment

Symptoms suggestive of overactive bladder (OAB) have a relatively high prevalence, with an estimated 16% of patients aged ≥40 years living with the condition.1 It affects both sexes and its prevalence increases with age. The International Continence Society defines OAB as urinary urgency, usually associated with frequency and nocturia, with or without urge incontinence, in the absence of urinary tract infection or other obvious pathology.2 It continues to have a significant impact on quality of life and has been associated with increased falls, fracture risk, and skin breakdown.3 GPs are often the first to review patients presenting with OAB and so must ensure that patients are managed appropriately, with referral to secondary care services when indicated. This article provides a clear pathway and practical approach in the management of these patients. ### History A diagnosis of OAB is initially based on a good history. Patients should be asked about the onset and duration of symptoms, which symptoms are the most bothersome, and any related concerns that they may have. Storage lower urinary tract symptoms (LUTS) predominate and should be noted: urgency, frequency, nocturia, or urinary incontinence (UI). If UI occurs it is important to …