GynaecologyFree in the app
Overactive bladder
Bladder training first, then drugs.
Source: NICE NG123 · TA290SolifenacinAnticholinergic5–10 mg once daily.⚠ Review at 4 weeks.
Oxybutynin IRAnticholinergic2.5–5 mg two or three times a day.⚠ Not for frail older women.
MirabegronBeta-3 agonist50 mg daily (25 mg in kidney or liver impairment).⚠ Check BP; not in severe uncontrolled hypertension.
- First: bladder training 6 weeks, reduce caffeine, vaginal oestrogen if atrophic.
- Refractory: urodynamics, botulinum toxin 100 U (must accept self-catheterisation), tibial or sacral nerve stimulation.
- Urodynamics are not needed before surgery for clear pure stress incontinence.
A summary for trained clinicians. Always check the full guideline, the patient in front of you and your hospital's protocol. Spotted an error? Tell us.