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Overactive bladder in older woman — RACGP Fellowship MCQ

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HardGeriatricsOveractive bladder in older womanRACGP Fellowship

A 75‑year‑old woman presents with urinary urgency and nocturia. Urinalysis is normal, post‑void residual is low, and pelvic examination shows atrophic vaginal changes. She has glaucoma and mild cognitive impairment. What is the most appropriate initial management?

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Correct answer: D — Use bladder training, pelvic floor muscle strategies and consider topical vaginal oestrogen

In this older woman with overactive bladder symptoms, first‑line management should be conservative: bladder training, pelvic floor muscle exercises, fluid and lifestyle modification, and topical vaginal oestrogen to address atrophic changes. Anticholinergics are relatively contraindicated due to her glaucoma (risk of precipitating angle closure) and cognitive impairment. Antibiotics are inappropriate given normal urinalysis and low suspicion of infection. Insertion of a catheter is unnecessary and invasive given low post‑void residual. Severe fluid restriction risks dehydration and is not evidence‑based. This approach aligns with Australian guidelines.

Reference: RACGP – Overactive bladder syndrome: management and treatment options (2012); Australian Prescriber/eTG – Management of urinary incontinence in adults (2014), https://australianprescriber.tg.org.au/articles/management-of-urinary-incontinence-in-adults.html