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Overactive bladder with anticholinergic burden — SCE Geriatric Medicine MCQ

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ModerateContinenceOveractive bladder with anticholinergic burdenSCE Geriatric Medicine

An 83-year-old woman with mild dementia is referred for urinary leakage. She passes urine every hour, has urgency, nocturia twice nightly and occasional urge incontinence; post-void residual is 30 mL. Urinalysis is negative, pelvic examination is unremarkable and she takes amitriptyline for neuropathic pain. What is the most appropriate management?

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Correct answer: B — Review anticholinergic burden and start bladder training with continence specialist support

The presentation is overactive bladder, but her existing anticholinergic burden and dementia make non-drug treatment and medication review the safest initial approach. NICE supports history, examination, urinalysis and conservative measures such as bladder training before pharmacological escalation in appropriate patients. Oxybutynin and amitriptyline can worsen cognition, constipation, falls and retention. The pearl is that continence management in older adults begins with reversible contributors and function, not pads or catheters.

Reference: NICE NG123; NICE NG56; BNF