skip to main content

Overactive bladder with urgency urinary incontinence — MSRA MCQ

Instant feedback + full explanation. One question, done properly.

ModerateLUTSOveractive bladder with urgency urinary incontinenceMSRA

A 64-year-old woman reports 7 months of urinary urgency, daytime frequency and urge urinary incontinence. A 3-day bladder diary shows frequent small-volume voids associated with urgency; nocturnal urine volume is 24% of total 24-hour output. She has no stress incontinence, dysuria, visible haematuria, recurrent UTI, voiding difficulty, constipation, cognitive impairment, glaucoma or vaginal dryness. Urine culture is negative and post-void residual volume is 35 mL. She has completed a supervised 6-week bladder-training programme, has reduced caffeine intake, and remains significantly troubled by frequency and urgency. She wishes to try medication. What is the most appropriate next management step?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Add a lowest-acquisition-cost oral anticholinergic, continue bladder training and review after 4 weeks

This woman has overactive bladder with urgency urinary incontinence: the diary demonstrates urgency-associated frequent small voids, there is no evidence of nocturnal polyuria, infection or incomplete bladder emptying, and she has no stress-predominant symptoms. She has had an adequate first-line trial of bladder training but remains troubled by frequency. NICE advises considering an overactive-bladder medicine in addition to bladder training in this situation, and recommends offering an anticholinergic medicine using the option with the lowest acquisition cost. A review is recommended 4 weeks after starting a new medicine. A further period of bladder training alone is reasonable for partial improvement or where medication is declined, but she has completed the minimum recommended programme and requests treatment. Vaginal oestrogen is appropriate when overactive-bladder symptoms coexist with genitourinary symptoms and signs associated with menopause, which are absent here. Vibegron is an option when antimuscarinics are unsuitable, ineffective or not tolerated; none of these applies before a first anticholinergic trial. Urodynamics and secondary-care invasive options are reserved for overactive bladder that has not responded to non-surgical management and medicine.

Reference: NICE NG123: Urinary incontinence and pelvic organ prolapse in women: management — recommendations (Updated March 2025) — https://www.nice.org.uk/guidance/ng123/chapter/Recommendations NICE NG123: Urinary incontinence and pelvic organ prolapse in women: management — medicines for overactive bladder (Updated March 2025) — https://www.nice.org.uk/guidance/ng123/chapter/Recommendations NICE TA999: Vibegron for treating symptoms of overactive bladder syndrome — recommendations (04 September 2024) — https://www.nice.org.uk/guidance/TA999/chapter/1-Recommendations