Overactive bladder in old age and treatment options in primary care

Overactive bladder (OAB) is characterized by episodes of urgency, micturition frequency, nycturia and, in majority of patients by urge

incontinence. It occurs frequently in older people and the prevalence increases with advancing age. 11–16 % of adult population is affected

and up to 20–30 % of elderly persons above 70 years. The treatment of choice are antimuscarininc drugs which supress detrusor

contraction by mechanism of blocking M3 and M2 muscarinic receptors in the bladder. Although there are fewer studies in geriatric

population all consistently prove antimuscarinics superiority over placebo. In primary care trospium chlorid was released for non-regulated

primary care physician prescribing. The risk of potential central anticholinergic adverse events is very low because trospium chlorid

does not cross blood-brain barrier. It is suitable also for older OAB patients with complex pharmacological regimen as it has a low risk

of drug interactions. Scientific evidence is sufficient for behavioral therapy in OAB. However, its implementation may be limited due to

availability or ability of the older patient to cooperate. In case the OAB treatment started by primary care physician is not sufficiently

effective the patient should be referred to a specialist´s treatment.

Keywords: overactive bladder, urgency, urge incontinence, elderly, pharmacotherapy, antimuscarinic drugs, primary care