Detrusor overactivity is a urodynamic observation characterised by involuntary detrusor contractions during the filling phase, which may be spontaneous or provoked. Patients most commonly present with ‘irritative’ symptoms comprised of frequency, and urgency with or without urge incontinence, although other symptoms may be present. The condition is most commonly idiopathic, but a small number of cases result from neurological disorders or as a result of continence surgery. Treatment is based on conservative measures and a variety of behavioural measurements to ‘re-educate’ the bladder. Current medications are principally anticholinergic, working by reducing detrusor activity within the bladder to dampen overactivity. Whilst these medications are effective their success is compromised by their side effects, which include dry mouth and constipation. Newer medications are now available giving a wider clinical choice that may allow better drug selection for individual patients to minimise the side effects. Surgery may have a role in refractory cases.
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