**7. Management of overactive bladder syndrome**

#### **7.1 Life style changes and bladder retraining**

Urogynaecology nurse specialist can provide and follow up with the patient the necessary life style changes that helps to improve the bladder overactivity these include, avoidance of bladder irritants such as tea and coffee and use of decaffeinated brands, lesser use of fizzy drinks such as cola. Reduction or preferably cessation of alcohol intake. Smoking cessation is advisable especially in those with mixed stress and over active components. Fluid restriction to 2–3 a day helps to minimise symptoms of detrusor overactivity [14, 15].

Further more, the nurse guides the patient through the bladder retraining which entails education of timed voiding and systematic delay of voids according to a time table. Starting with an aim for resisting the feeling of urgency and hence the voids every 30 mins that's extends gradually to reach a void every 2–3 hours [15].

#### **7.2 Pharmacotherapy**

The urogynaecology nurse provides the patient with information that is relevant to various medication used in the treatment of the bladder overactivity. The medications are prescribed by the clinicians and response to the treatment can be followed by the specialised nurse.

The first line of treating the bladder overactivity is the use of anticholinergics. Block the muscarinic receptors that mediate detrusor smooth muscle contraction and in turn relaxing effect on the detrusor muscle. The response to anticholinergics is notable on 6–8 weeks. They vary in the response based on their on selectivity for various muscaric receptos. Oxybutinin is usually the recommended first line in slow release form. It is none selective and hence has higher side effect profile compared to other variants but it is cost effective. Solifenacin, Darifenacin, Tolterodine, Trospium are more selective on the muscarinic receptors in the bladder and hence lesser systemic side effects. The most notable side effects of antimuscarinics are dry eye, dry mouth, constipation and urine retention. The nurse can check with patient if there is any contraindication for the anticholinergics such as acute open angle glaucoma, mythesga gravis or any voiding dysfunction [14–17].

Patients with voiding dysfunction along with bladder overactivity may be benefit of using mirabegrone which relaxes the bladder wall smooth muscles through stimulation of beta adrenergic receptors and blockage of alfa adrenergic receptors. The main contraindication is uncontrolled hypertension and hence it is important for nurse specialist check the patient's blood pressure prior they start on mirabegrone [15, 18].

#### **7.3 The role of oestrogen's**

Postmenopausal women who has atrophic vaginitis are usually having some degree of atrophic cystitis. The use of local of oestrogen to treat atrophic vaginitis helps to reduces the over active bladder symptoms to some egress in those patients. Urogynaecology nurse specialist should highlight such benefits of oestrogen cream to the patient and ensure the prescription given by the clinician is followed by the patient [19].
