Urgency you cannot defer. Bladder training beats going straight to tablets, and one widely used drug is a poor choice after 65.
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Overactive bladder is a sudden, difficult-to-defer need to pass urine, usually with going more often than normal and getting up at night. Some people also leak before reaching the toilet.
It is extremely common — affecting a substantial proportion of adults over 40 — and it is not an inevitable part of getting older, which is what most people are quietly told and quietly accept.
Two things are worth knowing before you start any treatment.
The first is that bladder training genuinely works and comes first. It is unglamorous, it takes about six weeks of deliberate effort, and it outperforms going straight to tablets. Most people are never offered it properly.
The second concerns the medication. Oxybutynin is still widely prescribed and is a poor choice in older people — it carries a meaningful anticholinergic burden, and cumulative exposure to this class of drug is associated with cognitive decline. National guidance specifically advises against it in frail older adults. If you are over 65 and taking it, that is worth a conversation.
Urgency incontinence — a sudden desperate need, then leaking. Suggests overactive bladder.
Stress incontinence — leaking on coughing, laughing, sneezing or exercise, without urgency. A different problem, treated differently, and pelvic floor training is the mainstay.
Mixed — both, which is very common.
Getting the type right determines the treatment, and it is established by history rather than by any test.
Visible blood in the urine, particularly without pain, needs urgent assessment for bladder cancer. Also: recurrent infections, pain, a palpable mass, difficulty starting or emptying, or new symptoms alongside weight loss.
Three days of recording — fluid in, urine out, timings, urgency episodes and leaks — tells you more than any test. It distinguishes urgency from stress incontinence, reveals excessive or poorly timed fluid intake, and gives a baseline to measure improvement against.
It is free, and it is skipped constantly.
Urodynamic testing is not required before starting conservative treatment or first-line medication. It is reserved for cases where surgery is being considered or the picture is unclear — and being sent for it early is unnecessary.
Urinary infection, diabetes, prostate enlargement, pelvic organ prolapse, constipation, medication effects, bladder stones, and — importantly — bladder cancer, which is why painless visible blood in the urine is never assumed to be an irritable bladder.
Bladder symptoms assess well remotely, because the diagnosis comes from a history and a bladder diary rather than an examination.
Examination for prolapse, a prostate assessment, or bladder scanning. We will say so rather than work around it.
Seek urgent assessment for:
Seek prompt assessment for:
The aim is to gradually stretch the interval between visits, retraining the bladder to hold more.
Do not cut down drastically. Concentrated urine irritates the bladder and makes urgency worse. Aim for around 1.5 to 2 litres a day.
Ask specifically which drug you are on. Oxybutynin carries a high anticholinergic burden and is not recommended in frail older people. Alternatives with less cognitive impact exist, and switching is straightforward.
If there is one thing to take from this page, it is to look up your local NHS continence service. Supervised pelvic floor physiotherapy is the most effective non-surgical treatment there is, it is free, and it is dramatically under-used.
This page follows NICE NG123 on urinary incontinence and pelvic organ prolapse in women, and NICE NG97 and CG97 for lower urinary tract symptoms in men.
Cumulative exposure to anticholinergic medication is associated with cognitive impairment and increased dementia risk, which is why drug choice in older people matters and why oxybutynin specifically is discouraged in this group.
Reviewed against NICE NG123, NG97 and CG97 current at the date shown above.
No. It becomes more common with age but it is not normal, and it is treatable.
A great many people accept it for years without mentioning it, which is the main reason it goes untreated.
Not drastically — that makes it worse. Concentrated urine irritates the bladder.
Aim for 1.5 to 2 litres a day, cut caffeine, and stop drinking a few hours before bed if nights are the problem.
Yes, and it is recommended as first-line treatment. It gradually retrains the bladder to hold more.
It needs at least six weeks of deliberate effort, and most people stop too soon or are never taught it properly.
Stop and stay still. Squeeze the pelvic floor firmly several times. Breathe. Wait for it to pass — it will.
Then walk calmly. Rushing to the toilet makes urgency stronger, not weaker.
If you are older or frail, probably not. It carries a high anticholinergic burden, and NICE advises against it in this group.
Alternatives with less cognitive impact exist, and switching is straightforward. Worth asking.
Anticholinergic drugs as a class are associated with cognitive impairment and increased dementia risk with cumulative use.
That does not mean nobody should take them — it means the choice of drug and the total burden across all your medicines should be considered deliberately.
Vaginal oestrogen specifically can help urinary symptoms after the menopause, and it is different from systemic HRT — it acts locally and carries none of the same risks.
It is genuinely under-prescribed and worth asking about.
Usually not, but visible blood in the urine is the exception and needs urgent investigation rather than being put down to an irritable bladder.
Also get seen for recurrent infections, persistent pain, or symptoms with weight loss.
Not before trying conservative treatment or first-line medication. NICE says explicitly not to do them routinely at that stage.
They are for when surgery is being considered or the picture is genuinely unclear.
August 30, 2026
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Same-day access is usually available, from 6am to 10pm, seven days a week. You choose a time that suits you rather than waiting on hold at 8am.
Yes. Care is led personally by Dr Mohammad Khan, so you are not passed between clinicians. Continuity is the point of a small practice: someone who knows your history and is listening attentively rather than working through a checklist.
Yes, with your consent. We can access your Summary Care Record during the consultation, so your current medications, allergies and significant history are in the room. That means fewer questions you have already answered elsewhere, and safer prescribing.
No. We are not here to replace GPs, only to support them. Your NHS practice remains responsible for your ongoing care, and with your consent we write to them after the consultation. We are useful when you need to be seen sooner, or want more time than a standard appointment allows.
Twenty unhurried minutes and a comprehensive assessment. A written treatment plan is included, along with any prescription, sick note or referral letter arising from the consultation, at no extra charge.
£40 for 20 minutes, self-pay. Membership is optional and never required. Priced for fairness, because we are not here to charge extortionate amounts for access to a doctor.
It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
Yes, where there is a genuine bacterial infection — cellulitis, impetigo, bacterial urine infections, confirmed strep throat. We will also frequently tell you that you do not need one. Most sore throats, coughs, colds and earaches are viral, and an antibiotic gives you the side effects with none of the benefit.
If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
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