Detrusor instability is a urodynamic diagnosis of bladder over activity defined by objectively demonstrable bladder contractions whilst the patient is trying to inhibit micturition. Patients most commonly present with 'irritative' symptoms comprising of frequency urgency and urge incontinence, although other symptoms may be present. The condition is most commonly idiopathic, but in a small number of cases represents an upper motor neurone lesion 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 reducing muscarinic activity within the bladder to reduce over activity. Whilst these medications are effective their success is compromised by the side effects including dry mouth and constipation. Newer medications are now available giving a wider clinical choice that may allow better drug selection for individual patients to minimize the side effects. In extreme cases surgery may be considered as a last resort. © 2001 Harcourt Publishers Ltd.
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