Volume 7 Issue 3 - 2013
Many GPs already treat patients with substance misuse problems and are well placed to offer screening, assessment, psychosocial interventions and prescribing to addictions patients. Emphasis in addiction treatment is shifting away from long term maintenance prescribing to recovery focussed services, recovery communities and integration of substance misusers into the world of work, education and training.
Overactive Bladder (OAB) is a clinical syndrome describing the symptom complex of urgency, with or without urgency incontinence and is usually associated with frequency and nocturia. Whilst a number of women may be managed based on a clinical diagnosis alone urodynamic studies may be useful in those women with complex or refractory symptoms. In the first instance all women will benefit from a conservative approach using bladder retraining although a number will require antimuscarinic therapy. For those women with persistent symptoms following medical therapy referral to secondary care for alternative treatment modalities such as intravesical Botulinum toxin, neuromodulation or reconstructive surgery may be considered. This review, whilst giving an overview of the syndrome, will focus on a practical clinical approach to managing women with symptoms of OAB in the primary care setting.
Back pain remains one of the most common presenting complaints in primary care and often presents both diagnostic and management challenges. Accurate early diagnosis, along with appropriate early specialist intervention is key in managing these conditions, which are often lifelong and associated with significant morbidity.