• Exclude or manage treatable causes of overactive bladder (for example cancer of the prostate or bladder, neurological conditions, infection, and bladder stones).
• Investigations to exclude treatable causes of an overactive bladder include urinalysis, renal function tests, and (depending on the clinical features) PSA (prostate specific antigen) level.
• It is often not possible to identify a specific underlying cause.
• If necessary, offer a choice of temporary urine containment products (such as sheath and leg bag, absorbent pads, and absorbent pants) to achieve social continence, and refer the man to the local continence service.
• To find the local continence service, telephone the Bowel and Bladder Foundation on 01536 533 255.
• Offer referral for supervised bladder training — this may be available from the local continence nurse, continence physiotherapist, or urology clinic.
• Advise the man on fluid intake and lifestyle, and offer information on self-help resources.
• If bothersome symptoms persist, offer an antimuscarinic (anticholinergic).
• For example oxybutynin — initially 5 mg two to three times daily, increased if necessary to a maximum of 5 mg four times daily. Elderly men require lower doses.
• For full prescribing information and choice of antimuscarinic drug, see Antimuscarinics for overactive bladder.
• Review every 4–6 weeks until symptoms are stable, and then every 6–12 months. Assess symptoms, quality-of-life, adverse effects, and the need to continue treatment.
• If treatment fails, refer the man for specialist urological assessment and management.
• Treatment options in secondary care include injection of botulinum into the bladder wall, implanted sacral nerve stimulation, and cystoplasty.

• Advise that:
• The Bladder and Bowel Foundation have a helpline (telephone 01536 533 255), and provide a range of resources on their website www.bladderandbowelfoundation.org, which include:
• A booklet on coping with urgency — this can be ordered from their online shop or downloaded for printing (pdf). The booklet includes detailed information on bladder retraining.
• A Just Can't Wait toilet card to use when the need to urinate arises while out shopping or socializing. Most shops and facilities are willing to help when they are shown the card. A small donation is requested to cover costs.

• Fluid intake should be within the man's usual range, and should not be limited excessively in an attempt to control symptoms — doing this could increase the risk of complications such as urinary tract infection.
• Lifestyle advice may include:
• Avoiding constipation, or treating it (if it is present).
• Maintaining a healthy lifestyle (with respect to body weight, exercise, diet, smoking, and alcohol consumption).
• Limiting intake of tea, coffee, chocolate, artificial sweeteners, and fizzy drinks.

For information on contraindications, cautions, drug interactions, and adverse effects, see the electronic Medicines Compendium (eMC) (http://emc.medicines.org.uk), or the British National Formulary (BNF) (www.bnf.org).