A psychological approach to detrusor instability incontinence in women

Detrusor instability is a common cause of urinary incontinence in women. Symptoms are those of urgency and urge incontinence produced by an inability to inhibit the bladder from contracting at inappropriate times. The exact aetiology in the vast majority of cases remains unknown. Treatment is often unsatisfactory. It has been proposed that ‘idiopathic’ detrusor instability is a psychosomatic disorder. Support for this view comes from clinical evidence, the results of psychological questionnaire studies and the results of behavioural treatments, e.g. bladder drill and biofeedback. The effect of hypnosis on patients with detrusor instability has been assessed both subjectively and objectively on urodynamic testing. The short‐term results are good but once formal treatment has been stopped the relapse rate is high as evidenced by the results of two years. It is suggested that if hypnosis is to be effective for the condition then formal treatment should be continued indefinitely.