Management of a patient with diabetes and a hypotonic bladder

Some years ago, Mrs Dorothy Evans, who has insulin-dependent diabetes, went to see her GP because she had urinary frequency and urgency. She was prescribed three courses of antibiotics, but her problems persisted. Her GP then prescribed an anticholinergic drug--used to treat detrusor (bladder muscle) hyperreflexia (unstable bladder)--but this provided Mrs Evans with little relief, so that over the next few years her life was dominated by her bladder. Mrs Evans now had to time her shopping trips to coincide with her bladder symptoms, and knew the location of all the local public toilets. She also experienced urinary tract infections each year, which were treated with antibiotics.