Overactive bladder a common yet challenging condition
Because an overactive bladder may cause day or nighttime symptoms, the condition can have a strong impact on a patient's life. Fear of "having an accident" in public often curtails professional and social activities, and can create a sense of isolation. Nighttime symptoms can also lead to disruptions in sleep patterns.
Symptoms of OAB
It is not known what causes overactive bladder. OAB has a number of main symptoms, with sufferers reporting any combination of one or more of the following symptomology:
-- Urgency-the sudden, compelling desire to urinate. This symptom can occur with or without urge incontinence (leakage)
-- Frequency-urinating 8 or more times during a 24 hour period
-- Urge incontinence-an involuntary, accidental loss of urine, also called "leakage" or "incontinence." (Important to note, this is different than stress incontinence, where a trigger, such as laughing or coughing, precedes the leakage event).
-- Nocturia-the complaint of having to wake at night one or more times to urinate.
Role of Urgency
In 2002, the International Continence Society (ICS) published new guidelines for overactive bladder management. These guidelines put new emphasis on the symptom of urgency, defined as "a sudden compelling desire" to urinate. The ICS now considers urgency a defining symptom of OAB and the most important symptom in terms of impact on a patient's life.
Prior to these guideline revisions, the impact of urgency in OAB had not been fully recognized, and trials of OAB treatments did not routinely include the reduction in urgency episodes as an efficacy variable. Today's practitioners increasingly realize treatment options that address urgency may provide important benefits for even the "dry" OAB sufferers.
Impact of OAB
In addition to physical symptoms, people with OAB suffer from a decline in quality of life. If left untreated, OAB can impact a sufferer 24 hours a day. The fear of constantly needing to have access to bathrooms can cause absences or poor performance/reduced productivity at work, and can result in isolation from friends and family, due to fears of socializing out of the home.
Some patients even avoid sexual intimacy because of anxiety and embarrassment caused by urine leakage or fear of leakage, while others experience declines in health and vitality and psychological problems. , Nocturia can cause sleep disruption, which can in turn, negatively affect the ability to function during the day. Patients with OAB are at increased risks for falls, and fractures related to falls. They also have a higher rate of urinary tract infections, and patients with OAB are more expensive to manage than patients who do not have the condition. It is estimated that the costs related to OAB in the year 2000 were nearly $14 billion in the United States.
Managing OAB
Despite the impact of OAB on quality of life and medical comorbidity, as many as 40 percent of people with the condition do not mention it to their healthcare professional. Although not a normally part of a routine exam, diagnosis of OAB is based on a focused patient history, a variety of questionnaires, a physical exam, and additional laboratory tests, if needed. In some cases, the symptoms of overactive bladder can be managed through behavioral interventions, such as Kegel exercises, or sometimes through surgical procedures.
Treatment
Anticholinergic medications, such as the muscarinic receptor antagonists, are commonly prescribed treatments for OAB, but often cause dry mouth or other related side effects, reducing the likelihood that patients will take the medications long-term (also called "persistency"). Medications that can improve all the key symptoms of the disease (urgency, frequency, and urge incontinence) with an acceptable side-effect profile will offer the most benefit, and lead to persistency with treatment. New muscarinic receptor antagonists are in development, which may offer a better balance between efficacy and tolerability.
Still, despite the various treatment options available already, more than 70 percent of people who do discuss it with their physician do not receive pharmacologic therapy. Some avoid the topic because of embarrassment, while others believe that bladder control problems are a normal part of aging that should be accepted. The truth is that OAB is not necessarily a consequence of aging and with appropriate treatment, its symptoms can be markedly improved in the great majority of cases.
Information provided by Yamanouchi Pharmaceutical Co. and GlaxoSmithKline
For more information please contact:
Jennifer Boyle, Edelman PR
(USA) 212-704-8169
C: 240-601-1067
References
1 Nitti, V. Clinical Impact of Overactive Bladder. Reviews in Urology. 4(4): S2-S6, 2002. Reference found on page S2.
2 Ouslander, J. Management of Overactive Bladder. New England Journal of Medicine. 350(8): 786-799. Reference found on page 786.
3 Ouslander, J. Management of Overactive Bladder. New England Journal of Medicine. 350(8): 786-799. Reference found on page 786.
4 Nitti, V. Clinical Impact of Overactive Bladder. Reviews in Urology. 4(4): S2-S6, 2002. Reference found on pages S2 and S3.
5 Nitti, V. Clinical Impact of Overactive Bladder. Reviews in Urology. 4(4): S2-S6, 2002. Reference found on page S2.
6 Ouslander, J. Management of Overactive Bladder. New England Journal of Medicine. 350(8): 786-799. Reference found on page 786.
7 Abrams P. Cardozo L. Fall M. Griffiths D. Rosier P. Ulmsten U. van Kerrebroeck P. Victor A. Wein A. Standardisation Sub-committee of the International Continence Society. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourology & Urodynamics. 21(2):167-78, 2002. Reference found on page 38, "Lower Urinary Tract Symptoms" section and page 40 "Symptom Syndromes Suggestive Of Lower Urinary Tract Dysfunction" section.
8 Abrams P. Cardozo L. Fall M. Griffiths D. Rosier P. Ulmsten U. van Kerrebroeck P. Victor A. Wein A. Standardisation Sub-committee of the International Continence Society. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourology & Urodynamics. 21(2):167-78, 2002. Reference found on page 40.
9 Chapple, CR. Lower Urinary Tract. BJU International. 93: 303-310. 2004. Reference found on page 304.
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11 Ouslander, J. Management of Overactive Bladder. New England Journal of Medicine. 350(8): 786-799. Reference found on page 786.
12 Ouslander, J. Management of Overactive Bladder. New England Journal of Medicine. 350(8): 786-799. Reference found on page 786.
13 Nitti, V. Clinical Impact of Overactive Bladder. Reviews in Urology. 4(4): S2-S6, 2002. Reference found on page S5.
14 Hu, T. Economics of Incontinence. Incontinence: 2nd International Consultation on Incontinence. Chapter 14:965-983. 2002. Reference found on page 972.
15 Milson, I. How Widespread are the symptoms of an overactive bladder and how are they managed? A population-based prevalence study. BJU International. 87:760-766, 2001. Reference found on page 760.
16 Ouslander, J. Management of Overactive Bladder. New England Journal of Medicine. 350(8): 786-799. Reference found on page 787.
17 Ouslander, J. Management of Overactive Bladder. New England Journal of Medicine. 350(8): 786-799. Reference found on page 790-791, "Non Pharmacologic Interventions."
18 Chapple, CR. Lower Urinary Tract. BJU International. 93: 71-77. 2004. Reference found on pages 75-77, "Discussion" section.
19 Milson, I. How Widespread are the symptoms of an overactive bladder and how are they managed? A population-based prevalence study. BJU International. 87:760-766, 2001. Reference found on page 760.
20 Voytas, J. The Role of Geriatricians and Family Practitioners in the Treatment of Overactive Bladder and Incontinence. Reviews in Urology. 4(4): S44-S49. 2002. Reference found on page S45.
21 Milson, I. How Widespread are the symptoms of an overactive bladder and how are they managed? A population-based prevalence study. BJU International. 87:760-766, 2001. Reference found on page 765.
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