This document discusses overactive bladder (OAB), including its definition, symptoms, prevalence, impact, and treatment options. It defines OAB as a syndrome characterized by urgency, with or without urge incontinence, usually accompanied by frequency and nocturia. It notes that OAB is very common, affecting 11-22% of adults over 40, and is more prevalent in older individuals and females. While over half of females with OAB seek treatment, far fewer males do. Non-pharmacological treatments discussed include behavior modification, diet and fluid management, and pelvic floor exercises.
2. Prostate: sex organ, semen, erection, ejaculation, affects urination What about the bladder? Urology: URINARY SYMPTOMS
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8. How Does Urge incontinence Occur? Wein AJ, Rovner ES. Int J Fertil. 1999;44:56-66. Stress incontinence: weak sphincter vs cough
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13. OAB - More Common Than Other Diseases Prevalence (%) 20 15 10 5 0 OAB 16.6 European Disease Prevalence Milsom I, et al. BJU Int . 2001;87:760-766. AIRE. http://www.asthma.ac.psiweb.com/executive/fr_executive.html. IDF. http://www.idf.org/e-atlas/home/index.cfm?node=84. O ’Brien JT, Ballard CG. BMJ . 2001;323:123-124. Capocaccia R, et al. Ann Oncol . 2002;13:831-839. Asthma 8.6 Diabetes 5.5 Alzheimer ’s Disease 4.0 2.0 Cancer
14. OAB Affects 11% to 22% of Adults Over 40 in Europe, Asia, and the United States Milsom I, et al. BJU Int . 2001;87:760-766. Stewart WF, et al. World J Urol . 2003;20:327-336. Homma Y, et al. ICS, 2003. 25 20 15 10 5 0 Prevalence (%) France Germany Italy Spain Sweden UK Japan Country Prevalence of OAB in Adults 40 USA Male Female
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16. Prevalence of OAB by Age 0 5 10 15 20 25 30 35 Prevalence (percent) <25 25-34 35-44 45-54 55-64 65+ Age (years) Men Women Adapted from Stewart W et al. WHO/ICI. 2001. Poster.
17. OAB Affects Older Milsom I, et al. BJU Int . 2001;87:760-766. OAB : older men more 50 40 30 20 10 0 Prevalence (%) 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+ Men Women
Control of micturition is not instinctive. It is a learned response. The production and storage of urine are autonomic processes at birth. Gradually, the release of urine comes under voluntary control. These processes are inhibited or initiated by the central nervous system and coordinated by the peripheral nervous system. Under normal circumstances, the first sensation of bladder fullness reaches the central nervous system when the bladder is at about half capacity. At about three-quarter capacity, the desire to urinate is usually triggered. This results in the simultaneous lowering of urethral resistance and contraction of bladder smooth muscle (the detrusor muscle), which allows urine to flow out of the bladder, which is under voluntary control. Symptoms of OAB occur when the detrusor muscle is overactive and contracts inappropriately while the bladder is filling. OAB may be caused by neurogenic factors, such as stroke, Parkinson ’s disease, multiple sclerosis, spinal cord injury, or sensitization of peripheral afferent nerve terminals. Psychological factors might also be responsible. OAB may also be caused by myogenic factors, such as bladder outlet obstruction, that can cause detrusor muscle cells to become “hyperexcitable,” resulting in involuntary detrusor contraction and increased sensitivity to contractile agonists. Abnormal neurotransmitters have also been implicated, as has failure of pelvic-floor inhibition. In many cases, these neurogenic and myogenic factors are interconnected and complementary. Wein AJ, Rovner ES. The overactive bladder: an overview for primary care health providers. Int J Fertil. 1999;44:56-66.
As mentioned previously, the spectrum of OAB symptoms encompasses urgency and frequency, as well as urge and mixed incontinence. This diagram points to the fact that the majority of people with OAB experience urgency without urinary incontinence (OAB dry). Of those who experience urinary incontinence, 47.5% experience urge urinary incontinence, 28.5% stress incontinence, and 24.0% mixed incontinence. Abrams P, Cardozo L, Fall M, et al. The standardisation of terminology in lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn. 2002;21:167-178. Stewart WF, Van Rooyen JB, Cundiff GW, et al. Prevalence and burden of overactive bladder in the United States. World J Urol. 2003;20:327-336. Hampel C, Wienhold D, Benken N, Eggersmann C, Thuroff JW. Definition of overactive bladder and epidemiology of urinary incontinence. Urology. 1997;50(suppl 6A):4-14. Abrams P. Describing bladder storage function: overactive bladder syndrome and detrusor overactivity. Urology. 2003;62(suppl 5B):28-37.
The 3 key terms in OAB are frequency, urgency, and urge incontinence. Frequency is defined as having to urinate 8 or more times in a 24-hour period. Nocturia, which causes the patient to wake more than once per night from a sound sleep to urinate, may or may not be present. Urgency is a sudden, compelling need to pass urine that the patient feels he or she cannot ignore without consequence. The consequence for some patients is urge incontinence—the involuntary leakage of urine accompanied by or immediately preceded by urgency. Milsom I, Abrams P, Cardozo L, Roberts RG, Thüroff J, Wein AJ. How widespread are the symptoms of an overactive bladder and how are they managed? A population-based prevalence study. BJU Int. 2001;87:760-766. Abrams P, Cardozo L, Fall M, et al. The standardisation of terminology in lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn. 2002;21:167-178.
OAB is substantially more prevalent than many other diseases that gain much more attention. In Europe, OAB prevalence is nearly twice that of asthma, 3 times that of diabetes, more than 4 times as prevalent as Alzheimer ’s disease, and 8 times more prevalent than cancer. Milsom I, Abrams P, Cardozo L, Roberts RG, Thüroff J, Wein AJ. How widespread are the symptoms of an overactive bladder and how are they managed? A population-based prevalence study. BJU Int. 2001;87:760-766. Asthma Insights & Reality in Europe. Executive summary. Asthma prevalence in Europe. Available at: http://www.asthma.ac.psiweb.com/executive/fr_executive.html. Accessed February 19, 2004. International Diabetes Federation. E-Atlas: Europe. Available at: http://www.idf.org/e-atlas/home/ index.cfm?node=84. Accessed February 19, 2004. O ’Brien JT, Ballard CG. Drugs for Alzheimer’s disease [editorial]. BMJ. 2001;323:123-124. Capocaccia R, Colonna M, Corazziari I, et al. Measuring cancer prevalence in Europe: the EUROPREVAL project. Ann Oncol. 2002;13:831-839.
Why should physicians care about OAB? There are several compelling reasons. More patients have OAB than you realize. Overall, 1 out of 6 adults over 40 years of age in Europe has OAB. In France, Germany, Italy, Spain, Sweden, the United Kingdom, Japan, and the United States, the prevalence of OAB ranges from 11% to 22%. Milsom I, Abrams P, Cardozo L, Roberts RG, Thüroff J, Wein AJ. How widespread are the symptoms of an overactive bladder and how are they managed? A population-based prevalence study. BJU Int. 2001;87:760-766. Stewart WF, Van Rooyen JB, Cundiff GW, et al. Prevalence and burden of overactive bladder in the United States. World J Urol. 2003;20:327-336. Homma Y, Yamaguchi O, Hayashi K, et al. Nation-wide epidemiologic survey on lower urinary tract symptoms in Japan. Presented at: Annual Meeting of the International Continence Society; October 5-9, 2003; Florence, Italy.
The NOBLE Research Program was a national survey designed to assess the prevalence and impact of OAB in the United States. The results show that the prevalence of OAB in men and women is surprisingly similar across age groups. The overall prevalence of OAB is 16.6% and increases with age in both men and women. The prevalence exceeds 30% among individuals older than 65 years.
As noted in a study of OAB in 6 European countries conducted by Milsom et al and published in 2001, OAB affects men and women nearly equally. Overall there is little difference in the prevalence of OAB according to gender―16% of men and 17% of women over 40 years of age had OAB. Furthermore, OAB prevalence increases with age. This is true both for men and women, and younger women in particular are worried about someday becoming incontinent. Whereas OAB is more prevalent in women between the ages of 40 and 59, it becomes more prevalent in men than women by age 60 and older. The exception is in men and women 70 to 74 years old, in whom the prevalence of OAB is equal. Milsom I, Abrams P, Cardozo L, Roberts RG, Thüroff J, Wein AJ. How widespread are the symptoms of an overactive bladder and how are they managed? A population-based prevalence study. BJU Int. 2001;87:760-766.
Numerous clinical studies have identified the impact of OAB on the quality of patients ’ lives, and these themes emerge consistently. OAB causes distress because of the fear of having an accident and embarrassment when accidents do occur. OAB is inconvenient to normal daily living. It requires patients to be cognizant of the locations of toilets wherever they go, or to plan their travel (and their lives) around where such facilities are located. It threatens patients’ self-esteem, which is reinforced by the sense of having lost control of one’s own body. All that patients with OAB want is to return to daily activities that are uninterrupted by OAB symptoms. Patients with OAB also have significantly lower health status and significantly greater health needs than people without OAB. Milsom I, Abrams P, Cardozo L, Roberts RG, Thüroff J, Wein AJ. How widespread are the symptoms of an overactive bladder and how are they managed? A population-based prevalence study. BJU Int. 2001;87:760-766. Wagner TH, Hu T-W, Bentkover J, et al. Health-related consequences of overactive bladder. Am J Manag Care . 2002;8(suppl):S598-S607.
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