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Overactive Bladder in Women Craig V OAB can have a significant negative impact on qual ity of life, Several studies have confirmed the negative impact of OAB, Learning ObjeCtiVes: including an increased risk of falls and fractures, as well as especially with urge incontinence, on sexual activity. Women 1. To be able to define overactive bladder. interference with social and physical activities and sleep. with frequency and/or urge incontinence, are less sexually active. 2. To understand the relevant medical history regarding overactive Psychosocial and physical well-being is often lower in OAB Scores in sexual QOL are lower in women with OAB than in bladder, and which tests are beneficial in the routine evaluation of patients, as are interference with task completion, sleep, work- age-matched controls. More than half of patients with idiopathic the condition. related activities, and sex and intimacy. Brown et al reported that urge incontinence scored as “depressed” on validated in a cohort of 6,000 community-dwelling older women followed for questionnaire, with nearly 7% being diagnosed with major 3. To understand the definition and role for behavioral modification. 36 months, 55% of patients experienced at least one fall and 8.5% depression. Urge incontinence was more highly associated 4. To understand the impact of overactive bladder on quality of life, sustained a fracture. Multivariate analysis demonstrated that OAB with depression than was stress incontinence, likely due to the and what factor exacerbate the condition. was an independent risk factor for both falls and fractures. The unpredictable nature of urge leakage. rush to the toilet during urgency predisposed women to falls they Although women with OAB often avoid sexual activity, it is not would not otherwise have, and fractures were sustained that may usually due to pain, but rather due to urgency and incontinence. not otherwise have occurred. Other factors that adversely affect Dyspareunia is more typical of bladder pain syndrome and pelvic QOL in OAB sufferers include depression, anxiety, interference pain syndromes. with physical activity (with secondary weight gain), social isolation, Continuing MediCal eduCation ProjeCt: sexual avoidance, and reduced workplace productivity. Overactive Bladder in Women Craig V. Comiter, MD REFERENCES FoR QuEStioN oNE: 4. Ouslander JG. Management of overactive bladder. N Engl J Med. 2004 Feb 19; Associate Professor of Urology 1. Uebersax JS, Wyman JF, Shumaker SA, McClish DK, Fantl AJ. Short forms 350(8):786-99. Director FPMRS Fellowship to assess life quality and symptom distress for urinary incontinence in women: the 5. Wein AJ. Diagnosis and treatment of the overactive bladder. Urology. 2003 Nov;62 Stanford University incontinence impact questionnaire and the urogenital distress inventory. Neurourol and (5 Suppl 2):20-7. Urodynam 1995;14:131-139. 6. Ouslander JG. Management of overactive bladder. N Engl J Med. 2004 Feb 19; 2. Jackson S, Donovan J, Brookes S, Eckford S, Swithinbank L, Abrams P. The Bristol 350(8):786-99. Female Lower UrinaryTract Symptoms questionnaire: development and psychometric 7. Rosenberg MT: Overactive bladder made ridiculously simple? Int J Clin Pract 2006, testing. Br J Urol, 1996; 77: 805–812. 60:631–633. 3. Dwyer PL, Rosamilia A. Evaluation and diagnosis of the overactive bladder. Clin REFERENCES FoR QuEStioN FouR: Obstet Gynecol. 2002 Mar;45(1):193-204. Disclosure record for Craig Vance Comiter, M.D. QUESTIOn 1: In a woman who complains of bothersome 4. Wein AJ. Diagnosis and treatment of the overactive bladder. Urology. 2003 Nov; 1. Payne CK. Epidemiology, pathophysiology, and evaluation of urinary incontinence Last reviewed/edited this information on February 16, 2011. 62(5 Suppl 2):20-7. and overactive bladder. Urology. 1998;51(suppl 2A):3-10. Coloplast: Consultant; Curant: Consultant or Advisor frequency every hour in the day, and occasional urinary 5. Ouslander JG. Management of overactive bladder. N Engl J Med. 2004 Feb 19; 2. Rosenberg MT, Overactive bladder: recognition requires vigilance for symptoms. leakage, which of the following tests are helpful at the 350(8):786-99. Cleve clin j med 2007; 74suppl 3:S21-9. 6. Sampselle CM. Teaching women to use a voiding diary. Am J Nurs 2003; 103:62–64. 3. Culligan PJ, Heit M. Urinary incontinence in women: evaluation and management. initial visit? Am Fam Physician 2000; 62:2433–2444, 2447, 2452. A. Urinalysis REFERENCES FoR QuEStioN two: 4. Wein AJ. Pathophysiology and categorization of voiding dysfunction. In: Wein AJ, 1. Payne CK. Conservative Management of Urinary Incontinence: Behavioral and Pelvic Kavoussi LR, Novick AC, Partin AW, Peters CA, eds. Campbell-Walsh Urology. 9th ed. B. Lower urinary tract symptoms (LUTS) questionnaire Floor Therapy, Urethral and Pelvic Devices. In: Wein AJ, Kavoussi LR, Novick AC, Philadelphia, PA: Saunders Elsevier; 2007:1973–1985. C. Bladder diary Partin AW, Peters CA, eds. Campbell-Walsh Urology. 9th ed. Philadelphia, PA: Saunders 5. Baigis-Smith J, Smith DAJ, Rose M, et al. Managing urinary incontinence in Elsevier; 2007, pp. 2124-2146. community-residing elderly persons. Gerontologist 1989;229:33. D. Urodynamic studies 2. Burgio KL, Whitehead WE, Engel BT. Urinary incontinence in the elderly: bladder- 6. McDowell BJ, Burgio KL, Dombrowski M, et al. Interdisciplinary approach to the E. Post void residual urine measurement sphincter biofeedback and toileting skills training. Ann Intern Med 1985:104: 507-515. assessment and behavioral treatment of urinary incontinence in geriatric outpatients. 3. Burgio KL: Behavioral treatment of urinary incontinence, voiding dysfunction, and J Am Geriatr Soc 1992;40:370–4. QUESTIOn 2: In women with OAB, which of the following overactive bladder. Obstet Gynecol Clin N Am 36 (2009) 475–491 7. Johnson TM, Burgio KL, Goode PS, et al. Effects of behavioral and drug therapy on 4. Kegel AH. Stress incontinence of urine in women: physiologic treatment. J Int Coll nocturia in older incontinent women. J Am Geriatr Soc 2005;53:846–50. is an example of behavioral therapy? Surg 1956;25:487–99. A. Pessary to correct cystocele 5. Burgio KL, Whitehead WE, Engel BT. Urinary incontinence in the elderly: bladder REFERENCES FoR QuEStioN FivE: sphincter biofeedback and toileting skills training. Ann Intern Med 1985;104:507–15. 1. Brown JS, Vittinghoff E, Wyman JF, et al. Urinary incontinence: does it increase risk B. Incontinence pads 6. Burgio KL, Robinson JC, Engel BT. The role of biofeedback in Kegel exercise training for falls and fractures? Study of Osteoporotic Fractures Research Group. J Am Geriatr C. Vaginal electromyography biofeedback training Soc. 2000;48:721-725. for stress urinary incontinence. Am J Obstet Gynecol 1986;157: 58–64. D. Discussion of normal bladder and sphincter function 7. Burgio KL, Goode PS, Locher JL, et al. Behavioral training with and without 2. Yu HJ, Chen FY, Huang PC, et al. Impact of nocturia on symptom-specific quality of biofeedback in the treatment of urge incontinence in older women: a randomized life among community-dwelling adults aged 40 years and older. Urology 2006;67:713–8. E. Use of oxybutynin on an “as needed” basis controlled trial. JAMA 2002;288:2293–9. 3. Zorn BHh, Montgomery H, Pieper K, et al: Urinary incontinence and depression. 8. Goode PS, Burgio KL, Locher JL, et al. Effect of behavioral training with or without J Urol 1999, 162:82-4. QUESTIOn 3: Which symptoms are considered typical pelvic floor electrical stimulation on stress incontinence in women: a randomized 4. Das AK, Carlson AM, Hull M, et al: Improvement in depression and health-related for patients with overactive bladder? controlled trial. JAMA 2003;290:345–52. quality of life after sacral nerve stimulation therapy for treatment of voiding dysfunction. 9. Andersson KE. Antimuscarinics for treatment of overactive bladder. Lancet Neurol Urology 2004, 64:62-8. A. Dysuria 2004; 3:46–53 5. Stach-Lempinen B, Hakala AL, Laippal P, et al: severe depression determines quality of life in urinary incontinent women. al Neurourol Urodyn 2003:22: 563-8. B. Straining REFERENCES FoR QuEStioN thREE: 6. Melville J Delaney K, Newton K, et al: Incontinence severity and major depression C. Urge incontinence 1. Newman DK, Giovannini D. The overactive bladder: a nursing perspective. Am J in incontinent women. et al Obstet Gynecol 2005: 106:585-92. D. Bladder pain Nurs 2002; 102:36–45. 7. Moghaddas F, Lidfeldt J, Nerbrand C, et al. prevalence of urinary incontinence in 2. Abrams P. Describing bladder storage function: overactive bladder syndrome and relation to self-reported depression, intake of serotonergic antidepressants, and hormone E. Frequency detrusor overactivity. Urology. 2003 Nov;62(5 Suppl 2):28-37; therapy in middle-aged women: a report from the Women’s Health in the Lund Area 3. Dwyer PL, Rosamilia A. Evaluation and diagnosis of the overactive bladder. Clin study. Menopause 2005; 12: 318-24. QUESTIOn 4: Factors that may exacerbate OAB Obstet Gynecol. 2002 Mar;45(1):193-204. symptoms include: A. Diuretics B. Heart failure C. Venous insufficiency PhysiCian AccreDitatiOn stateMent PhysiCian CreDit stateMent D. Constipation The University of North Texas Health Science Center at Fort Worth The University of North Texas Health Science Center has E. All of the above Office of Professional and Continuing Education is accredited by requested that the AOA Council on Continuing Medical Education the American Osteopathic Association to award continuing medical approve this program for 1 hour of AOA Category 2B CME credits. QUESTIOn 5: OAB can adversely affect quality of life education to physicians. Approval is currently pending. (QOL). Which of the following is not typically related to OAB? The University of North Texas Health Science Center at Fort Worth The University of North Texas Health Science Center at Fort Worth A. Sleep disturbance Office of Professional and Continuing Education is accredited designates this enduring material for a maximum of 1 AMA PRA B. Social activities interference by the American Council for Continuing Medical Education Category 1 Credit(s)™.
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