OAB or overactive bladder is defined as increased urinary urgency, with or without urge urinary incontinence, usually with frequency and nocturia. Urgency is the sudden, intense desire to urinate. Urge incontinence is defined as the unwanted urine leakage (referred to as "wetting accidents") that happens shortly after urgency.
Urge urinary incontinence is caused by involuntary bladder contractions that occur as your bladder fills. With urge urinary incontinence, a person may be aware of the urge sensation but will be unable to stop leakage before reaching the toilet. Urine loss is usually in large amounts that soak underwear and even outer clothing. Frequency is urinating more than eight times in a day.
An additional symptom seen very often, especially in the elderly, is nocturia, awakening more than two times at night to void. Getting up at night to urinate will often disrupt sleep. Many people find it difficult to discuss their OAB problem with their doctor or nurse.
Prevelance of Overactive Bladder (OAB)
Overactive Bladder (OAB) is a bothersome medical condition that affects more than 17 million men and women of all ages, although its incidence increases significantly with age. In the past, many experts believed that such voiding dysfunction symptoms as urgency and frequency were harmless and did not cause significant problems for individuals.
New research shows that the triad of symptoms - urinary frequency, urgency and urge incontinence, alone or in combination - can have a significant impact on someone's quality of life. Other medical conditions or diseases such as urinary tract infection or bladder tumors can cause bladder irritation leading to OAB. Some medical conditions, especially strokes, impair inhibition of bladder contractions (detrusor hyperreflexia.)
Considered abnormal at any age, overactive bladder is a highly prevalent condition that affects both men and women but is more common in women. Many people never report symptoms of overactive bladder due to their perceptions that treatment is not available or effective or that the symptoms are normal consequences of aging or childbirth. Effective treatment includes the combination of drug therapy with behavioral interventions.
Impact of Overactive Bladder (OAB)
Overactive bladder adversely affects a person's daily routines and quality of life. Approximately two-thirds of men and women report that their symptoms have an effect on daily living such that they have a poor quality of sleep, more depression, and an overall lower quality of daily life than persons who do not experience overactive bladder. In fact, compared with persons with diabetes mellitus, persons with overactive bladder experience a lower quality of life. Weekly or more frequent urge incontinence with associated urgency and nocturia has been shown to increase the risk of falls in elderly women who are attempting to urinate during the night. overactive bladder that includes urge incontinence is also a major contributor to the decision to admit an older person to a nursing home.
Overactive bladder has been called the closet disorder since only one-third of regularly incontinent women discuss their problem with a health care provider and two-thirds of patients first seeking medical advice have had their symptoms for more than two years. Instead of seeking help, many people with overactive bladder adjust their habits and lifestyle to accommodate the management of symptoms and may adopt such coping mechanisms as restricting fluids and urinating to a timed schedule or at the first sensation of urgency. Car trips and vacations are limited. Shopping, visiting public places, entertaining or socializing are curtailed and in some cases stopped. Finding accessible public toilets, a behavior referred to as 'toilet mapping', becomes a source of major anxiety. Initially, increasing the frequency of bladder emptying, often referred to a "defensive voiding" may reduce the number of incontinent episodes.
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. Urology. 2003;61:37-49.
Abrams P., Freeman, R, Anderstrom, C, Mattiasson, A. Tolterodine, a new antimuscarinic agent: as effective but better tolerated than oxybutynin in patients with an overactive bladder. British Journal of Urology. 1998;81:801-810.
Abrams P., Cardozo, L, Fall, M, Griffiths, D, Rosier, P, Ulmsten, U, et.al. The standardisation of terminology of lower urinary tract function. Neurourology and Urodynamics. 2002;21:167-178.
Anderson, K-E. New parmacologic targets for the treatment of the overactive bladder: an update. Urology. 2004;ppl 3A):32-41.
Anderson, R., Mobley, D., Blank, B., Saltzman, D., Susset, J., Brown, J. Once daily controlled versus immediate-release oxybutynin chloride for urge urinary incontinence. 1999; The Journal of Urology. 161:1809-1812.
Appell, R. Chancellor, M., Zobrist, H. Thomas, H.. Sanders, S.. Pharmacokinetics, metabolism and saliva output during transdermal and extended-release oral oxybutynin administration in healthy subjects. Mayo Clinical Proceedings. 2003;78:696-702.
Burnett, A., Davila, G Willy, Newman, Diane, Hardestry, S. Clinical and Cost-Effective Strategies in the Management of Urinary Incontinence. Managed Care Consultant. 2002;5-39.
Burgio K., Locher J., Goode P. Combined Behavioral and Drug Therapy for Urge Incontinence in Older Women. JAGS. 2000; 48: 370-374.
Chancellor M., Freedman, S, Mitcheson, HD, Antoci, J, Primus, G, Wein, A. Tolterodine, an effective and well tolerated treatment for urge incontinence and other overactive bladder symptoms. Clinical Drug Investigations. 2000;19:83-91.
Chapple CR, Yamanishi T, Chess-Williams R. Muscarinic receptor subtypes and management of the overactive bladder. Urology. 2002;60 (Suppl 5A):82-89.
Cruz, F. Mechanisms involved in new therapies for overactive bladder. Urology. 2004;sppl 3A):65-73.
Davila, G Willy, Daugherty CA, Sanders SW. A short-term, multicenter, randomized double-blind dose titration study of the efficacy and anticholinergic side effects of transdermal compared to immediate release oral oxybutynin treatment of patients with urge urinary incontinence. The Journal of Urology. 2001;166(1):140-145.
Diokno, A., Appell, R., Sand, P., Dmochowski, R., Gburek, B., Klimberg, I., Kell, S.. Prospective, randomized, double-blind study of the efficacy and tolerability of the extended-release formulations of oxybutynin and tolterodine for overactive bladder: results of the OPERA trial. Mayo Clinical Proceedings. 2003;78:687-695.
Dmochowski RR, Davila GW, Zinner NR, et al. Efficacy and safety of transdermal oxybutynin in patients with urge and mixed urinary incontinence. J Urology. 2002;168:580-586.
Halaska, M., Ralph, G., Wiedeman, A., Rimus, G., Ballering, B., Hofner, K & Jona., G. Controlled, double-blind, multicentre clinical trial to investigate long-term tolerability and efficacy of trospium chloride in patients with detrusor overactivity. World J Urology. 2003;20:392-399.
Hampel, CC., Wienhold, D., Benken, N., Egersmann, C., Thuroff, JW. Definition of overactive bladder and epidemiology of urinary incontinence. Urology. 1997;50[suppl 6A]:4-14.
Hofner, K., Oelke, M., Machtens, S., Grunewald, V. Trospium chloride-an effective drug in the treatment of overactive bladder and detrusor hyperreflexia. World J Urology. 2001;19:336-343.
Kelleher, Con. Economic and Social Impact of OAB. European Urology Supplements. 2002;1:11-16.
Kelleher, C, Pleil, A.M., Reese, P. R., Burgess S. M,, Brodish, P. H. How much is enough and who says so? The case of King's Health Questionnaire and overactive bladder. BJOG. 2004;111:605-612.
Hu TW, Wagner TH, Bentkover JD. Estimated economic costs of overactive bladder in the United States. Urology. 2003;61:1123-1128.
Madersbacher H, Stohrer M, Richter R, et al. Trospium chloride versus oxybutynin: a randomized, double-blind, multicenter trial in the treatment of detrusor hyper-reflexia. Br J Urol. 1995;75:452-456.
Milsom, I, Stewart, W, Thuroff, JW The Prevalence of Overactive Bladder. The American Journal of Managed Care. 2000; 6(11), Sup:S565-S573.
Murphy M, Carmichael AJ. Transdermal drug delivery systems and skin sensitivity reactions. Incidence and management. Am J Clin Dermatol. 2000;1:361-368.
Newman, D.K. & Wein, A.J. Overcoming Overactive Bladder, New Harbinger, Los Angeles, California, 2004.
Newman, Diane. Managing and Treating Urinary Incontinence. Baltimore: Health Professions Press;2002.
Ouslander, J.O. Management of overactive bladder. JAMA 2004;350(8):786-799.
Shah D, Badlani G. Treatment of overactive bladder and incontinence in the elderly. Rev Urol. 2002;4(Suppl 4):S38-S43.
Stewart W, Herzog R, Wein A. The prevalence and impact of overactive bladder in the U.S.: results from the NOBLE program. 2001; Neurourology Urodynamics. 20:406-408.
Wein AJ, Rovner ES. Definition and epidemiology of overactive bladder. Urology. 2002;60(Suppl 5A):7-12.
Wein AJ, Rovner ES. The overactive bladder: an overview for primary care health providers. 2000; Int J Fertil Womens Med. 1999; 44: 56-66.
Zinner, N., Gittelman, M., Harris, R., Susset, J., Kanellos, A., Auerbach, S. Trospium cloride improves overactive bladder symptoms: a multicenter phase III trial. Journal of Urology. 2004;171:2311-2315.
Posted December 2003
Updated August 2009