Update on the Pharmacologic Management of Overactive Bladder: The Present and the Future

Pamela Ellsworth; Eileen Kirshenbaum

Disclosures

Urol Nurs. 2010;30(1):29-39. 

In This Article

What is the Impact of OAB?

OAB has a significant impact on quality of life (QOL) and a ffects daily living in a variety of domains, including psychological, social, domestic, occupational, sexual, and physical domains. From a psychologic standpoint, individuals suffering from OAB may have a loss of self-esteem, feel guilty, fear being a burden to their family and friends, and fear the odor of urine. These individuals may decrease their social interactions, limiting travel to areas where a known bathroom is nearby. From a domestic standpoint, individuals with UUI may wear specialized underwear, use protective bedding, and wear dark, bulky clothing to hide the protective undergarments. OAB symptoms may lead to absences from work and decreased productivity. Symptoms of OAB may also lead to limitation or cessation in physical activity. Finally, sexual relationships may be adversely affected by OAB, with sufferers avoiding sexual contact and intimacy for fear of leakage or the odor of urine.

Up to 65% of men and 67% of women who suffer from OAB noted their symptoms had an effect on daily living (Milsom et al., 2001). Health-related QOL assessments using the 36-Item Short-Form (SF-36) Health Survey, a standardized generic instrument that measures health-related QOL during the previous month in eight domains (physical functioning, role functioning, social functioning, mental health, vitality, health perception, emotional role, and bodily pain), have demonstrated that OAB causes QOL limitations and/or impairment in domains, including physical activity, psychological wellbeing, social activity, sexual activity, occupational productivity, and domestic logistics (Kelleher, Kreder, Pleil, Burgess, & Reese, 2002). More disease-specific QOL questionnaires, such as the King's Health Questionnaire (originally developed to evaluate QOL in women with UI) have demonstrated the significant impact OAB has on QOL and identified the impact of OAB to be even greater than the impact of stress UI (Kelleher, Cardozo, Khullar, & Salvatore, 1997). Moreover, when compared to the impact of other disease states on QOL, individuals with OAB had a lower QOL in the social and functional domains of the SF-36 compared to patients who had diabetes mellitus (Abrams, Kelleher, Kerr, & Rodgers, 2000).

The morbidity of OAB extends well beyond its affects on QOL. Significant medical comorbidities include increased risk of falls and fractures (Brown, Vittinghoff et al., 2000), individuals with UUI have a higher risk of hospitalization (30% increased risk for women and 50% increased risk for men), and older adults with UUI have a greater chance of being admitted to nursing homes (Brown, McGhan, & Chokroverty, 2000; Thom, Haan, & van Den Eeden, 1997). There is also a strong association between OAB and depression (Zorn, Montgomery, Pieper, Gray, & Steers, 1999), and medical comorbidities increase costs associated with OAB (Darkow, Fontes, & Williamson, 2005).

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