Review
Etiology and Treatment of Overactive Bladder in Women
Abstract
Overactive bladder (OAB) is a condition that affects millions of women in the United States (US). Although the etiology is largely unknown, risk factors include Caucasian race, insulin-dependent diabetes mellitus, and history of depression. Patients present with urgency with or without urinary incontinence and often have urinary frequency and nocturia. Most patients can be evaluated in the office setting utilizing simple testing. Current treatments consist of behavioral/lifestyle modification, usually in combination with antimuscarinic drug therapy. Improvements in the adverse effect profiles of antimuscarinic drugs have positively impacted quality of life. When appropriately evaluated, most patients presenting to primary care providers can be effectively treated.This content is limited to qualifying members.
Existing members, please login first
If you have an existing account please login now to access this article or view purchase options.
Purchase only this article ($25)
Create a free account, then purchase this article to download or access it online for 24 hours.
Purchase an SMJ online subscription ($75)
Create a free account, then purchase a subscription to get complete access to all articles for a full year.
Purchase a membership plan (fees vary)
Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.
References
1. Abrams P, Cardozo L, Fall M, et al; 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. Neurourol Urodyn 2002;21:167–178.
2. Milsom I, Abrams P, Cardozo L, et al. 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.
3. 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.
4. Irwin DE, Milsom I, Hunskaar S, et al. Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study. Eur Urol 2006;50:1306–1315.
5. McGrother CW, Donaldson MM, Hayward T, et al; Leicestershire MRC Incontinence Study Team. Urinary storage symptoms and comorbidities: a prospective population cohort study in middle-aged and older women. Age Ageing 2006;35:16–24.
6. Wagg AS, Cardozo L, Chapple C, et al. Overactive bladder syndrome in older people. BJU Int 2007;99:502–509.
7. Mardon RE, Halim S, Pawlson LG, et al. Management of urinary incontinence in Medicare managed care beneficiaries: results from the 2004 Medicare Health Outcomes Survey. Arch Intern Med 2006;166:1128–1133.
8. Griffiths AN, Makam A, Edwards GJ. Should we actively screen for urinary and anal incontinence in the general gynaecology outpatients setting?—a prospective observational study. J Obstet Gynaecol 2006;26:442–444.
9. Harris SS, Link CL, Tennstedt SL, et al. Care seeking and treatment for urinary incontinence in a diverse population. J Urol 2007;177:680–684.
10. Irwin DE, Milsom I, Kopp Z, et al. Impact of overactive bladder symptoms on employment, social interactions and emotional well-being in six European countries. BJU Int 2006;97:96–100.
11. de Groat WC, Yoshimura N. Pharmacology of the lower urinary tract. Annu Rev Pharmacol Toxicol 2001;41:691–721.
12. Andersson KE, Wein AJ. Pharmacology of the lower urinary tract: basis for current and future treatments of urinary incontinence. Pharmacol Rev 2004;56:581–631.
13. Wein AJ. Pathophysiology and categorization of voiding dysfunction, in Walsh P, Retik A, Vaughan ED Jr, et al (eds): Campbell's Urology. Philadelphia, Saunders, 2002, ed 8, pp 887.
14.de Groat WC. The urothelium in overactive bladder: passive bystander or active participant? Urology 2004;64(6 suppl 1):7–11.
15. Basra R, Artibani W, Cardozo L, et al. Design and validation of a new screening instrument for lower urinary tract dysfunction: the bladder control self-assessment questionnaire (B-SAQ). Eur Urol2007;52:230–237.
16. Coyne KS, Zyczynski T, Margolis MK, et al. Validation of an overactive bladder awareness tool for use in primary care settings. Adv Ther 2005;22:381–394.
17. Coyne KS, Matza LS, Thompson CL. The responsiveness of the overactive bladder questionnaire (OAB-Q). Qual Life Res 2005;14:849–855.
18. Blaivas JG, Panagopoulos G, Weiss JP, et al. Validation of the overactive bladder symptom score. J Urol 2007;178:543–547; discussion 547.
19. Nixon A, Colman S, Sabounjian L, et al. A validated patient reported measure of urinary urgency severity in overactive bladder for use in clinical trials. J Urol 2005;174:604–607.
20.Homma Y. The clinical significance of the urodynamic investigation in incontinence. BJU Int 2002;90:489–497.
21. Burgio KL. Influence of behavior modification on overactive bladder. Urology 2002;60(5 suppl 1):72–76; discussion 77.
22. Wilson PD, Berghmans B, Hagen S, et al. Adult conservative management, in Abrams P, Cardozo L, Khoury S, et al (eds): Incontinence Management. Paris, Health Publications, 2005, pp 855–894.
23. Wallace SA, Roe B, Williams K, et al. Bladder training for urinary incontinence in adults. Cochrane Database Syst Rev 2004;1:CD001308.
24. Ouslander JG, Ai-Samarrai N, Schnelle JF. Prompted voiding for nighttime incontinence in nursing homes: is it effective? J Am Geriatr Soc 2001;49:706–709.
25. Burgio KL, Whitehead WE, Engel BT. Urinary incontinence in the elderly. Bladder-sphincter biofeedback and toileting skills training. Ann Intern Med 1985;103:507–515.
26. Brubaker L, Fanning K, Goldberg EL, et al. Predictors of discontinuing overactive bladder medications. BJU Int 2010;105:1283–1290.
27. Abrams P, Andersson KE. Muscarinic receptor antagonists for overactive bladder. BJU Int 2007;100:987–1006.
28. Chapple CR, Martinez-Garcia R, Selvaggi L, et al; for the STAR study group. A comparison of the efficacy and tolerability of solifenacin succinate and extended release tolterodine at treating overactive bladder syndrome: results of the STAR trial. Eur Urol 2005;48:464–470.
29. Chapple CR, Fianu-Jonsson A, Indig M, et al; STAR study group. Treatment outcomes in the STAR study: a subanalysis of solifenacin 5 mg and tolterodine ER 4 mg. Eur Urol 2007;52:1195–1203.
30. Hay-Smith J, Herbison P, Ellis G, et al. Which anticholinergic drug for overactive bladder symptoms in adults. Cochrane Database Syst Rev 2005;3:CD005429.
31. Steers WD, Herschorn S, Kreder KJ, et al; Duloxetine OAB Study Group. Duloxetine compared with placebo for treating women with symptoms of overactive bladder. BJU Int 2007;100:337–345.
32. Duthie J, Wilson DI, Herbison GP, et al. Botulinum toxin injections for adults with overactive bladder syndrome. Cochrane Database Syst Rev 2007;3:CD005493.
33. Schurch B, Denys P, Kozma CM, et al. Botulinum toxin A improves the quality of life of patients with neurogenic urinary incontinence. Eur Urol 2007;52:850–858.
34. Reitz A, Denys P, Fermanian C, et al. Do repeat intradetrusor botulinum toxin type A injections yield valuable results? Clinical and urodynamic results after five injections in patients with neurogenic detrusor overactivity. Eur Urol 2007;52:1729–1735.
35. Mattiasson A, Blaakaer J, Høye K, et al. Simplified bladder training augments the effectiveness of tolterodine in patients with an overactive bladder. BJU Int. 2003;91:54–60.
36. Chancellor MB, Kianifard F, Beamer E, et al. A comparison of the efficacy of darifenacin alone vs. darifenacin plus a Behavioural Modification Programme upon the symptoms of overactive bladder. Int J Clin Pract 2008;62:606–613.
37. Hunsballe JM, Djurhuus JC. Clinical options for imipramine in the management of urinary incontinence. Urol Res 2001;29:118–125.
38. Glazener CM, Evans JH, Peto RE. Tricyclic and related drugs for nocturnal enuresis in children. Cochrane Database Syst Rev 2003;3:CD002117.
39. Andersson KE. LUTS treatment: future treatment options. Neurourol Urodyn 2007;26(6 suppl):934–947.
40. Janknegt RA, Hassouna MM, Siegel SW, et al. Long-term effectiveness of sacral nerve stimulation for refractory urge incontinence. Eur Urol 2001;39:101–106.
41. van Kerrebroeck PE, van Voskuilen AC, Heesakkers JP, et al. Results of sacral neuromodulation therapy for urinary voiding dysfunction: outcomes of a prospective, worldwide clinical study. J Urol 2007;178:2029–2034.
42. Peters KM, Macdiarmid SA, Wooldridge LS, et al. Randomized trial of percutaneous tibial nerve stimulation versus extended-release tolterodine: results from the overactive bladder innovative therapy trial. J Urol 2009;182:1055–1061.
43. Colli E, Digesu GA, Olivieri L. Overactive bladder treatments in early phase clinical trials. Expert Opin Investig Drugs 2007;16:999–1007.
44. Chapple CR, Yamaguchi O, Ridder A, et al. Clinical proof of concept study (Blossom) shows novel β3 adrenoceptor agonist YM178 is effective and well tolerated in the treatment of symptoms of overactive bladder. Eur Urol Suppl 2008;7:239.
45. Andersson KE, Pehrson R. CNS involvement in overactive bladder: pathophysiology and opportunities for pharmacological intervention. Drugs 2003;63:2595–2611.
46. Grond S, Sablotzki A. Clinical pharmacology of tramadol. Clin Pharmacokinet 2004;43:879–923.
47. Safarinejad MR, Hosseini SY. Safety and efficacy of tramadol in the treatment of idiopathic detrusor overactivity: a double-blind, placebo-controlled, randomized study. Br J Clin Pharmacol 2006;61:456–463.
48. Ishizuka O, Igawa Y, Lecci A, et al. Role of intrathecal tachykinins for micturition in unanaesthetized rats with and without bladder outlet obstruction. Br J Pharmacol 1994;113:111–116.
49. Green SA, Alon A, Ianus J, et al. Efficacy and safety of a neurokinin-1 receptor antagonist in postmenopausal women with overactive bladder with urge urinary incontinence. J Urol 2006;176:2535–2540.
