Overactive Bladder (OAB) and Urinary Incontinence Clinical Care Pathway

Overactive bladder (OAB) is a symptom complex of lower urinary tract symptoms of urgency, frequency with or without urinary incontinence. It is prevalent in both men and women (10.8% and 12.8% respectively). According to Irwin and colleagues (2006), women have a higher rate (13.1% vs 5.4%) of urinary incontinence (urgency, stress, or mixed), are more likely (19% vs 12%) to report frequency of more than eight times per day, and are more bothered by urinary frequency than men (66% vs 46%).



Data on racial differences shows that African American women have higher rates of OAB (45.9%) than white (43.4%), Hispanic (42%), and Asian (26.6%) women (Coyne 2012). Women with OAB and UI appear to self-manage their symptoms as a large population-based study (n=26,466 women) reported that over 70% of women with UI and associated symptoms did not seek help (Raasthoj et al, 2019). Embarrassment is often reported as a reason why women with OAB do not seek help (Dmochowski & Newman, 2007). Clinicians are not asking patients about bladder issues such as OAB and/or UI despite the significant economic cost to both the individuals and the healthcare system (Lukacz 2017; Minassian, 2012).

But there are effective treatments including newly approved medications (e.g. vibegron).

The American Urological Association’s treatment guideline for OAB (AUA, 2019; Lightner et al., 2019) has three recommendations levels: first-line treatment is lifestyle changes and behavioral therapy, second-line treatment is pharmacologic therapy, and third-line treatment involves neuromodulation. Behavioral therapies can easily be incorporated in practice as they are not only safe and effective but a cost effective management for OAB & UI of all level of severity. Following a Clinical Care Pathway, based on the AUA guidelines, when assessing patients at-risk for OAB, can improve treatment of men and women with OAB.

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Written by: Diane K. Newman, DNP, ANP-BC, FAAN is an Adjunct Professor of Urology in Surgery, Perelman School of Medicine, University of Pennsylvania and Co-Director of the Penn Center for Continence and Pelvic Health

References:
  1. American Urological Association. Diagnosis and Treatment of Non-Neurogenic Overactive Bladder (OAB) in Adults: an AUA/SUFU Guideline (2019); 
  2. Coyne KS, et al. Racial differences in the prevalence of overactive bladder in the United States from the epidemiology of LUTS (EpiLUTS) study. Urology 2012;79(1): 95-101.
  3. Dmochowski R, & Newman DK. Impact of overactive bladder on women in the United States: Results of a national survey. Current Medical Research and Opinion, 2007; 23(1), 65-76.
  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;50:1306–15.
  5. Lightner DJ, Gomelsky A, Souter L et al: Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU Guideline amendment 2019. J Urol 2019; 202: 558
  6. Lukacz ES, Santiago-Lastra Y, Albo ME, Brubaker L. Urinary incontinence in women: A review. JAMA. 2017;318:1592-1604.
  7. Minassian VA, Yan X, Lichtenfeld MJ, Sun H, Stewart WF. The iceberg of health care utilization in women with urinary incontinence. Int Urogynecol J. 2012;23;1087-1093.
  8. Raasthoj, I., Elnegaard, S., Rosendal, M., & Jarbol, D. E. (2019). Urinary incontinence among women-which personal and professional relations are involved? A population-based study. International Urogynecology Journal, 30(9), 1565–1574. https://doi.org/10.1007/s00192-018-3804-2


October 2021
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