LINTHICUM, MD USA (PRESS RELEASE) - May 23, 2012 - New guidelines released today by the American Urological Association (AUA) emphasize behavioral therapies (such as bladder training, pelvic floor muscle training and fluid management) as a first-line treatment for overactive bladder, followed by medications and neuromodulation.
Overactive bladder, also known as urge incontinence, is not a disease, but rather a complex of symptoms (generally not life threatening) that includes urinary urgency (a strong sudden urge to urinate), nocturia (the need to urinate at night), frequent urination and, in some cases, urgency incontinence or involuntary bladder leakage.
Patients who present with these symptoms should be evaluated with a careful medical history, physical exam and urinalysis to exclude other conditions that could be responsible (including infection, obstructing prostate, etc.). In some patients, urine cultures or post-void residual assessment may need to be performed. Additionally, patients may be asked to complete voiding diaries or symptom assessment questionnaires.
Once the diagnosis of overactive bladder has been validated, clinicians should first offer behavior modification therapies, including bladder training, bladder control strategies, pelvic floor muscle training and fluid management. Second-line treatments include oral anti-muscarinic medications (such as darifenacin, fesoterodine, oxybutynin, solifenacin, tolterodine or trospium). In some patients with severe refractory symptoms or for those in which anti-muscarinics are not acceptable, sacral neuromodulation , percutaneous neuromodulation or off label use of onabotulinim toxin A may be an option.
“Patients with overactive bladder symptoms often find themselves restricting their daily lives, avoiding leaving the house or participating in activities where bathroom access may be difficult. This has a serious negative impact on quality of life,” said Dr. E. Ann Gormley, who chaired the panel that developed the guideline. “It is important that clinicians recognize this complex of symptoms and work with patients to help them find ways to manage their symptoms.” A full copy of the guideline, Diagnosis and Treatment of Overactive Bladder (Non-Neurogenic) in Adults is is available online at www.AUAnet.org.
About the American Urological Association: Founded in 1902 and headquartered near Baltimore, Maryland, the American Urological Association is a leading advocate for the specialty of urology, and has more than 18,000 members throughout the world. The AUA is a premier urologic association, providing invaluable support to the urologic community as it pursues its mission of fostering the highest standards of urologic care through education, research and the formulation of health policy.
American Urological Association