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Over Active Bladder –Quality of Life Implications
OAB is a clinical syndrome defined as urgency with or without urge incontinence usually with frequency and nocturia. It is a common problem: one... Read More
 
Over Active Bladder –Quality of Life Implications
Introduction
OAB is a clinical syndrome charectarized by urgency, frequency, nocturia and incontinence usually.  This syndrome affects  greatly the quality of life.
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OAB is a clinical syndrome defined as urgency with or without urge incontinence usually with frequency and nocturia. It is a common problem: one European survey of 16776 people aged 40 or older found an overall prevalence of over active bladder symptoms were frequency (85 per cent), urgency (54 per cent) and urge incontinence (36 per cent).

The overall prevalence of OAB is similar in men and women but incontinence is more common and symptoms worsen sooner among women. prevalence increases differently with age from 9 per cent in women and 3 per cent in men aged 40-44, 31 and 42 per cent respectively at age 75 or older.

OAB adversely affects quality of life in about 30 per cent of people aged 40 or older in UK, with a significant impact on social and physical functioning, emotion and particularly mobility in women. There is also a significant detrimental effect on mood and quality of sleep .Urinary urgency is the symptom patients say is most troubling, with the greater impact on quality of life than incontinence, frequency or nocturia.

Overall the impact of OAB on quality of life reported by patients is comparable with that associated with diabetes.

Concordance issues in OAB
Despite the associated morbidity many patients do not take their medication as prescribed or discontinue treatment. In one randomized trial involving 348 patients with OAB (defined as detrusor instability), of the 256 who could be followed up, only 18 percent has persisted with anticholinergic drug treatment for at least 6 months
Three analyses of US medical claims databases found that few patient persist with treatment for a year ,even with newer modified – release formulations that are claimed to reduce adverse effects.

In one, 47 per cent of patients taken an anticholinergic drug had stopped treatment after 3 months and 82 per cent had stopped by the year's end ; the mean duration of treatment was 86 days.
The second analysis found that 88 per cent of patients stopped treatment within a year , mostly within 6 months and only 15 per cent of patient took at least 80 per cent of their prescribed medication .
In the third, the mean duration of treatment for first time users of anticholinergic drugs was 91 days with oxybutynin and 143 days with tolterodine.

Theses studies did not investigate the reasons for this early discontinuation of treatment but it is likely that lack of effectiveness and adverse effects are the most common causes.

Adherence to treatment could be improved by adopting a joint approach between patient and healthcare provider. To achieve this ,clinicians need to enquire about patients' beliefs and concerns about their condition and its treatment and give them autonomy in decision making .in turn, patients need to understand their condition and the options for treatment they should have realistic expectations of what can be achieved with drug treatment and of the nature and likely hood of adverse effects so they can agree suitable goals and they should be offered ongoing support .

Finally, treatment should deliver an improvement in symptoms without the penalty of intolerable adverse effects .

Adapted from wagg, A; Maffatt, J.; and spinks, J.eds.confidence through bladder control .the role of propverine – current thinking
1- Abrams p, cardozo L, fall M,et al.the standardization of terminology of lower urinary tract function : report from the standardization sub committee of the international continence society . neurourol urodynamics 2002;21:167-78

2- milsom 1 , 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; 87:760-6.

3- Mcgrother CW, Donaldson MM,shaw C,etal storage symptoms of the bladder : prevalence incidence and need for services in the UK.BJU Int 2004;93:763-9.

4- Strew WF,van rooyen JB,cundiff Gw,etal prevalence and burden of overactive bladder in the united states world J urol  2003;20:327-36.

5- van der vaart CH , De Leeuw JR , Roovers JP, et al. the effect of urinary incontinence and over active bladder symptoms on quality of life in young women.BJU Int 2002;90:544-9.

6- coyne KS, Zhou Z thomptoms c.versi E.the impact of urinary urgency and frequency on health-related quality of life in overactive bladder : results from a national community survey.value health 2004;7:455-63.

7- Kelleher CJ,Cardozo LD, Khuller V,et al a medium term analysis of the subjective efficacy of treatment for women with detrusor instability and low bladder compiliance. Br J Obstel Gynaecol 1997;104:988-93.

8- Mcghan wf.cost effectiveness and quality of life considerations in the treatment of patients with overactive bladder .Am J manage care 2001;7:62-75

9- Noe L, sneeringer R, patel B, et al .the implications of poor meducation persistence with treatment for overactive bladder.manag care interface 2004:17:54-60.

10- Chui MA,Williamson T,Arciniegra J et al .patient persistency with medications for overactive bladder .value health 2004;7:366(abstract).

11-YU YF, Yu AP , Ahn J, et al. Medication treatment persistence of overactive bladder /urinary incontinence patients in a California Medicaid program and the benefit of their refill adherence on urinary tract infection .value health 2003;6:191.

12-Zhou Z, Barr C, Torigoe Y, et al. persistence of therapy with drugs for overactive bladder value health 2001;4:161(abstract)

13- Dowell J.Jones A, Snadden D .exploring medication use to seek concordance with non adherent' patients: a qualitative study. Brj Gen pract 2002;52:24-32.

 
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