Clinical Review

The management of overactive bladder syndrome

BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e2365 (Published 17 April 2012) Cite this as: BMJ 2012;344:e2365
  1. Serge P Marinkovic, director of urology and female pelvic medicine and reconstructive surgery 1,
  2. Eric S Rovner, professor of urology2,
  3. Robert M Moldwin, associate professor of clinical urology, director of the Interstitial Cystitis Center3,
  4. Stuart L Stanton, professor emeritus of urogynaecology4,
  5. Lisa M Gillen, independent researcher and writer5,
  6. Christina M Marinkovic, clinical director of nursing services6
  1. 1St Joseph Hospital, Fort Wayne, IN, USA
  2. 2Department of Urology, Medical University of South Carolina, Charleston, SC, USA
  3. 3Arthur Smith Institute of Urology, Albert Einstein College of Medicine, New Hyde Park, NY, USA
  4. 4Female Reconstructive Surgery, St George’s School of Medicine, London, UK
  5. 5Department of Urology, Southern Illinois School of Medicine, Springfield, IL, USA
  6. 6Department of Family Medicine, Southern Illinois School of Medicine, Decatur, IL, USA
  1. Correspondence to: S P Marinkovic urourogyn{at}yahoo.com or serge1127{at}yahoo.com
  • Accepted 20 February 2012

Summary points

  • Patients with overactive bladder syndrome have a frequent and strong desire to urinate (with or without incontinence), which adversely affects quality of life

  • The causes of overactive bladder syndrome are probably multifactorial

  • Verified patient reported outcome questionnaires help assess the severity of symptoms of urgency, frequency, and nocturia and track their improvement with treatment

  • Conservative treatments such as reducing fluid intake, avoiding foods and drinks that irritate the bladder, regulating voiding, and performing pelvic floor muscle exercises regularly may be combined with anticholinergic drugs

  • Poor adherence to drug treatment is common but may be improved by managing side effects and finding the most suitable drug for individual patients

  • Second line treatments include sacral neuromodulation, tibial nerve stimulation, and intermittent botulinum toxin injection into the detrusor muscle

In 2010, the International Continence Society restated the definition of overactive bladder syndrome as a condition with characteristic symptoms of “urinary urgency, usually accompanied by frequency and nocturia, with or without urgency incontinence, in the absence of urinary tract infection or other obvious pathology.”1 In 2009, disease specific total expenditures for this syndrome exceeded $24.9bn (£15.76bn; €19.01bn).2 However, overactive bladder syndrome remains underdiagnosed and undertreated, despite prevalence estimates in men and women of 17% in the United States (National Overactive Bladder Evaluation study) and 12-17% in six European nations.2 3 One population based prevalence study found that 60% of older or disabled patients seek treatment but only 27% receive it.4 The study also showed that overactive bladder syndrome is associated with worse quality of life scores than those in hypertension, depression, diabetes, and asthma. In fact, many patients are unaware that useful medical treatment is available.4 Retrospective observational studies have shown that the medical and surgical consequences of overactive bladder—particularly in older or disabled patients—include depression, falls, fractures, urinary …

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