Family Practice Advance Access originally published online on May 26, 2006
Family Practice 2006 23(5):568-577; doi:10.1093/fampra/cml018
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Perceptions and behaviours of women with bladder control problems
a Department of Urology, William Beaumont Hospital Royal Oak, MI, USA
b Division of Urogynecology, Evanston Continence Center, Northwestern University Medical School Evanston, IL, USA
c Department of Urology, Wake Forest University School of Medicine Winston-Salem, NC, USA
d Ortho-McNeil Neurologics Inc. Titusville, NJ, USA
Correspondence to: Ananias C. Diokno, M.D., William Beaumont Hospital, 3535 West 13 Mile Road, Suite 438, Royal Oak, MI 48073-6710, USA; E-mail adiokno{at}beaumont.edu
Received 10 June 2005; Accepted 3 April 2006.
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Abstract |
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Objectives. To evaluate women's perceptions about bladder control problems.
Methods. 757 women with one or more bladder control symptoms (frequency, urgency, stress or urge urinary incontinence and nocturia) participated in an Internet-based survey. A separate study involved 12 focus groups including a total of 180 women with bladder control problems.
Results. Respondents in the survey reported multiple symptoms, e.g. stress urinary incontinence (72%), frequency (56%), nocturia (45%), urge urinary incontinence (43%) and urgency (33%). Women in both the survey and the focus groups revealed extensive use of coping mechanisms to manage their symptoms. The focus groups revealed that many women were not aware that overactive bladder (OAB) is a pathophysiological condition. Approximately 30% of respondents in the survey felt uncomfortable talking to their doctor about their condition. Among women who did speak with their doctor, stress-related symptoms were described more readily than urge-related symptoms. In the survey, only about half (56%) of the women felt their OAB medication was effective, and half (50%) stopped taking their medication at some point. Information from the focus groups suggested that some women may have unrealistic expectations of onset of efficacy or extent of benefit and may be unprepared for managing side effects.
Conclusions. Feelings of embarrassment and limited understanding of the pathophysiology of OAB can contribute to miscommunication between a woman and her doctor. Patient education regarding reasonable expectations coupled with suggestions for coping with unwanted side effects will likely result in better management.
Keywords. Overactive bladder, population-based survey, women, behaviours, attitudes.
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Introduction |
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Overactive bladder (OAB) has been defined by the International Continence Society (ICS) as urgency, with or without urge urinary incontinence (UI), usually with frequency and nocturia, and in the absence of proven infection or other obvious pathology.1 The symptoms associated with OAB often occur as a result of involuntary detrusor contraction (detrusor overactivity) during bladder filling. Overactive bladder is estimated to affect approximately 17% of women and 16% of men in the United States.2 Prevalence increases with age, with estimates of about 30% in women 65 years of age and older. In many individuals, the symptoms of OAB are pervasive, compromising quality of life and requiring lifestyle changes.2–4 Data from the National Overactive Bladder Evaluation (NOBLE) Program revealed that OAB with or without urge UI was associated with significantly lower quality of life, increased depression, and poorer quality of sleep compared with matched controls.2 A recent report, using data from the NOBLE survey, estimated the total cost of OAB in the United States at more than $12 billion in 2000, which is comparable to the estimated costs of osteoporosis and gyneacological cancers.5
Despite the negative impact on physical and emotional well-being, many women do not seek help for their bladder control problems.6–8 Instead, they devise extensive coping mechanisms to manage their symptoms, e.g. bathroom mapping, voiding frequently, drinking less, crossing their legs and wearing pads and diapers. Many women are reluctant to discuss their bladder problems with their physician. Many feel their bladder control condition is a normal part of aging that must be endured. Others are unaware that effective therapies (behavioural and pharmacological) are available.
Few studies have evaluated the perceptions and behaviours of women with bladder control conditions.6–9 The Overactive Bladder Patient Segmentation Study included a large population-based survey of women with bladder control problems. The objectives of the survey were to (1) investigate the general habits, attitudes and behaviours of women with OAB, (2) assess overlap of OAB symptoms, (3) evaluate patients' perceptions of physician interaction regarding OAB and (4) assess awareness and usage of medications for OAB. In parallel with, but distinct from, the segmentation survey, focus groups of women with OAB were assembled in geographically diverse cities in the United States to obtain an in-depth understanding of women's attitudes toward and perceptions of OAB, as well as drivers of behaviour with regard to seeing a physician and managing their condition. Women in the survey did not participate in the focus groups, and women in the focus groups did not participate in the survey.
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Methods |
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Quantitative survey
The quantitative segment of the Overactive Bladder Patient Segmentation Study was conducted via an Internet survey using an online panel consisting of more than 1.2 million pre-identified, pre-qualified individuals who agreed to participate in research surveys. United States 2000 census data was used to ensure that the distribution of individuals invited to participate in the survey was representative of the US population.
The survey was conducted in January 2003 by a health care marketing research firm in accordance with the code of standards and ethics of the Council of American Survey Research Organizations.
Initially, e-mail invitations were sent to women between 40 and 70 years of age. Respondents were directed via the Internet to a screening questionnaire to determine if they met pre-specified criteria to participate in the survey. To qualify, women had to self-report one or more of the following bladder control conditions for at least one year (1) frequency (defined as micturition eight or more times per day), (2) stress urinary incontinence (defined as accidental leakage of urine when coughing, sneezing, laughing, jumping or in association with any other physical activities one or more times per week); (3) nocturia (defined as waking up to go to the bathroom two or more times during the night), (4) urge urinary incontinence (defined as accidental leakage of urine associated with a strong sudden urge to urinate one or more times per week, but not associated with coughing, sneezing, laughing or any other physical activity); and (5) urgency (defined as urge to urinate, but very little or no urine). Subjects who qualified for the study were immediately asked to complete the Internet survey. Dimensions contained in the questionnaire included a psychographic attitudinal battery, bladder control perceptions, awareness and utilization of treatments for OAB and perceptions of communications with their physician about OAB. The questionnaire took approximately 30 minutes to complete. Respondents were paid an honorarium of $5.00.
Focus groups
In parallel with, but distinct from, the quantitative Internet survey, focus groups of women with bladder control problems were assembled in order to obtain an in-depth understanding of attitudes towards and perceptions of OAB, as well as behaviours with regard to managing their condition and discussing their condition with a physician. The women in the focus groups did not participate in the survey. The focus group sessions took place in 2 phases. During Phase 1, 4 sessions were conducted in Phoenix, Arizona on 29 January 2003 and Philadelphia, Pennsylvania on 3 February 2003. Two sessions, stratified by age (45–53 and 54–65 years), were conducted in each city. In order to participate in the sessions, a woman had to have one or more of the following symptoms of overactive bladder for at least one year (1) frequency (defined as micturition eight or more times per day), (2) urge urinary incontinence and (3) urgency. Women who suffered from stress urinary incontinence and nocturia (defined as waking up to go to the bathroom two or more times during the night) were not excluded from participation unless it was the only condition they reported. During Phase 2, 8 focus groups were held across 2 cities: Chicago, Illinois (26 February 2003) and Orlando, Florida (6 March 2003). Two groups of women 40–50 years of age and 2 groups of women 51–60 years of age convened in each city. Participants self-reported at least one of the following bladder control conditions for at least one year—urgency or urge urinary incontinence. The purpose of the focus groups in Phase 2 was to test the validity of concepts that were developed as a result of Phase 1.
Analyses
A multivariate analytical program, the Chi-squared Automatic Interaction Detector (CHAID), was used to construct (non-binary) trees and develop a scoring algorithm for placing all respondents of the survey population into segments. The data presented in this report were segmented into respondents who suffered from incontinence (stress or urge UI), designated ‘wet’, and those who had other symptoms of OAB (frequency, urgency, nocturia), designated ‘dry’. Women who self-reported incontinence plus other symptoms of OAB were included in the wet group. Women who reported frequency, urgency and nocturia without incontinence were included in the dry group. A 2-tailed student t-test was used to assess differences between the two groups. All significance testing was conducted at 90% CI.
A sample size of 700 survey respondents was considered sufficient to conduct an attitudinal and behavioural patient segmentation. One hundred subjects in the sample of OAB sufferers were to have taken a prescription medication in the past year and discontinued taking the medication. It was estimated that the proportion of individuals with bladder control problems in the online panel would be about 17%, based on known incidence rate of OAB in the US.2
The objective of the focus groups was to obtain an in-depth understanding of perceptions and behaviours through one-on-one discussions in small groups. Because of the small numbers of subjects and the open-ended nature of the discussion, formal analyses of our focus group results were not performed.
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Results |
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In total, 25,000 e-mail messages were sent to members of the online panel inviting them to participate in the Overactive Bladder Patient Segmentation survey. Of these, 4,207 respondents attempted the questionnaire. Seven hundred and fifty-seven (18%) respondents met the eligibility criteria and completed the questionnaire. The demographics of the survey population are summarized in Table 1. Although all respondents had to have reported one or more bladder control symptoms to be included in the sample, only 50% of respondents reported having a medical bladder control condition. As shown in Table 2, the majority of participants self-reported as suffering from multiple bladder control symptoms. Stress urinary incontinence (72%) was the most commonly reported symptom. Approximately 50% of all women who reported stress urinary incontinence also suffered from urge urinary incontinence. More than 70% of women with urinary incontinence (urge and stress) considered it to be very or extremely bothersome.
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A total of 102 women took part in the four focus groups in Phase 1, and 78 women participated across the eight focus groups in Phase 2. For many participants, this was the first time they had talked about their condition openly. A common response was, ‘I'm so glad to see that I'm not alone’.
Bladder control perceptions
Notable differences were observed between incontinent women (wet group) versus non-incontinent women (dry group) on responses to survey items about their perceptions of their bladder control condition (Table 3). Differences between groups were most prominent in quality-of-life items. Wet respondents were more likely than dry respondents to feel frustrated, angry, depressed and overwhelmed about their bladder control condition. Wet respondents were also more likely to feel unclean and embarrassed by their condition than dry respondents. More wet than dry respondents limited their activities, avoided social situations and felt it was easier to stay home than go out because of their condition. Wet respondents were also more likely to avoid sexual/intimate relationships than dry respondents.
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The focus groups revealed a lack of knowledge about the physiology of bladder control. Many women were not aware that OAB is a pathophysiologic disorder related to the bladder or that the bladder is a muscle. During nearly all focus group sessions, participants asked ‘How does the bladder work’, ‘How much fluid can a bladder really hold’, ‘How do Kegels (versus medication) help?’ Women expressed feelings of humiliation, shame and anxiety because of their bladder control problems. Participants considered their condition to be ‘socially unacceptable’ and ‘annoying’. Representative comments included feelings of ‘anger’, (being) ‘restricted’, ‘old’, ‘stinky’, ‘soiled’, (a) ‘soggy mess’, ‘dirty’, ‘unfeminine’, ‘helpless’ and ‘exhausted’. Women in the older age groups (54–65 and 50–60 years) were more likely to express an acceptance of their condition; e.g. ‘just a part of life’, ‘part of getting older’, ‘part of having kids’, or ‘there are worse things I could have’. Women in the younger age groups (45–53 and 40–50 years) tended to express more anger when discussing their bladder problems. Common coping mechanisms mentioned included bathroom mapping, sitting nearest to the door or bathroom when in public, crossing their legs, wearing pads or diapers, having a change of underwear or clothes readily available and carrying around towels in the trunk of the car. Some women talked about carrying around bottles or a mayonnaise jar in the car. One woman spoke about bringing her own rug to sleep on when staying overnight at her son's house, which allowed her to conceal her condition from her family.
Humour appeared to be a common underlying coping mechanism. In order to mask feelings of anxiety and embarrassment, participants made statements such as, ‘Grandma's pee pee dance’, ‘Every bathroom in South Jersey has my name on it’, ‘It's like Niagara Falls (when I have an accident),’ (I have an) ‘industrial strength urethra (because of bladder exercises), but I still wet my pants,’ and ‘The medication is drying you out on the wrong end’.
In discussions on the impact of their condition on their self-confidence, participants revealed incidents such as ‘urinating in bed’ (with the husband there), an ‘accident in the passenger's seat of a car while on a date’, ‘having an accident while shopping’, or ‘leaking/accident’ while at the movies with grandchildren or at a party with friends. They also spoke of fears, such as having an episode at ‘my son's wedding’, facing a ‘long line to the bathroom’, and ‘not getting in the door (of my house) quick enough’.
Discussion of the impact of bladder problems on personal life included effects on intimate relationships, e.g. ‘We don't have spontaneous sex anymore’, or ‘I have to shower beforehand to clean myself off’. Women spoke of nicknames such as ‘Spongebob Square Pants’ or ‘Grandma Pee Pants’. They spoke of motels that have a washer/dryer as a primary requirement for how they choose lodging facilities when planning vacations. With respect to social activities, many women admitted giving up their favourite activities, such as tennis, running, dancing or playing on a trampoline with their kids. At work, they struggle with the fear of being judged because they are away from their desk so often due to bathroom visits. They keep a change of clothes and pads or diapers in their desk. They are tense when sitting in meetings with co-workers for fear of having a ‘smelly accident’ or ‘visible leak’.
Interactions with a physician about overactive bladder
Participants in the survey responded to a series of questions related to their perceptions about their physician (Table 4). Responses were generally similar in the wet and dry groups. Approximately 75% of respondents felt that they would discuss their bladder condition with their doctor if they knew it was a treatable medical condition. Less than half of the respondents (45%) felt strongly that their doctor listens to their concerns. Approximately 30% of respondents in the survey felt uncomfortable talking to their doctor about their condition, and 25% reported they are or would be embarrassed to talk about their bladder condition with their doctor. About 15% of respondents felt their doctor did not take their bladder condition seriously.
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Other questions in the survey were designed to evaluate physician visits for OAB (Table 5). Less than half (47%) of the 757 participants reported that they had discussed their bladder control condition with a physician. In 88% of cases where such discussions occurred, they were initiated by the patient. A larger proportion of wet patients (90%) relative to dry patients (83%) said they initiated and discussed their condition with the physician. Among patients who had talked with a physician about their condition, 74% reported the discussion included one or more methods for managing their bladder control problem. Of the respondents, 10% reported that their doctor told them they simply had to ‘live with it’. If medication was discussed as a potential management method, 88% of the time a prescription was written, and the majority of these patients (84%) filled the prescription. In the total survey population (N = 757), only 12% received and filled a prescription for their bladder control condition; the proportion was higher for wet patients (16%) relative to dry patients (4%).
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In the focus groups, barriers to seeing a doctor included perceptions that they could ‘handle the problem on their own’, it was ‘not a life-threatening illness’, they had ‘other more serious problems’, their condition was ‘just a part of getting older’, and it was ‘something they brought on themselves’ (e.g. overweight, child birth, hysterectomy or diabetes). Other barriers included rumours about botched surgeries and painful tests, fear that their symptoms might reflect a more serious problem, and embarrassment to talk about it. Among women who talked to their physician about their bladder condition, most were advised to try Kegel or bladder exercises, lose weight or change their diet. Few physicians offered the option of taking medication for their bladder condition. Commonly, women were told to ‘see if it gets worse, then come back’, that ‘the (Kegel/bladder) exercises should take care of it’ or ‘your bladder is like a worn-out old pair of shoes.’ Women related that office visits often included diagnostic procedures they felt were ‘painful’, ‘uncomfortable’, ‘embarrassing’, ‘insulting’ or ‘primitive/barbaric’. Such procedures were variously described as ‘inserting of a rod into the urethra’, ‘I had to fill up my bladder with water and jump up and down so the doctor could see if I dripped, leaked or had an accident’, ‘I had to pee in a cup while they x-rayed me.’ When speaking with their physician, participants revealed that it was easier for them to describe the stress-related incontinence symptoms, and they were less likely or embarrassed to talk about their urge-related incontinence symptoms.
Medication use for overactive bladder
A summary of survey respondents' attitudes and behaviours with regard to OAB medication use is presented in Table 6. Incontinent women (wet group) were more likely than non-incontinent women (dry group) to feel strongly that they would seek prescription medication and take it if they knew it could control their symptoms. Wet women were also more likely to feel strongly that they would put up with mild side effects if the medication was effective. More than half of all respondents felt that OAB medication made sense only when the problem was worse than what they experienced (54% in the wet group and 68% in the dry group).
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In the survey, 138 women reported that they had taken or were currently taking OAB medication. Of these, 69 (50%) reported that they had discontinued an OAB medication at some point. The most common reason for discontinuing their medication was inadequate efficacy (42%) followed by adverse events or intolerability (30%), physician switched medication (17%), cost (14%) and condition improved (8%). Among those who had taken or who were currently taking a prescription medication to treat their bladder control condition, slightly more than half (56%) felt the medication was effective in managing their bladder condition. Of the 69 survey respondents who were currently using medications to treat their bladder control condition, 73% reported that they were satisfied with the current medication. The majority of respondents (82% of wet women and 100% of dry women) experienced few, if any, side effects due to the medication.
In the focus groups, many women were not taking nor had taken medication to treat their bladder condition. Nearly all participants expressed concern regarding the side effects of the various medications. Other concerns included interactions with other drugs (a particular concern among the older women groups), cost and inadequate effectiveness. Some women felt that if the medication was not a cure, they need not take it. When further queried regarding their expectation of onset of efficacy, many expected the medications to work within a week of beginning medication. When efficacy was not realized, several participants reported that they had discontinued the medication. Other women reported discontinuing the medication due to dry-mouth side effects (one woman stating, ‘and if the drug isn't working anyway...’).
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Discussion |
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The Overactive Bladder Patient Segmentation survey and complementary focus group sessions were conducted to gain a better understanding of women with OAB. The high degree of overlap of bladder control symptoms observed in this study is consistent with other epidemiology studies.8,10 The focus groups revealed a considerable lack of knowledge about the pathophysiologic cause of bladder control problems. Similarly, Shaw et al. found a general lack of knowledge of OAB and available treatments among individuals with urinary symptoms.7 Only half (50%) of the women in the survey felt that they had a medical bladder control condition, even though all participants had to have reported one or more bladder control symptom to be included in the sample. Respondents were more likely to identify themselves as being overweight or obese (61%). This self-identification offers insight into their level of self-esteem as well as their ability to interact comfortably in social situations and with their physician. Not unexpectedly, wet women (reporting stress or urge urinary incontinence) relative to dry women (reporting frequency, urgency, nocturia only) were more likely to feel unclean, embarrassed and overwhelmed by their condition. Significantly more wet than dry respondents limited their daily activities, avoided social situations and limited sexual/intimate relationships. Women in both the survey and the focus groups revealed elaborate coping mechanisms to manage their bladder control problems.
More than half of the respondents in the survey felt that their bladder problem was a normal part of aging or a condition they just had to live with. This attitude of acceptance was commonly expressed in the focus groups as well, although it was more prevalent among older women than their younger counterparts. These findings are consistent with those previously reported.7 Interestingly, more than half of the survey respondents felt that prescription medication was warranted for bladder problems that were worse than what they experience. Yet, these women were urinating, on average, more than nine times per day, and incontinent women were experiencing an average of one incontinent accident a day. Further, more than 70% of incontinent women considered their condition very or extremely bothersome. Approximately 47% of our survey respondents had spoken to a physician about their bladder control condition, and 88% of these discussions were initiated by the patient. These results are consistent with another cross-sectional survey of women with incontinence in the US.6 Further, in a Swedish survey, Hagglund et al. found that only 26% of women with long-term urinary incontinence had sought professional help.11 The most common reason for not seeking help was a belief that the problem was minor and they could cope with it on their own.
Among women in the focus groups who had discussed their bladder problems with their doctor, there was a tendency to understate the degree and impact of their symptoms, as well as a tendency to describe stress-related incontinence symptoms and fail to mention urge-related incontinence symptoms. In a survey of women presenting with urinary symptoms, Rodriguez et al. found that physicians underestimated the degree to which patients were bothered by their symptoms 25% to 37% of the time.9 The reluctance to talk about urge urinary incontinence and a lack of understanding of the physiology of bladder control may contribute to miscommunication between physicians and patients. Many physicians advise their patients to try Kegel or bladder exercises, lose weight or change their diet. While these recommendations may be appropriate for stress urinary incontinence, some may not be helpful for women suffering from urge urinary incontinence. The focus groups revealed that few physicians offered the option of taking medication for bladder problems. Among physicians who did suggest medication, most did not give a thorough explanation of the product's efficacy and side effects.
Only about 9% of women in the survey were currently taking medication for their bladder control problems, findings which are consistent with those of Diokno et al.6 Half (50%) of the women who had tried OAB medication, stopped taking it at some point. The most common reason for stopping medication was inadequate efficacy. When women in the focus groups were queried regarding their expectation of onset of efficacy, many expected the medications to work within a week of beginning the medication. The relatively high discontinuation rate for OAB medication may reflect patients' unrealistic expectations of onset of effect and extent of benefit and unpreparedness for managing side effects. In a notable exception, a woman in one of the focus groups remarked she had been taking OAB medication for about two years and was very happy with her treatment. On further probing, it was discovered that her physician had presented her with realistic expectations regarding efficacy and side effects. "I wasn't promised a cure, I was told it would work at least half the time and it would take a couple of weeks before I realized the full effect." This illustrates the importance of adequately informing the patient about the product's efficacy and side effect profile. Clearly, there is a need for better patient education regarding reasonable expectations of onset of effect, extent of treatment benefit and potential side effects.
As with all epidemiological studies, there were inherent biases in the survey methodology and data analyses. Although the survey sample was derived from a large online panel of more than a million individuals, it was not a random sample. Subjects had opted to participate in research surveys and they had Internet access. It could be argued that women with less education and in lower income brackets are under-represented in this study because they are less able or willing to complete such a survey. Greenfield Online, Inc., which maintains the online panel, collects an extensive demographic profile of their panel members. Census data were used to ensure, with the exception of gender (female) and age (40–70 years) restrictions, that the distribution of individuals invited to participate in the survey was representative of the US population. The validity of the survey sample is supported by the fact that the proportion of participants from the invited sample who met the criteria for the study is consistent with the estimated prevalence of OAB in the United States.2 The survey sample only included women between the ages of 40 and 70 years; thus, our findings do not provide information about men or younger women (<40 years) with bladder control problems. The focus groups provided anecdotal experiences that are not necessarily representative of the US population of OAB sufferers. However, the information obtained from the focus group sessions was consistent with the data obtained from the survey. Statistical significance for a difference between survey groups (wet versus dry) was declared at 90% CI, which implies that 10% of the responses that showed a statistically significant difference were not, in fact, different. Statistical testing at 90% probability of a true difference is common for self-reported dimensions because of the inherent subjectiveness of the measures and because of individual variability.
Where do we go from here? These data provide impetus to encourage public health services and private sectors to advocate for mass public education regarding the basic physiology of bladder control, specifically to dispel the many myths that are prevalent in the community regarding the diagnosis and treatments for OAB and urinary incontinence. Another goal should be to devise the means to reach community-dwelling sufferers with bladder control problems and encourage them to avail themselves of tools to control, if not cure, their problem rather than continue the many coping behaviours that can perpetuate the problem. Lastly, a greater effort is needed in the medical community to educate physicians and other caregivers of the need to be proactive in identifying and treating OAB and urinary incontinence.
In practice, effective intervention starts with making the diagnosis of bladder control problems. This calls for sensitivity, skill and effort on the practitioner's part in order to get past the patient's reluctance to discuss symptoms that can carry social stigma and can be embarrassing. Treatment options include behavioural modification, medication and surgery. In the course of following the patient over time, it is valuable to determine not only if the patient has improved with the choice of treatment, but also if the patient is satisfied with the degree of bladder control that has been achieved. Patients who still find control inadequate despite improvement can be asked if they want to do more. For patients with OAB, doing more could involve starting or increasing the dose of medication or combining behavioural modification with medication. For patients with stress incontinence, doing more could include behavioural modification or consideration of surgical options. For patients with symptoms of both stress and urge incontinence, doing more could involve behavioural modification along with medication for urge incontinence, and consideration of surgical options if control is still unsatisfactory.
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Conclusions |
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Data from the Overactive Bladder Patient Segmentation Study were consistent with other epidemiology studies. Women with bladder control problems are aware of their coping mechanisms and recognize the negative impact of their condition on their daily activities, social functioning, and interpersonal relationships. They are uninformed about the physiology of bladder control, and they are embarrassed and reluctant to talk about their condition. This lack of understanding along with a reticence to discuss urge-related incontinence with their doctor may result in misdiagnoses and recommendations for treatment that are more appropriate for stress urinary incontinence. Some women may have unrealistic expectations of onset of efficacy and extent of benefit and may be unprepared for managing side effects. Adequate patient education regarding reasonable expectations coupled with suggestions for coping with unwanted side effects will likely result in better management of overactive bladder.
Source of funding and conflict of interest
This study was funded by Johnson & Johnson Pharmaceutical Services. Drs Diokno, Sand and MacDiarmid are paid consultants for Johnson & Johnson and a number of other pharmaceutical companies. Dr Armstrong and Ms Shah are employed by Johnson & Johnson and each receives equity interest in the company as part of their executive compensation package.
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Acknowledgments |
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TNS Intersearch conducted the Overactive Bladder Patient Segmentation survey and performed the analyses. Mary Lou Quinlan from Just Ask a Woman LIVE(tm) conducted the focus groups. Karen Miner assisted in the preparation of this manuscript.
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Notes |
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Diokno AC, Sand PK, Macdiarmid S, Shah R and Armstrong RB. Perceptions and behaviours of women with bladder control problems. Family Practice 2006; 23: 568–577.
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References |
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1 Abrams P, Cardozo L, Fall M, et al. (2002) The standardisation of terminology of lower urinary tract function: Report from the standardisation sub-committee of the International Continence Society. Neurourol Urodyn. 21:167–178 Available at: http://www.continet.org/documents/ICS_Terminology_Report_2002.pdf. Accessed May 24, 2004.
2 Stewart W, Van Rooyen JB, Cundiff GW, et al. (2003) Prevalence and burden of overactive bladder in the United States. World J Urol 20:327–336.
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6 Diokno AC, Burgio K, Fultz NH, et al. (2004) Medical and self-care practices reported by women with urinary incontinence. Am J Manag Care 10(pt 1):69–78.
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