© The Canadian Journal of Urology™; 21(Supplement 2); June 2014
enlarging prostate, which is commonly referred to as
benign prostatic hyperplasia (BPH).
3
Combined, the
symptoms arising from the bladder or the prostate are
called LUTS or Lower Urinary Tract Symptoms.
Prevalence
In a 2011 study in the United States Coyne et al
demonstrated that the prevalence of OAB symptoms is
greater than 30%. They found that 1 in 3 adults greater
or equal to 40 years of age reported symptoms of OAB
at least “sometimes”. Although women appeared to
have a higher prevalence from ages 40-70, after the
age of 70 the levels were essentially the same.
4
To put
this into perspective, patients suffer of OAB symptoms
more commonly than diabetes, asthma, coronary artery
disease or chronic sinusitis just to name a few.
5
Treatment gaps
Most patients wait long periods after symptom onset to
seek treatment andmany do not approach the PCP at all.
Unfortunately many are embarrassed or are fearful that
theywill need invasiveprocedures or surgery. Somehave
the perception that there is a lack of available or effective
treatment.
6
They alter their lifestyle and develop coping
mechanisms such as using diapers or other absorbent
products,wearingdark, baggyclothing, carryingextrasets
of clothing or only travelingwhere they knowbathrooms
are readily accessible.
7
One study found that less than
half of the patients with probable OAB discussed the
symptomswithaPCPanditwas thepatientwhogenerally
initiated the conversation. Additionally, only a small
percentage of eligible patients are prescribedmedication.
8
Primary care approach
The key in the PCP approach to OAB is to be able
to provide a simple evaluation as well as having
effective and safe treatment options. This starts with
acknowledging symptoms and then elucidating the
cause. Treatment can be empiric once other urologic and
nonurologic causes of the LUTS symptoms are ruledout
or dealt with. The algorithm presented here, Figure 1,
offers a logical and practical approach in evaluating the
patient with symptoms consistent with OAB.
3
A practical primary care approach to overactive bladder
Figure 1.
Practical approach in evaluating the patient with symptoms consistent with overactive bladder (OAB).
