© The Canadian Journal of Urology™; 21(Supplement 2); June 2014
Address correspondence to Dr. Matt T. Rosenberg, Mid
Michigan Health Centers, 214 N West Avenue, Jackson, MI
49201 USA
A practical primary care approach
to overactive bladder
Matt T. Rosenberg, MD,
1
Erik S. Witt,
1
Jack Barkin, MD,
2
Martin Miner, MD
3
1
Mid Michigan Health Centers, Jackson, Michigan, USA
2
Department of Surgery, University of Toronto, Humber River Regional Hospital, Toronto, Ontario, Canada
3
Departments of Family Medicine and Urology, Miriam Hospital, Brown University, Providence, Rhode Island, USA
ROSENBERG MT, WITT ES, BARKIN J, MINER M.
A practical primary care approach to overactive
bladder.
Can J Urol
2014;21(Suppl 2):2-11.
The evaluation and treatment of overactive bladder (OAB)
starts in the primary care office and can be accomplished
efficiently, effectively and, most importantly, safely. With
appropriate knowledge of the disease and an understanding
of what to look for the primary care physician (PCP) can
readily make the empiric diagnosis and initiate treatment.
The key for the PCP is to be able to distinguish the
uncomplicated patient from the complicated one and know
when to refer, if necessary. It is also essential to be able to
able to identify confounding conditions that could either
be the cause of the symptoms or, in fact, make them worse.
The algorithmpresented in this paper describes a simplified,
yet complete, approach to the patient presenting with lower
urinary tract symptoms (LUTS) consistent with OAB. In
the paper, we explain the disease itself, its prevalence and
impact, the evaluation as well as the different treatment
modalities that are available for the patient. Appropriate
follow up, therapy adherence techniques and referral
recommendations are also discussed.
Key Words:
overactive bladder, primary care
approach
to identify the at-risk patient as well as present all of the
therapeutic options. Most importantly, this education
should show the PCPwhen it is appropriate to refer and
the “redflags” towatchout for. It is for all of these reasons
that we present a practical approach to the evaluation
and treatment of OAB.
Definition of disease
OAB is a syndrome or symptom complex defined
as: “Urgency, with or without urgency incontinence,
usually with frequency and nocturia.
2
Urgency is a
sudden, compelling need to void which is difficult to
defer. Frequency is defined as voidingmore than 8 times
per day. Nocturia is voiding more than once per night.
Incontinence is defined as the involuntary loss of urine.
It is referred to as urge incontinence (UI) when preceded
by urgency and stress urinary incontinence (SUI) when
this loss occurs while coughing, sneezing, laughing, or
as a result of other physical activities.
3
These symptoms
describe failure of the bladder to store urine, one of its
basic functions. Another way to define bladder storage
issues is todescribe themas “irritative symptoms”. This is
auseful distinctive for thePCPwhen trying todifferentiate
those symptoms caused by bladder dysfunction, storage
or irritative issues, from those symptoms caused by
the prostate, obstructive or voiding issues. Obstructive
symptoms describe difficulty with the act of voiding
which include poor flow, hesitancy or intermittency.
Obstructive symptoms are generally caused by the
Introduction
The evaluation and treatment of overactive bladder
(OAB) has often been considered the domain of the
specialist, the urologist or urogynecologist, but not the
primary care physician (PCP). One explanation may be
historical as extensive testingwas done in the initialwork
up. Another reasonmay be because themajority of PCPs
have limited training in urologic disease, thus referral
has been easier than delving into something outside of
their comfort level. Recently, the American Urological
Association (AUA) put out new guidelines describing
a simplified approach advocating an evaluation that
does not require testing in the uncomplicated case.
1
This
truly does put the PCP in the position of the gatekeeper
for OAB. Unfortunately, the PCP is spread very thin
with a multitude of disease states to deal with as well
as less and less time to spend with the patient. Add
that to the limited urologic training and the result is an
under-diagnosed and under-treated disease. However,
OAB is not just a quality-of-life issue, there are also
serious ramifications such increased fall and fracture
risk, infections and skin breakdown from wet clothing.
Education for the PCP is the key to assistance for the
many that needlessly suffer from bladder issues. This
education should clarify the simple approach necessary
2
