Prevalence and burden of overactive bladder in the United States

Abstract

The National Overactive BLadder Evaluation (NOBLE) Program was initiated to better understand the prevalence and burden of overactive bladder in a broad spectrum of the United States population. Objective: To estimate the prevalence of overactive bladder with and without urge incontinence in the US, assess variation in prevalence by sex and other factors, and measure individual burden. Design: US national telephone survey using a clinically validated interview and a follow-up nested study comparing overactive bladder cases to sex-and age-matched controls. Setting: Noninstitutionalized US adult population. Participants: A sample of 5,204 adults ‡18 years of age and representative of the US population by sex, age, and geographical region. Main outcome measures: Prevalence of overactive bladder with and without urge incontinence and risk factors for overactive bladder in the US. In the nested case-control study, SF-36, CES-D, and MOS sleep scores were used to assess impact. Results: The overall prevalence of overactive bladder was similar between men (16.0%) and women (16.9%), but sex-specific prevalence differed substantially by severity of symptoms. In women, prevalence of urge incontinence increased with age from 2.0% to 19% with a marked increase after 44 years of age, and in men, increased with age from 0.3% to 8.9% with a marked increase after 64 years of age. Across all age groups, overactive bladder without urge incontinence was more common in men than in women. Overactive bladder with and without urge incontinence was associated with clinically and significantly lower SF-36 quality-of-life scores, higher CES-D depression scores, and poorer quality of sleep than matched controls. Conclusions: the NOBLE studies do not support the commonly held notion that women are considerably more likely than men to have urgency-related bladder control problems. The overall prevalence of overactive bladder does not differ by sex; however, the severity and nature of symptom expression does differ. Sex-specific anatomic differences may increase the probability that overactive bladder is expressed as urge incontinence among women compared with men. Nonetheless, overactive bladder, with and without incontinence, has a clinically significant impact on quality-of-life, quality-of-sleep, and mental health, in both men and women. Overactive bladder (OAB) is a common disabling condition that affects health-related quality of life (HRQL) [1]. Estimates of the prevalence and related social burden of OAB vary widely, in part due to variation in the assessment of symptoms, the populations surveyed, the methods used to collect data, and the criteria used to define OAB. Recently, the International Continence Society (ICS) derived a consensus symptomatic definition of OAB as urinary urgency, with or without urge incontinence, usually with urinary frequency and nocturia, in the absence of pathologic or metabolic factors that would

Neural Control of the Lower Urinary Tract

“…In a rat model of chronic cystitis induced by cyclophosphamide or hydrochloric acid, it has been shown that capsaicin-sensitive bladder afferent neurons increase their excitability due to decreased density of A-type K + (K A ) currents, associated with the decreased expression of the Kv1.4 α-subunit (260,703). Similar somal hyperexcitability due to reduced K A current expression after chronic tissue inflammation has also been detected in afferent neurons innervating the rat stomach (135) or the guinea pig ileum (592). Thus, the reduction in K A current size could be a key mechanism inducing afferent hyperexcitability and pain in visceral organs including the bladder.…”

Epidemiology of Lower Urinary Tract Symptoms: Emphasis on the Status in Korea

“…Stewart et al [36] performed a CS, population-based, random-sampled study. They collected data from 5,204 Americans by use of a computer-assisted TI method, and reported that the prevalence of OAB was slightly higher in women (16.0% in men, 16.9% in women).…”

A retrospective study of treatment persistence and adherence to mirabegron versus antimuscarinics, for the treatment of overactive bladder in Spain

“…Health-related quality of life (HRQoL) is profoundly affected in patients who experience OAB symptoms, as demonstrated by clinically meaningful impairments in HRQoL scores [4]. Aspects of life affected by OAB symptoms include sexual health, personal relationships, performing daily activities [5, 6], employment and productivity in the workplace [6, 7].…”