Hi-R-Ed Online

This course was written by Cindy Nissen, RN, MSN, CWCN and edited for presentation by Hi-R-Ed Online, a continuing education program development company. Hi-R-Ed Online is an accredited provider of continuing education courses for nurses, case managers, social workers and registered dietitians.

The focus of today’s program is an examination of overactive bladder, often characterized by a distinct set of symptoms: urgency (wither with or without urge incontinence), usually with a high frequency and related nocturia.

Let's begin with our learning objectives.

Learning Objectives

The Learning Objectives for this course are fairly straightforward. While we will assume you have some knowledge of overactive bladder, we will make an effort to provide you with a working knowledge of overactive bladder, what it is, how it is treated, and self-care that can be taught to the client.

The purpose of setting learning objectives at the beginning of the course is to set the framework and goals for the information that we will cover.

Once the course is completed you should be able to:

– Identify two barriers to diagnosis and management of OAB

–Describe four complications associated with OAB

–Discuss two pharmacological and two non-pharmacological treatment options for OAB

–Identify and describe uses for at least three different types of absorbent products used with OAB

Let's begin by defining the syndrome of overactive bladder, and the scope of this underreported condition. The treatment barriers for this significant, yet often ignored health concern, as well as the complications associated with OAB will be discussed. The components needed to facilitate a diagnosis of OAB will be reviewed. Evidence-based treatments, including both pharmacological and behavioral therapy options for improved clinical outcomes will be identified as well as appropriate absorbent products will be recommended.

Overactive Bladder Defined

•Automatic Urination

•Detrusor Dyssynergia

•Detrusor Instability

•Urge Incontinence

Overactive Bladder has been referred to by a variety of terms throughout modern medicine. In the 1920’s it was described as, “automatic urination” and in the 1960’s was described as, “detrusor dyssynergia” or “detrusor instability” and “urge” incontinence. In the late 1990’s, the term “overactive bladder” became the more accepted term.

The FDA defines OAB as, “a clinical syndrome that includes not only urinary incontinence but urgency, frequency, dysuria and nocturia as well.” The International Continence Society defines the OAB syndrome as urgency, with or without urge urinary incontinence, and is usually associated with frequency and nocturia. The Centers for Medicare and Medicaid Services (CMS) describe within the F-315 interpretative guidelines (the relatively new tag CMS uses for the management of urinary incontinence), “urge incontinence” (OAB) is associated with detrusor muscle overactivity (excessive contraction of smooth muscle in wall of urinary bladder) resulting in sudden, strong urge to expel moderate to large amounts of the bladder before the bladder is full. The definitions refer to OAB as a syndrome which is a cluster, or constellation, of symptoms (urgency, frequency, nocturia) with may or may not be associated with incontinence. OAB may be referred to as “dry” OAB or without an unexpected loss of urine; “wet” OAB is associated with urinary incontinence.

Symptoms

•Urgency

•Frequency

•Nocturia

•UUI

The International Continence Society defines these symptoms as the following. Urgency is a “sudden compelling desire to void that is difficult to defer.” Frequency is defined as the “need to void eight or more times in a 24 hour period.” Frequency is also described as voiding more than every two hours. Nocturia is “waking at night two or more times to void and urge urinary incontinence is defined as, “the involuntary leakage of urine accompanied by, or immediately preceded by, urgency.” It is important to remember that these symptoms are present when all other neurological, metabolic or other disease states have been ruled out as the cause for these symptoms. Rick Fields-Gardner