The patient with an overactive bladder--symptoms and quality-of-life issues

Psychosocial adjustment to illness is an important as the status of the physical disease itself; focusing on this necessitates some measurement of abstract, subjective feelings of "quality of life" (QOL). Assessments of QOL are particularly important for conditions such as urinary incontinence (UI) that have little or no impact on mortality.

This presentation describes the reasons for, and methods of, measuring lower urinary tract symptoms and disease impact. Validated instruments available for such measurements are reviewed, as are published studies that address the impact of UI (and urge incontinence in particular) on QOL. Potential applications for these new disease measures are discussed.

The bladder is an unreliable witness, and symptom assessment is diagnostically disappointing; cystometry is essential if a definitive diagnosis is required. However, objective tests take no account of the patient's perception of the problem. General health status questionnaires have been used to show that urge incontinence is associated with emotional problems, reduced social and recreational activity, and sexual dysfunction. Newly developed, condition-specific instruments have greater specificity and, hence, improved sensitivity for measuring incontinence and its impact. These instruments have the potential for monitoring disease progression and evaluating treatment outcome.

In a proportion of people with bladder overactivity, the disorder has a profound impact on the QOL. Methods of measuring this impact have been developed that may allow identification of this group of individuals while also improving the assessment of treatment efficacy. However, this science is in its infancy and these dimensions await further exploration.