It is estimated that over 37 million people in the United States, men and women of all ages, suffer from Overactive Bladder (OAB) of some severity. While many of these patients may see improvement from simple behavioral changes such as moderating diet or fluid intake, others may need more intensive treatment including medications. But the number of bladder specialists in the US is limited and cannot possibly accommodate seeing even most of those patients with OAB. Therefore, it is important to ask the question of which patients really need to see a specialist to have OAB properly treated.
It is worth spending a moment to look at how OAB is diagnosed and how comfortable general practitioners are likely to be with this evaluation. The key in diagnosing Overactive Bladder is a good patient history. Questions about how frequent or urgently urination is occurring are important. So are questions about the circumstances of urine leakage. Does this occur with exercise or laughing or bending over – which may suggest stress incontinence? Or are incontinence episodes preceded by urgency suggesting urgency incontinence. It is very important to identify other possible causes of symptoms such as surgery, radiation therapy, or neurological abnormalities which may cause symptoms similar to those of OAB. It could be argued that primary care providers, who are accustomed to sorting through lots of patient information to develop a diagnosis, may be particularly skilled at assessing the causes of incontinence.
Certain factors can make the diagnosis and treatment of incontinence particularly challenging or require more invasive or complex testing to properly evaluate. These factors may suggest the need for referral to a specialist such as a urologist. Such warning signs include difficulty emptying the bladder, presence of blood in the urine, or known neurological diseases. If incontinence follows shortly after surgery or follows radiation therapy, more extensive testing is often necessary and may benefit from a specialist’s expertise. However, these are the exceptions rather than the rule and most people experiencing OAB symptoms can be properly evaluated by their primary care provider.
Role of a Specialist
For those patients who do need to see a urologist for evaluation of OAB, what can they expect? Hopefully, they will find that, initially, there isn’t much of a difference. The focus should still begin with taking an accurate history including details of symptoms, factors that make those symptoms better or worse, previous surgeries or radiation treatments, and previous treatments such as medications. For some patients with a complicated history or symptoms that have not responded to multiple treatments in the past, more extensive testing may be recommended. This can include looking into the bladder with a small, flexible, lighted scope (called a cystoscopy). A few patients will require a pressure test of the bladder (called a urodynamic evaluation). But these tests are used in only a small proportion of OAB patients.
Don’t Give Up
Regardless of whether care for OAB is delivered by a primary care provider or a specialist, there is a high degree of frustration associated with seeking treatment for urinary incontinence. This is due to a variety of factors but the challenges are many. In developing a dedicated Overactive Bladder Clinic over several years, we learned that it takes a true effort on the part of both patient and provider to see improvement in urinary symptoms. Whether it is a general practitioner or specialist, seek out someone who will listen and provide support in various ways.