Overactive bladder (OAB) in women: questionnaire based approach

DOI - 10.21276/obgyn.2020.7.6 ISSN Print – 2454-2334; ISSN Online – 2454-2342 RESEARCH ARTICLE Overactive bladder (OAB) in women: questionnaire based approach Veena Ganju Malla, AmitaTuteja, Pushpa Singh Corresponding author: Dr Veena Ganju Malla, Professor, Department of Obstetrics and Gynaecology, ABVIMS & Dr. RML Hospital, New Delhi, India; Email - Distributed under Attribution-Non Commercial – Share Alike 4.0 International (CC BY-NC-SA 4.0) ABSTRACT Objectives: We aim to study the prevalence of various lower urinary tract symptoms in women with overactive bladder (OAB). We also evaluated the impact of OAB on patient’s quality of life (QOL) through various validated self reporting questionnaires. Methods: An observational cross-sectional study was done where a total of 200 patients who were confirmed cases of OAB were included in the study. The patients were questioned using four structured well designed validated questionnaires and the data were recorded and analysed. Results: Age of patients ranged from 18 to 72 years. Urine frequency (99%) was the most commonly reported symptom followed by nocturia (91%) and urgency (89%). The mean scores for American urology association symptom index (AUASI) was 17, total bothersomeness score (TBS):30.17, urogenital distress inventory (UDI) - 6:58.75 and incontinence impact questionnaire (IIQ -7) was 75.95. Higher scores in IIQ-7 and UDI-6 correlated well with negative impact on quality of life and this association was found to be statistically significant. Conclusion: This study offers an introduction to the concept of QOL assessment using short form questionnaires for patient with symptoms of OAB. Many sufferers seek to manage their symptoms by adjusting to the problem instead of seeking treatment. This has not only puts a negative impact on the quality of life of women but also puts a financial burden on society especially in the developing countries. Keywords: Overactive bladder, questionnaires, quality of life. Overactive bladder (OAB) is defined as “urinary urgency, usually with frequency and nocturia, with or without urgency urinary incontinence (UUI), in the absence of urinary tract infection (UTI) or other obvious pathology”. The condition is highly prevalent and is associated with significant economic burden and lower health related quality of life (HRQoL). It affects millions of people worldwide but often goes unreported as most women consider it as part of normal ageing and suffer in silence. Even the previous studies have focussed on incontinence and therefore prevalence and clinical impact of OAB has been grossly th underestimated and thus not managed properly. Although OAB is not life threatening, but symptoms associated with it can have a profound impact on quality of life of women. Despite the negative impact of OAB on HRQoL, a recent registry-based, online survey study which was conducted across various countries found that a major proportion of such patients never consult a physician regarding their urine related bladder symptoms. In addition, the study also found that the ones who consulted waited for long period before the symptoms were so troublesome that they could not avoid consultation. Received: 10th March 2020. Accepted: 14 April 2020. Malla VG, Tuteja A, Singh P. Overactive bladder (OAB) in women: questionnaire based approach. The New Indian Journal of OBGYN. 2020; 7(1): 26-30. The New Indian Journal of OBGYN. 2020 (July-December); 7(1) Above all, the physicians assessment of the disease burden of these symptoms is shown to be inaccurate and non reproducible. Thus, considering the high prevalence of OAB in women, in conjunction with the fact that many patients fail to mention their problems during clinical consultations, women may benefit from screening for symptoms related to OAB, including UUI, through self reporting questionnaires. The advent of validated condition specific questionnaires proves to be a rapid technique of eliciting the impact of symptoms on quality of life and has encouraged their inclusion in clinical trials of continence care. Only by fully understanding the impact of urinary incontinence on quality of life of women can hope to improve its treatment. Here, we aim to study the prevalence of various lower urinary tract symptoms in women with OAB. We also evaluated the impact of OAB on patient’s quality of life (QOL) through various validated self reporting questionnaires. Materials and methods An observational cross-sectional study was done where a total of 200 patients who were confirmed cases of OAB according to the ICS definition1 and attending urogynaecology clinic who agreed to participate in the study were included in the study. The patients were questioned using four structured well designed validated questionnaires in detail to enquire about their symptoms and its impact on quality of life. Informed consent was taken from them. Institutional ethical committee approval was taken for the study. The patients were asked questions about urinary tract symptoms, demographic data (age, marital status, parity), BMI, menopausal status, history of surgical intervention and any associated comorbidities. The diagnosis of OAB in the present study was based on self reported symptoms according to the ICS definition.1 To obtain an OAB specific QOL symptoms assessment, AUASI (American urology association symptom index), and total bothersomeness score (TBS) were used and for measuring the impact of the symptoms on the QOL, short forms of urogenital distress inventory (UDI-6)4 and incontinence impact questionnaire (IIQ-7) were used. AUASI questionnaire consisted of 7 items, each with a 5 point response scale. The UDI-6 questionnaire had 6 items each with a 3 point response scale, which were summed and transformed to a 0 to 75 scale. The short form IIQ-7 questionnaire consists of 7 items, covering 4 domains; physical activity, social relationships, travel and emotional health, each with a 4 point response scale. Patients were asked to rate the extent to which their urinary symptoms affect their daily functioning from 0(not at all) to 3(greatly). The items scored were summed and then transformed to a 0 to 100 scale. A high score indicated worse quality of life in both UDI--6 and IIQ-7 questionnaires. Data was coded and analysed using descriptive statistics, which were reported as the mean and standard deviation (quantitative variables) or as the number and percentage (qualitative variables). The statistical analysis was carried out by calculating the Pearsons correlation coefficient. A 5% level of significance was used throughout the present study. Results Patients ranged from 18 to 72 years with majority being in the 36 to 50 yr age group.63% patients were with parity Table 1: Demographic characteristics Categories Percentages Age in years 18-35 28 36-50 46 >50 26 Parity <2 37 >3 63 BMI (Kg/m2) <19 7 19-23 24 23.1-27 35 >27 34 H/O Hysterectomy Present 20 Absent 80 Postmenopausal wome (...truncated)