1. Overactive Bladder — A Disturbing Problem Presented by (insert name of presenter here)

2. Overactive Bladder Definition: Overactive bladder Overactive bladder is a chronic condition in which the bladder starts to contract too early when it is filling with urine.

3. Overactive Bladder Frequency OVERACTIVE BLADDER Urgency Urge incontinence

4. Symptoms of Overactive Bladder Frequency Urge Incontinence Urgency Bladder pressure > urethral pressure

5. Diagrammatic Representation of Overactive Bladder Pressure Bladder pressure > urethral pressure

6. FrequencyFrequency Going to the toilet often (more than eight times in a 24-hour period)

7. UrgencyUrgency strongsudden A strong and sudden desire to urinate

8. Urge Incontinence Urge incontinence occurs when there is a very strong urge to pass urine and which cannot be held back, resulting in the person wetting himself on the way to the toilet Image source: Society for Continence (Singapore)

9. Case Study 1 “My boyfriend and I don’t go out very often because of my problem. If we do go out, let’s say to a departmental store, the first thing that I look for is the toilet. If I can’t find one, I leave the store. That’s how serious the problem is.” Devi, 27 years old

10. Case Study 2 “I visit the toilet frequently during the day – about 10 or 12 times, I think? And at night I wake up 3 or 4 times just to go to the toilet. I used to think that if I go to bed later, I wouldn’t have to get up so often. But that’s not true.” Michelle, 36 years old

11. Case Study 3 “It’s so embarrassing. I see the lady who cleans the toilet more often than I see my colleagues or my boss. Because I am away from my desk so often, I always get these looks from my colleagues who think I’m lazy or trying to skive…I’m just too shy to tell anyone the truth.” Ahmad, 53 years old

12. Case Study 4 “Having this problem is really bothersome! For instance, I totally avoid taking the bus or the MRT because I can’t ask the driver to stop when I suddenly have the urge to go to the toilet, can I? Also, I always wear dark clothing and carry extra pads wherever I go – just in case I leak suddenly.” Mdm Tan, 67 years old

13. Problems Associated with Lack of Bladder Control Physical Psychological Social Sexual Occupational/Financial

14. Physical Problems Limitation or stopping of physical activities Discomfort due to dampness Unpleasant odour Skin rashes/ ulcers Confinement in nursing homes Falls Insomnia Dehydration

15. Psychological Problems Loss of independence - feels tied to home Fear of embarrassment Loss of dignity & self esteem Depression Feeling of being a burden Suicide Affects career

16. Social Problems Reduction in social interaction/ increased social isolation Alteration of travel plans (e.g. plan around availability of toilets) Cessation of some hobbies

17. Sexual Problems Avoidance of sexual contact

18. Occupational/Financial Problems Absence from work Job loss Change of job Poor relationship with employers/ employee Financial loss

19. Vicious Circle of Bladder Control Problems IsolationGuilt Social, domestic, physical, sexual and psychological problems Absence from work Depression

20. Quality of Life quality of life significantly impaired overactive bladderStudies show that the quality of life is significantly impaired in people with overactive bladder.

21. Quality of Life The Short-Form-36 measures quality of life in eight health domains: –Physical functioning –Role limitations due to physical health –Bodily pain –General health perceptions –Vitality –Social functioning –Role limitations due to emotional problems –Mental health

22. Quality of Life Scores range from 0 to 100, with 100 representing perfect health. Lower score represents lower quality of life.

23. Physical Functioning 30 40 50 60 70 80 90 Overactive Bladder Diabetes Hypertension Depression Control Group

24. Role Limitations (Physical) 30 40 50 60 70 80 90 Overactive Bladder Diabetes Hypertension Depression Control Group

25. Bodily Pain 30 40 50 60 70 80 90 Overactive Bladder Diabetes Hypertension Depression Control Group

26. General Health Perceptions 30 40 50 60 70 80 90 Overactive Bladder Diabetes Hypertension Depression Control Group

27. VitalityVitality 30 40 50 60 70 80 90 Overactive Bladder Diabetes Hypertension Depression Control Group

28. Social Functioning 30 40 50 60 70 80 90 Overactive Bladder Diabetes Hypertension Depression Control Group

29. Role Function Emotional 30 40 50 60 70 80 90 Overactive Bladder Diabetes Hypertension Depression Control Group

30. Mental Health 30 40 50 60 70 80 90 Overactive Bladder Diabetes Hypertension Depression Control Group

31. SummarySummary overactive bladder hypertension depression People with overactive bladder score similar to, or slightly lower than, individuals with diabetes or hypertension in the physical domains, and substantially lower than all other individuals, except those with depression, in the social and mental domains.

32. Cause of Overactive Bladder unknownIn the majority of cases, the underlying cause is unknown. neurologicalIn some patients, the cause may be a neurological deficit. Multiple sclerosis Stroke Parkinson’s Disease Spina Bifida Spinal cord damage

33. SummarySummary Overactive bladder disturbingOveractive bladder is a disturbing problem. NOTIt is NOT due to aging. treated improvedIt can be treated and improved.