OAB is a clinical syndrome defined as urgency with or without urge incontinence usually with frequency and nocturia. It is a common problem: one European survey of 16776 people aged 40 or older found an overall prevalence of over active bladder symptoms were frequency (85 per cent), urgency (54 per cent) and urge incontinence (36 per cent).

The overall prevalence of OAB is similar in men and women but incontinence is more common and symptoms worsen sooner among women. prevalence increases differently with age from 9 per cent in women and 3 per cent in men aged 40-44, 31 and 42 per cent respectively at age 75 or older.

OAB adversely affects quality of life in about 30 per cent of people aged 40 or older in UK, with a significant impact on social and physical functioning, emotion and particularly mobility in women. There is also a significant detrimental effect on mood and quality of sleep .Urinary urgency is the symptom patients say is most troubling, with the greater impact on quality of life than incontinence, frequency or nocturia.

Overall the impact of OAB on quality of life reported by patients is comparable with that associated with diabetes.

Concordance issues in OAB
Despite the associated morbidity many patients do not take their medication as prescribed or discontinue treatment. In one randomized trial involving 348 patients with OAB (defined as detrusor instability), of the 256 who could be followed up, only 18 percent has persisted with anticholinergic drug treatment for at least 6 months
Three analyses of US medical claims databases found that few patient persist with treatment for a year ,even with newer modified – release formulations that are claimed to reduce adverse effects.

In one, 47 per cent of patients taken an anticholinergic drug had stopped treatment after 3 months and 82 per cent had stopped by the year's end ; the mean duration of treatment was 86 days.
The second analysis found that 88 per cent of patients stopped treatment within a year , mostly within 6 months and only 15 per cent of patient took at least 80 per cent of their prescribed medication .
In the third, the mean duration of treatment for first time users of anticholinergic drugs was 91 days with oxybutynin and 143 days with tolterodine.

Theses studies did not investigate the reasons for this early discontinuation of treatment but it is likely that lack of effectiveness and adverse effects are the most common causes.

Adherence to treatment could be improved by adopting a joint approach between patient and healthcare provider. To achieve this ,clinicians need to enquire about patients' beliefs and concerns about their condition and its treatment and give them autonomy in decision making .in turn, patients need to understand their condition and the options for treatment they should have realistic expectations of what can be achieved with drug treatment and of the nature and likely hood of adverse effects so they can agree suitable goals and they should be offered ongoing support .

Finally, treatment should deliver an improvement in symptoms without the penalty of intolerable adverse effects .

Adapted from wagg, A; Maffatt, J.; and spinks, J.eds.confidence through bladder control .the role of propverine – current thinking
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