Continence Coach: Anxiety and Fears in Women with Overactive Bladder

  The National Association for Continence (NAFC) recently released findings from a 2012 nationwide survey of women regarding overactive bladder (OAB), the sixth national survey of Americans orchestrated by the NAFC in the last 12 years. Supported by a grant to the NAFC from MSD Consumer Care, Inc, a subsidiary of Merck & Co, Inc, the research was conducted by Kelton Global Research and contracted by the NAFC. The survey compared responses from 1,017 women ages 40 to 65 years with no OAB symptoms to 652 women of the same ages with mild to moderate symptoms of OAB. The margin of error in comparing the two major groups of respondents was ± 3.8%.   Methodology. Utilizing constructs drawn from the Health Belief Model,¹ a social learning and psychological model that attempts to explain and predict health behaviors, the NAFC worked closely with Kelton in organizing and framing specific questions. This represents the first time an established sociological theory has been utilized as a platform for constructing research questions for such purposes in this field.

  The purpose of the survey was to learn about perceptions and concerns that arise as women age and where bladder health is among their list of worries. The survey also examined women’s fears about the seriousness of OAB and related bladder problems and willingness to take action to resolve a variety of health issues through lifestyle changes and other actions.

  In order to identify and segregate women according to symptom severity, the research firm applied a published, validated screening tool² to recruit potential respondents, the first time this tool was used in this manner for a nationwide consumer survey. Women were tapped because they are at least twice as likely to experience OAB and urinary incontinence as men; middle-aged women were targeted because of the impact of menopause with regard to signs of aging and general health vulnerability. Middle age is also a time when chronic diseases and conditions begin to surface. Responses were analyzed by various comparative subgroups by age: 40 to 49 years old and 50 to 65 years old.

  Key findings. Although 78% of women without symptoms of OAB feel in control of their lives most of the time, 52% with OAB symptoms believe they are “in the driver’s seat.” This large difference between the two groups poignantly illustrates how unsettling it is for women in the prime of their lives to lose even the mildest degree of bladder control. Not only are they less in control of their lives, but they also don’t feel as much in control of their health in general. For example, 56% of women with OAB symptoms report they usually feel healthy, compared to 81% of their counterparts without OAB symptoms. In addition, 25% of women with OAB symptoms feel somewhat or extremely unhealthy, compared to 9% of women without OAB symptoms. Moreover, 30% of OAB sufferers say they are as concerned about their bladder health as they are with the inevitability of graying hair (32%) and wrinkles (32%), which may suggest they perceive OAB to be a normal part of aging, even though this is not the case. This sense of fatalism has been documented in earlier consumer research by the NAFC.³

  Even more revealing is the preoccupation with the fear of public embarrassment from not reaching the toilet in time to avoid an accident. Half (52%) of women with OAB symptoms worry about such an embarrassment occurring an average of nearly once a day, compared to 7% of women without OAB symptoms. Additionally, 79% of OAB sufferers express fear not being able to engage in activities; losing the freedom to travel is their greatest worry. Less than one in five women with OAB symptoms (18%) feel properly in control of their bladders, compared to 58% of their counterparts without such symptoms. More detailed information regarding the study’s results will be forthcoming, as data mining and interpretation continue.

  Implications. Even while self-reported consumer data can trigger additional questions, the growing body of research of consumer beliefs and perceptions helps health educators and healthcare providers refine their understanding of what motivates or inhibits people in their health-seeking behavior. This knowledge can enhance our ability to engage with the consumer, cultivate more compliant patients, and achieve better outcomes for a healthier and happier population at greater efficiencies in delivering care.

Dr. Muller is the Executive Director, National Association For Continence (NAFC). The NAFC is a national, private, nonprofit organization dedicated to improving the quality of life of people with incontinence. The NAFC’s purpose is to be the leading source for public education and advocacy about the causes, prevention, diagnosis, treatments, and management alternatives for incontinence.

This article was not subject to the Ostomy Wound Management peer-review process.

1. Rosenstock IM, Strecher VJ, Becker MH. Social learning theory and the health belief model. Health Educ Q. 1988;15(2):175–183.

2. Blaivas J, Panagopoulous G, Weiss JP, Somaroo C, Chaikin DC. The urgency perception score (UPS): validation and test-retest. J Urol. 2007;177(1):199–202.

3. Muller N. What Americans understand and how they are affected by bladder control problems: highlights of recent nationwide consumer research. J Urol Nurs. 2005;25(2):109–115.