Continence Coach: An Alternative to Chamber Pots in the Bedroom

     Much has been published in the past decade about people living with overactive bladder (OAB), a term that did not exist before the 21st century. OAB was coined as a diagnosis category by pharmaceutical marketers trying to mainstream their language to help ordinary citizens connect the dots between daily symptoms of rushing to the toilet and solutions to mitigate the urgency and frequency of urination. An awkward term like urge incontinence was too unfamiliar and certainly not sufficiently descriptive. Hence, marketing gave birth to overactive bladder.

     The pharmaceutical industry has increasingly sought to capitalize on the trend of people living longer with chronic diseases and conditions rather than dying early from life-threatening illnesses or traumas. Aging baby boomers demanding quality-of-life standards fuel industry ambitions and opportunities. Nevertheless, throughout the numerous studies quantifying how quality of life is compromised by symptoms of OAB, few have focused on quality of sleep as a critically important activity that is affected.

     Nocturia is described by the International Continence Society¹ as “sleep-disturbing voiding” and defined specifically as “the complaint that the individual has to wake at night one or more times to void.” The American Urological Association² (AUA) states nocturia is “considered a clinical problem if frequency is greater than twice a night.”

     Nearly 9 years ago in the first quarter of 2001, the National Association For Continence (NAFC) completed its first nationwide survey of 1,001 men and women ages 30 to 70 years. Conducted by Yankelovich Partners and funded by Pharmacia Corporation (now owned by Pfizer), the study was one of the first to attempt to quantify the prevalence of nocturia, or frequent awakenings to use the toilet. Among respondents who revealed they are aroused from sleep during the night to go to the bathroom, almost two in five (38%) have to get up twice or more often and one in eight (13%) of these individuals say they sometimes do not make it to the toilet before accidentally losing urine.³

     Less than 2 years later (December 2002), the NAFC contracted Harris Interactive to conduct an online interview. Participants included 1,228 women, age 40 to 65 years, with a household income of $35,000 or more. The research found OAB sufferers experience poorer health than those free from OAB symptoms, living with multiple medical conditions such as gastrointestinal disorders (32.2% versus 13.9%), hypertension (35.1% versus 15.2%), obesity (39.1% versus 17.1%), and arthritis (42.5% versus 19.9%), with and without OAB, respectively. OAB sufferers are two to three times more likely than non-sufferers to experience disturbed sleep, difficulties concentrating, tiredness, overeating, and lack of self-esteem, according to survey responses.³

     It is time for nocturia to be addressed, better understood, and treated by practitioners for what it is. Consumer research completed this year by the NAFC and others is shining new light on the subject. We now have data on how nocturia specifically affects socialization, physical intimacy, and relationships. According to the National Center for Sleep Disorders Research at the National Institutes of Health,⁴ approximately 30% to 40% of adults have some sort of chronic and persistent sleep disorder resulting in chronic sleep deprivation. How much of the problem is connected to OAB is not known.

     As clinicians, how do you question patients about their symptoms? What intervening steps do you recommend to mitigate symptoms? What behavioral strategies do you employ? What do you not know about addressing nocturia? We all could do a better job of giving nocturia the attention it deserves. Otherwise, chamber pots should be brought back in fashion, with love for every baby boomer and beyond.

The National Association For Continence is a national, private, non-profit 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. ICS Factsheet 2: Overactive Bladder. Available at: www.icsoffice.net. Accessed October 14, 2009.

2. 2007 American Urological Association Annual Meeting Highlights- OAB. Available at: www.auanet.org/content/education-and-meetings/on-line-education/amhighlights/oab1007.pdf. Accessed October 14, 2009.

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

4. Hossain JL, Shapiro CM. The prevalence, cost implications, and management of sleep disorders: an overview. Sleep Breath. 2002:6:85–102.