Your Comprehensive Guide to Overactive Bladder

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Your Comprehensive Guide to

Overactive Bladder

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Overactive bladder (OAB) can range from being a simple nuisance to a severe problem in a person’s life. The more you know about its causes and treatments, the easier it will be to manage. This booklet provides the information that you need to know about OAB. We hope you not only fi nd it informative and educational, but that it points you in the right direction in solving your OAB problems.

A number of healthcare professionals may be involved in the diagnosis, treatment and management of OAB, including:

◆ General practitioners/Family doctors

◆ Urologists

◆ Urogynecologists

◆ Gynecologists

◆ Nurse Continence Advisors

If you are experiencing symptoms of OAB, it is important to speak to a

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What is overactive bladder (OAB)?

Overactive bladder (OAB) is a chronic medical condition that is marked by the sudden, and sometimes uncomfortable, need to urinate. This can occur at any time during the day or night, and it may or may not result in the leakage of urine.

OAB occurs when the bladder’s smooth muscle, known as the detrusor muscle, squeezes while the bladder is still fi lling instead of when it is completely full. When this muscle squeezes, signals are sent to your brain resulting in the urge to urinate.

This urgency sometimes leads to more trips than normal to the bathroom and for some people, an involuntary loss of urine. OAB can be both frustrating and embarrassing for sufferers, but luckily, there are treatments and strategies to help you manage its symptoms.

urine

urethra

Normal Bladder

Detrusor muscle contracting when bladder is full

detrusor muscle

urine

urethra

Overactive Bladder

Detrusor muscle contracting before bladder is full

detrusor muscle

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Do you have OAB?

If you suspect that you have OAB, the fi rst step towards getting a proper diagnosis and treatment is to track your symptoms and discuss them with your healthcare professional at your next visit – they will be able to provide you with an accurate diagnosis. Here are a few simple questions that may help you to determine whether you are experiencing OAB symptoms:

Yes No

Do you experience the sudden and overwhelming need to urinate, which is diffi cult to put off?

When you experience the sudden urge to urinate, is this followed by an uncontrolled leaking of urine?

Do you feel that you need to go to the bathroom too often during the day?

Do you feel like you are getting up to go to the bathroom during the night too often?

Do you avoid social or intimate activities because you worry about leakage problems?

Do you plan your daily activities around how accessible washrooms are to you?

If you answered ‘yes’ to any of the above questions, you may be suffering from OAB. Make sure to see your healthcare professional to discuss your symptoms, so that you can be properly diagnosed, rule out other medical conditions, and help you to decide the best treatment approach for you.

Keep in mind that working together with your healthcare professional will go a long way in helping to manage your OAB symptoms successfully. You can become an active partner in your treatment by learning as much as you can about OAB and how you can manage it through educational resources, such as this booklet.

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Differences between OAB and incontinence

While people often refer to ‘OAB’ and ‘incontinence’ as if they are the same thing, it is important for you to understand that they are two different conditions. Incontinence is a more general term defi ned as the accidental, involuntary or unwanted leakage of urine. Urinary incontinence can develop at any age, but as we age, it can become more common because of changes in the body and illness that affect our bladder function. While leakage can be a symptom of OAB, not everyone has this symptom. There are also various forms of incontinence, such as:

Stress urinary incontinence: Involuntary leakage on effort or exertion, such as sneezing or coughing

Mixed incontinence: Involuntary leakage associated with both urgency and exertion or effort

Urge incontinence: Involuntary leakage accompanied by or preceded by urgency

OAB defi ned

According to the Canadian Urological Association, there are four key traits that make up and defi ne OAB:

Frequency:

The need to urinate up to eight or more times during the day

Urge incontinence:

The involuntary leakage of urine accompanied or preceded by urgency

Urgency:

A strong need to urinate that is often diffi cult to defer

Nocturia:

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Who does OAB affect?

You will probably be a little relieved to know that you are not alone – between 12 to 18 per cent of Canadians suffer from OAB. Approximately two thirds have dry OAB (OAB without urge incontinence), while the remaining one third have wet OAB (OAB with urge incontinence). Even though OAB affects all ages, it tends to be increasingly common with age. Both men and women are equally at risk of developing OAB. However, women are more likely than men to discuss their condition and seek treatment.

How does OAB affect you?

While OAB is not a life-threatening disease, it is an emotionally distressing condition, which can adversely affect your daily routine and quality of life. For example, you may experience:

◆ Reduced social activity: You may not go out as much or stop doing things you enjoy.

◆ Stress, frustration and anxiety: You often worry about having a wetting accident.

◆ Sleep disturbances: You may fi nd yourself getting up frequently during the night to make trips to the bathroom.

◆ Skin rashes and urinary tract infections: These problems can occur due to frequent wetting accidents and over-washing with soap and water to prevent odour.

◆ Increased risk of falls and fractures: The risk of injury and accidents can increase because of rushing to the bathroom, particularly at night.

◆ Work-related issues: OAB can negatively affect your work productivity, which has both direct and indirect fi nancial implications (e.g., time off work, loss of earning, pad usage)

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Risk factors to consider

Although no precise causes for OAB have been determined, there are various underlying risk factors that can contribute to an overactive bladder condition.

Some risk factors are common and may include:

◆ Urinary tract infections ◆ Side effects of medications ◆Obesity

◆ Pregnancy ◆ Menopause

Others are less common and more severe, such as:

◆ Nerve damage caused by spinal cord lesions or injuries ◆ Neurological disease (e.g., Multiple Sclerosis, Parkinson’s

disease) ◆Stroke

◆ Blocked urethra due to enlarged prostate ◆ Prostatic surgery in men

While each risk factor may be associated with OAB, some may be linked to various forms of incontinence. For example, some people may experience leakage with any sort of effort or exertion, such as sneezing, laughing, coughing or exercise. This is referred to as ‘stress urinary incontinence,’ which is different from OAB.

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You can download a copy of a bladder diary by visiting:

www.powderroom.ca

ACCIDENTS

Time

Drinks Urine Accidental leaks

Did you feel a strong urge to go?

What were you doing at the time?

What kind?How much?How many times?

How much?

(circle one) (circle one) (circle one) having sex, lifting, etc.Sneezing, exercising,

7–9 p.m. Yes No 9–11 p.m. Yes No 11–1 a.m. Yes No 1–3 a.m. Yes No 3–6 a.m. Yes No 6–8 a.m. Yes No 8–10 a.m. Yes No 10–12 p.m. Yes No 12–2 p.m. Yes No 2–4 p.m. Yes No 4–6 p.m. Yes No

I used _______ pads. I used _______ diapers today (write number).

Questions to ask my health care professional: ________________________________________________________________________________________ _________________________________________________________________________________________________________________________________

Testing for OAB

In some cases, there is a test that a specialist may perform, called an urodynamic test, to help evaluate the cause of your symptoms and guide your treatment. For this test, a catheter (a small plastic tube) may be passed into the bladder and rectum, and fl uid is then used to fi ll the bladder. During the test, you will be asked how your bladder feels and when you feel the need to urinate. While emptying your bladder, the volume of water and the bladder pressure will be recorded. Test results can help to determine how your bladder muscles are working.

Diagnosing OAB

Keeping a bladder diary

Only your healthcare professional can diagnose OAB, but you can help by keeping an accurate and up-to-date bladder diary. Charting your symptoms in your bladder diary (e.g., frequency of urination, degree of urgency, wetting episodes) can help your healthcare professional make the proper diagnosis.

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Finding the right treatment

A number of treatment options are available to help manage your OAB symptoms. The kind of therapy you and your healthcare

professional decide is best for you depends on you and your individual symptoms. Ways to manage your OAB can include making lifestyle changes, special exercises and prescription medication.

Making lifestyle changes

Making lifestyle changes is usually the fi rst step in treating OAB because it is non-invasive, poses little threat of side effects and often provides effective ways to relieve your symptoms. This type of treatment works by teaching you how you can improve your OAB symptoms without medication. Lifestyle changes that may help OAB include dietary changes, managing your intake of fl uids that

contribute to symptoms (e.g. coffee, tea, soft drinks), reducing or quitting smoking and losing weight, to name a few.

Using behavioural therapies

Behavioural therapies and changes which

have been found to improve the symptoms

of OAB include:

◆ Pelvic muscle rehabilitation (e.g. Kegel exercises)

◆ Fluid management

◆ Scheduled toileting/Prompted voiding

◆ Bladder retraining

A specialized healthcare professional, such as a nurse continence advisor or an uro-physiotherapist, can provide these therapies.

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Pelvic muscle rehabilitation (Kegels)

Kegel exercises are an important part of maintaining a healthy pelvic fl oor. They strengthen the pelvic muscles that support your bladder. Strengthening this muscle group allows the urethra to close properly and keep in urine which helps to control stress urinary incontinence, as well as suppress urge in the overactive bladder.

Weak pelvic muscles Pelvic muscles

strengthened with Kegel exercises

Pelvic muscle contractions are unable to constrict the urethra completely, which may allow urine to leak from the bladder.

Pelvic muscle contractions are strong enough to close the urethra completely, so that the bladder can hold in urine. urethra urethra urethral sphincter bladder neck bladder neck urethral sphincter strong pelvic muscles weak pelvic muscles

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How to do Kegel exercises:

Kegel exercises are quick and easy to do anywhere at anytime, without anyone even knowing that you are doing them. There are two kinds of Kegel exercises you can do, which you can read about below.

Tip: When practicing these exercises, do the long exercise fi rst, followed by the short exercise.

Long Kegel exercise

1. Stand, sit, or lie down with knees approximately 25 cm/10 inches apart. 2. Using the muscles that prevent you from releasing rectal gas,

squeeze and pull up on these muscles. You should feel your rectal muscles tightening. Try not to squeeze your buttock muscles together or hold your breath while doing this exercise. 3. Hold this position for 5 to 10 seconds.

4. Now relax the muscles for 5 to 10 seconds. 5. Repeat the above steps 12 to 20 times.

Short Kegel exercise

1. Squeeze and hold the pelvic muscles, as described in the long exercise, for 1 second and then relax for 1 second.

2. Repeat the above step 5 times. 3. Relax for 10 seconds.

4. Repeat all of the above steps, in sequence, 3 to 4 times.

Kegel exercises should be performed 3 to 5 times a day. Remember to do them consistently and properly. Try not to become discouraged if these exercises do not work right away. As with any other muscle group in your body, it takes some time to strengthen your pelvic muscles (often several weeks). Furthermore, you should continue doing Kegel exercises, even when your OAB symptoms improve, to keep your pelvic muscles strong.

How can you increase the effectiveness of Kegel

exercises?

Because of where your pelvic muscles are situated, it is hard to know whether you are working this muscle group correctly. Receiving

biofeedback or electrical stimulation therapy (described in the next section), can help to increase the effectiveness of Kegel exercises.

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EMG Biofeedback Therapy Printout

Patient ID: 073081 12:33 20 16 12 8 4 0 Rest 10 sec. Work 5 sec.

Biofeedback therapy

Biofeedback therapy, where available, is a procedure typically performed by healthcare professionals in a hospital or clinic. The procedure requires placing electrodes either:

◆ In the vagina of female patients

◆ In the anus of male patients

◆ On the skin in the perineal area (the area between the anus and genital organs)

These electrodes, which are connected to a monitor, are able to read the activity of the pelvic muscles, while you perform Kegel exercises. Initially, you will see a fl at line on the monitor that shows you the activity of the pelvic muscles when they are resting and relaxed. When you begin to contract your pelvic muscles, the line will shift upwards, which indicates that the muscle is actively being contracted.

Watching the monitor while performing Kegel’s will enable you to fi gure out what it feels like when you are contracting the pelvic muscles correctly.

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Managing your fl uid intake

Keeping an accurate and up-to-date bladder diary while monitoring your fl uid intake will allow you to identify which kinds of beverages may improve or worsen your OAB symptoms.

Here are some examples:

Bladder friendly fl uids: Fluids to limit or avoid:

• Water • Apple juice • Cranberry juice • Grape juice

• Caffeinated products • Alcohol should be limited • Citrus juices

Having OAB may sometimes make you nervous about drinking fl uids, especially before going out or while you are out. You should not try to reduce the amount of fl uids that you drink to avoid going to the bathroom, since staying hydrated is essential for good health. Here are some other ways to help you manage your fl uid intake:

◆ Drink a minimum of 5-6 cups of only “bladder-friendly” fl uids per day and avoid consuming fl uids later in the evening.

◆ Reduce fl uid intake after 6 p.m. if you fi nd that you have to wake up at night one or more times to urinate (called ‘nocturia’). Do not try to make up for fl uid intake missed during the day by drinking a large amount of fl uid in the evening.

◆ Avoid consuming a large volume of fl uids at any one time; it can overwhelm the bladder, which may hinder its ability to hold urine.

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Other behavioural therapies to help you manage

your OAB symptoms include:

Scheduled toileting/Prompted voiding

• Going to the bathroom at specifi c time periods to minimize the sudden and sometimes uncomfortable need to urinate.

• For example, if you normally experience urgency episodes every 3 hours, you should urinate every 2 hours.

Bladder Retraining

• Involves scheduled toileting, where the length of time between bathroom trips is gradually increased.

• This therapy trains your bladder to delay voiding for longer time intervals.

For each of these therapies, you should receive counselling from a specialized healthcare professional.

Similar to managing your fl uid intake, scheduled toileting and bladder retraining techniques are most effective in improving your OAB symptoms when you consistently and accurately document each time you have to go to the bathroom in your bladder diary.

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Beyond behavioural therapies

If behavioural therapies alone are not enough to effectively control your OAB symptoms, your healthcare professional may recommend trying prescription medication. In fact, the chances of treatment success are better when behavioural and drug therapies are used in combination.

Prescription medication

A class of drugs called ‘antimuscarinic agents’ are commonly used to treat OAB. These agents work by stopping the bladder muscle from contracting too early, allowing the bladder to fi ll completely.

Consequently, you may experience less urgency, fewer accidents and make fewer trips to the bathroom. The following antimuscarinic agents are currently available in Canada:

◆ Vesicare®_{(solifenacin succinate)}

◆ Detrol®_/Detrol®_{LA (tolterodine L-tartrate)}

◆ Ditropan®_{/Ditropan XL}®_{(oxybutynin chloride)}

◆ Enablex®_{(darifenacin)}

◆ Oxytrol®_(oxybutynin)

◆ Trosec®_{(trospium chloride)}

◆ Uromax®_{(oxybutynin chloride)}

What to expect from your medication

While some individuals may experience OAB symptom relief soon after beginning treatment with drug therapy, others require several weeks to notice that their medication is having an impact on their OAB symptoms. Be sure to follow your treatment regimen and continue taking medication as your healthcare professional prescribed to ensure that you get the best possible result.

If you experience any of the common side effects (e.g., dizziness, dry mouth), discuss them with your healthcare professional as soon as possible, so you can decide together whether you need a different dose or medication.

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Other treatment options

In some cases, behavioural modifi cations and drug therapy may not provide enough relief from OAB symptoms. More invasive treatment techniques may be required, such as surgery.

Surgery

Surgery is a more aggressive way to treat OAB and is performed only in rare circumstances when other OAB treatments have not

been successful. The main goal of surgery is to increase the bladder’s ability to hold urine. Surgery can range from minimally

invasive to more invasive procedures.

Neuromodulation

A surgical procedure that involves the implantation of an electronic device into the lower part of your spine. The device produces mild electrical impulses to regulate the nerves that control the bladder, sphincter, and pelvic muscles.

Bladder lifts

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Managing OAB

Hopefully, this booklet has answered many of your questions about OAB and has helped to provide you with enough information to understand your symptoms and feel comfortable talking to your healthcare profes-sional about OAB.

We hope that you will remember four key points about how to manage OAB symptoms:

For more information on OAB, visit www.powderroom.ca.

Talk to your healthcare professional: Talking about OAB with a healthcare professional is the fi rst step towards managing your symptoms and starting to feel better. Remember that a healthcare professional is there to help you.

Stick with your treatment:

Much like a diet or a fi tness regimen, your chances of getting the results you want are better if you stick with the program. You will achieve better results if you closely follow your OAB treatment program.

Be patient:

It takes time for OAB symptoms to improve. Try not to get discouraged. It may take a few weeks to a few months to see improvement.

For more information on OAB visit www powderroom ca

Try a balanced approach:

It has been shown that a balance of changing your lifestyle and correctly taking your prescription medication offers you the best chances for improving your OAB symptoms.

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Here are a few other resources that you

may fi nd useful:

Websites

The Powder Room: www.powderroom.ca is an online community

that welcomes and supports individuals living with overactive bladder (OAB). On the website, you can fi nd reliable information and practical tips, as well as share experiences, concerns, and stories about OAB.

The Canadian Continence Foundation: www.continence-fdn.ca Maritime Women’s Bladder Health: www.womensbladderhealth.com

The Simon Foundation for Continence: www.simonfoundation.org The Canadian Women’s Health Network: www.cwhn.ca

Women’s Health Matters: www.womenshealthmatters.ca Vancouver Coastal Health: www.vch.ca

American Urological Association: www.urologyhealth.org

Books

The Incontinence Solution: Answers for Women of All Ages

by William Parker, Amy Rosenman and Rachel Parker

Managing and Treating Urinary Incontinence

by Diane Kaschak Newman

Urinary & Fecal Incontinence: Current Management Concepts

by Dorothy B. Doughty

Overcoming Overactive Bladder: Your Complete Self-Care Guide

by Diane K. Newman and Alan J. Wein

100 Q&A About Overactive Bladder and Urinary Incontinence

by Pamela Ellsworth

I Laughed So Hard I Peed My Pants!: A Woman’s Essential Guide for Improved Bladder Control by Kelli Berzuk

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Frequently asked questions (FAQs)

1. Am I going to have OAB forever?

While there may be no complete cure for OAB, fortunately, OAB can be successfully managed with behavioural therapy and/or prescription medication. Together, you and your healthcare professional can come up with the best strategy to improve your OAB symptoms. This may require you to make lifestyle changes and/or use prescription

medication. Talk to your healthcare professional about what treatment options will allow you to take control of your OAB.

2. I am not old – so why do I have OAB?

Even though your chance of developing OAB tends to increase with age, it can affect all ages. Some suspected risk factors for OAB include pregnancy, menopause, obesity, urinary tract infection, bladder

dysfunction and abnormal bladder muscle activity; and these can affect anyone at anytime in their lives.

3. Are women more likely to develop OAB than men?

OAB is just as common in men as in women. However, women are more likely than men to discuss their condition and seek treatment.

4. What types of behavioural and/or lifestyle changes can I make to help improve my OAB symptoms?

There are various changes you can make that may help you improve your OAB symptoms:

➤ Avoiding beverages containing alcohol or caffeine ➤ Keeping fi t

➤ Quitting smoking ➤ Kegel exercises

➤ Scheduled washroom breaks ➤ Keeping your bowel regular ➤ Losing weight

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5. Will severely reducing my fl uid intake allow me to avoid going to the bathroom often?

No, it is not healthy to severely reduce the volume of fl uids you drink. Doing so may actually worsen the condition, as concentrated urine can be irritating to the bladder. Your body needs fl uids to be able to work properly, so drink a minimum of 5-6 cups of fl uids per day. Just remember to drink “bladder-friendly” fl uids to help improve your OAB symptoms.

6. If I am not sure I am doing my Kegel exercises correctly, is there someone I can talk to?

Yes! Consult the doctor or the healthcare professional (i.e., nurse continence advisor, physiotherapist) who instructed you on how to do Kegel exercises.

7. How soon will I see an improvement in my OAB symptoms once I begin prescription medication?

This varies with each individual. Some people experience symptom improvement within a couple of weeks, while others do not begin to see improvement until after more than a month of treatment. The most important thing to keep in mind is to continue taking your medication as prescribed by your healthcare professional.

8. I have to attend an upcoming event. Can I just take my medication that day to control my OAB symptoms?

No, the prescription medication that your healthcare professional prescribed requires at least a couple of weeks to fully take effect. Prescription medication also affects individuals in different ways, so it may work faster or more slowly for you.

9. What happens when I stop taking my medication?

Stopping medication may cause your OAB symptoms to come back. Because there is no cure for OAB, you must continue taking your medication to control OAB symptoms.

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10. Will I need to continue wearing a protective pad or absorbant garment if I continue my prescription

medication?

Hopefully not! The goal of prescription medication is to improve your OAB symptoms so that you can regain full control. If you are taking your prescription medication as recommended by your healthcare professional and are still not achieving the desired results, talk to your healthcare professional for advice on other treatment options or additional therapies that can help you get the most relief. This may mean increasing your medication dose or switching to a different medication.

11. Can pregnancy and childbirth affect bladder control?

Yes, some women suffer from stress incontinence after childbirth, but generally regain bladder control within six weeks. Unfortunately, some women may not regain bladder control, in which case treatment is required.

12. What can I do to minimize my OAB symptoms during sexual intercourse?

This is a common and embarrassing problem for OAB patients. To reduce your OAB symptoms during intercourse, it may help to fi rst empty your bladder.

13. Why should I avoid consuming products that contain caffeine?

You should try to limit your consumption of caffeinated products because caffeine causes the kidneys to increase the production of urine. This causes the bladder to fi ll up more quickly, which increases urination frequency.

14. Why should I limit my alcohol intake to no more than one drink a day?

It is a good idea to limit your alcohol consumption because alcohol may affect bladder control. Similar to caffeine, alcohol causes the kidneys to produce more urine, which consequently may worsen your OAB symptoms.

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Glossary

Antimuscarinic Agents: A group of drugs that alter the normal signalling pathways in the body that regulate the urge to urinate.

Detrusor Muscle: Bladder smooth muscle. Contraction of the bladder muscle causes urine to be expelled through the urethra.

Frequency: The need to urinate up to eight or more times during the day.

Mixed Urinary Incontinence: Involuntary leakage associated with urgency and also with exertion, effort, sneezing or coughing.

Nocturia: Waking up at night one or more times to urinate.

Stress Urinary Incontinence: Involuntary leakage on effort or exertion, such as sneezing or coughing.

Urethra: The tube that carries urine from the bladder to outside the body.

Urge Urinary Incontinence: The involuntary leakage of urine accompanied or preceded by urgency.

Urgency: A strong need to urinate that is diffi cult to defer.

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References:

1. Corcos J, et al. Canadian Urological Association Guidelines on Urinary Incontinence. Can J Urology 2006;12:3127-3138.

2. Ouslander J. Management of Overactive Bladder. N Engl J Med 2004;350:786-799. 3. Irwin D, Milsom I, Hunskaar S, et al. Population-Based Survey of Urinary Incontinence,

Overactive Bladder, and Other Lower Urinary Tract Symptoms in Five Countries: Results of the EPIC Study. European Urology. 2006;50:1306-1314.

4. Wein A and Rackley R. Overactive Bladder: A Better Understanding of Pathophysiology, Diagnosis and Management. J Urology 2006;175:S5-S10.

5. Corcos J, et al. Prevalence of overactive bladder and incontinence in Canada. Can J of Urology 2004;11:2278-2284.

6. Milsom I, Abrams P, Cardozo L, et al. How widespread are the symptoms of an overactive bladder and how are they managed? A population-based prevalence study. BJU International (2001)’87, 760-766.

7. Kelleher C, et al. Improved Quality of Life in Patients with Overactive Bladder Symptoms Treated with Solifenacin. BJU International 2005;95:81-85.

8. Freeman R and Adekanmi O. Overactive Bladder. Best Pract Res Clin Obstet Gynaecol 2005;19:829-841.

9. Overactive Bladder Patient. The Canadian Urology Association. 2005.

10. Canadian Urological Association. Accessed Jan 2007. Address: http://www.cua.org/ 11. Pelvic Muscle Exercises - Kegel Exercises for Urinary Incontinence. The Canadian

Continence Foundation. Accessed Aug 2006.

Address: http://www.continence-fdn.ca/pdf/pelvicmuscleexercises.pdf

12. Brown C. Urinary Incontinence? Biofeedback May Help! The Canadian Continence Foundation. Accessed Aug 2006.

Address: http://www.continence-fdn.ca/pdf/URINARY%20INC%20BIOFEEDBACK.pdf 13. The Canadian Continence Foundation. Accessed Aug 2006.

Address: http://www.continence-fdn.ca

14. Abrams P, et al. Muscarinic receptors: their distribution and function in body systems, and the implications for treating overactive bladder. Br J Pharmacology 2006;148:565-578. 15. Vesicare Product Monograph. Astellas Pharma Canada, Inc. 2006.

16. Detrol Product Monograph. Pfi zer Canada, Inc. 2006. 17. Detrol LA Product Monograph. Pfi zer Canada, Inc. 2006. 18. Ditropan Product Monograph. Janssen-Ortho Inc. 2006. 19. Ditropan XL Product Monograph. Janssen-Ortho Inc. 2006.

20. Enablex Product Monograph. Novartis Pharmaceuticals Canada, Inc. 2006. 21. Oxytrol Product Monograph. Paladin Inc. 2006.

22. Trosec Product Monograph. Oryx Pharmaceuticals Inc. 2006. 23. Uromax Product Monograph. Purdue Pharma 2005.

24. Wein A. Diagnosis and Treatment of the Overactive Bladder. Urology 2003;62(Suppl 5B):20-27.

25. Greenwell T, et al. Augmentation Cystoplasty. BJU International 2001;88:511-525. 26. Pregnancy, Childbirth and Bladder Control. The Canadian Continence Foundation

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VES1107029EN VES1107029EN Your Comprehensive Guide to Overactive Bladder

has been made available through the Powder Room,

an interactive and educational program designed to foster communication around overactive bladder (OAB). It is a place to share experiences,

questions, concerns, stories and thoughts about OAB. Join this growing community today at www.powderroom.ca. The Powder Room has been made possible thanks to an educational grant from Astellas Pharma Canada, Inc., a leader in the ﬁ eld of urology.

Your Comprehensive Guide to Overactive Bladder