An Alternative to Chamber Pots in the Bedroom

Much has been published in the literature in the past decade about people living with overactive bladder (OAB).  Prior to the 21^st century, the term did not even exist.  As a diagnosis category, it was coined 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 descriptive enough. Marketing gave birth to “overactive bladder.”

As the pharmaceutical industry has increasingly sought to capitalize on the trend of people living longer with chronic diseases and conditions rather than life-threatening illnesses or traumas, it has realized the demand for quality of life standards by aging baby boomers actually fuels its ambitions and opportunities. Nevertheless, throughout the numerous studies quantifying how quality of life is impacted 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 Society as “sleep-disturbing voiding” and defined specifically as “the complaint that the individual has to wake at night one or more times to void.” ¹ The American Urological Association (AUA) states that nocturia is “considered a clinical problem if frequency is greater than twice a night.”²

Nearly nine years ago, in the first quarter of 2001, NAFC completed its first nationwide survey of 1,001 men and women ages 30 to 70, conducted by Yankelovich Partners and funded by Pharmacia Corporation (now owned by Pfizer).  The study was one of the first that attempted to quantify the prevalence of nocturia, or frequent awakenings to use the toilet.   Among those respondents who revealing  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.  One in eight (13%) of these individuals say they sometimes do not make it to the toilet before accidentally losing urine .³

Less than two years later, NAFC contracted Harris Interactive to interview online 1,228 women age 40-65 with a household income of $35,000 or more.  Conducting the survey in December 2002, the research found OAB sufferers live in poorer health than those free of OAB symptoms.  In addition to living with multiple medical diseases such as gastrointestinal disorders (32.2% vs. 13.9%), hypertension (35.1% vs. 15.2%), obesity (39.1% vs. 17.1%), and arthritis (42.5% vs. 19.9%), 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. ⁴

It’s time for nocturia to be tackled, better understood, and treated by practitioners for what it is.  Consumer research completed this year by NAFC and in publication is shining a new spotlight on the subject.  We now have data on how nocturia specifically affects socialization, physical intimacy, and relationships with others.  According to the National Center for Sleep Disorders Research at the National Institutes of Health, about 30 to 40 percent of adults have some sort of chronic and persistent sleep disorder resulting in chronic sleep deprivation.⁵ How much of the problem is connected to OAB?  We really do not know the precise answer to this.

How do you clinicians question patients about their symptoms, what intervening steps do you  recommend to mitigate symptoms, what behavioral strategies do you employ, and what do you not know about addressing nocturia?  We could all 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!

1 (2) ICS Factsheet 2: Overactive Bladder, July 2005, available online and accessed October 14, 2009, from http://www.icsoffice.net

(2) 2007 American Urological Association Annual Meeting Highlights- OAB: http://www.auanet.org/content/education-and-meetings/on-line-education/amhighlights/oab1007.pdf

(3)  Muller N.  What Americans understand and how they are affected by bladder control problems:  Highlights of recent nationwide consumer research.  Urologic Nursing; 2005: 25, 109 – 115.

(4) Ibid.

(5) Hossain JL, Shapiro CM.  The prevalence, cost implications, and management of sleep disorders: an overview.  Sleep Breath; 2002: 6, 85-102.