Researcher Receives $150k Grant To Explore The Connection Between OAB and IC
Did you know that the term “overactive bladder” was created by a marketing company for use in those “Gotta Go, Gotta Go Right Now” television ads that appeared in the 1990’s? It was a clever and very customer friendly way of discussing INCONTINENCE. The motivation, of course, was the approval of new anticholinergic medications by the FDA (aka Ditropan & Detrol).
Because “overactive bladder” was seen millions of times on TV, it very quickly gained credibility in the patient community because, well, most assumed that if it was on TV, it was a real condition. But, if you scan the medical journals, you’ll see that the term was quite new, also introduced in the early 1990’s. Dr. Magnus Fall (Sweden) published a paper defining three “subtypes” of bladder overactivity in the elderly.(1) Japanese researchers published a study showing that electrical pelvic floor stimulation could be used in the management of incontinence due to overactive bladder.(2) As the decade progressed, additional studies were presented comparing the use of various medications, acupuncture and others in the treatment of overactive bladder which, at that time, was associated with incontinence due to detrusor muscle overactivity.
In the late 1990’s however, doctors & researchers began asking for a clearer definition. Did OAB include just incontinence or could a diagnosis also be based on the symptoms of frequency and urgency? For some urologists, this tread very close to how they diagnosed interstitial cystitis at the time. Patients presenting with urinary frequency and urgency, without incontinence, were generally assumed to have mild interstitial cystitis. Patients with incontinence were generally assumed to have OAB or, more technically, detrusor overactivity. As one IC researcher said to me at the time, the OAB craze was indeed making a diagnosis of IC much more challenging.
As an IC support group leader at the time, what I found very interesting was the influence of the pharmaceutical industry who clearly saw big bucks in the sales of products that treated overactive bladder. Their marketing budgets skyrocketed as more medications were approved by the FDA. It was also in their interest to see an expanded definition. If OAB was confined to incontinence, that market was small however if it was expanded to include the symptoms of frequency and urgency, their profit potential also rose. There was also some discussion that they may have offered an incentive to researchers who supported an expanded definition. Certainly, the OAB marketing coffers were substantial at urology conferences around the world as doctors were veritably “wined and dined” by the pharmaceutical industry. (A few years ago, new rules were passed that stopped such open and overt cash rewards.)
But, for the uber urology and bladder science enthusiast, there were some clear distinctions between OAB and other conditions, specifically the symptom of “urgency.” Patients with OAB urgently sought out the restroom to avoid leakage. In contrast, patients with interstitial cystitis urgently sought out a restroom to reduce and avoid pain. Subtle but distinct.
In 2001, the International Continence Society formalized their definition for overactive bladder as “symptom syndrome suggestive of lower urinary tract dysfunction,” focusing primarily on the symptom of “urgency, with or without urge incontinence, usually with frequency and nocturne.“(3)
Thirteen years later, there is still consider confusion and debate over the relationship between IC, OAB and, also, chronic prostatitis. Are they variations of the same condition? Are they unique? How do they differ? It’s an important question that deserves further exploration.
Relationship of IC and OAB to Be Studied
Yesterday, the Astellas European Foundation announced that they have awarded a $150,000 grant to Dr. Marianne Gamper to conduct a formal study to identify markers that may identify a potential relationship between IC and OAB. She said “We want to identify, quantify, and compare molecular marker levels in patient samples and associate the results with the severity of clinical findings. The prize money directly provides the essential financial support for our laboratory work, thereby enabling us to continue our fundamental and important research on debilitating chronic bladder diseases.”(4)
Thirty five research teams submitted proposals for this years reward and we thrilled that such an important study has been funded. The research will be conducted in Austria and Switzerland.
(By Jill Osborne MA, President – IC Network)
(1) Geirsson G, Fall M. Lindstrom S. Subtypes of overactive bladder in old age. Age Ageing 1993 March;22(2):125-31 – http://www.ncbi.nlm.nih.gov/pubmed/8470559
(2) Ishigooka M, et al. Electrical pelvic floor stimulation in the management of urinary incontnence due to neuropathic overactive bladder. Front med Biol Eng. 1993;5(1):1-10 – http://www.ncbi.nlm.nih.gov/pubmed/8323877
(3) Wein AJ, et al. Definition and epidemiology of overactive bladder. Urology 2002 Nov;60(5 Suppl1):7-12; discussion 12 – http://www.ncbi.nlm.nih.gov/pubmed/12493342
(4) Press Release – Astellas European Foundation, April 14, 2014 – http://www.dddmag.com/news/2014/04/astellas-european-foundation-awards-2014-urology-grant