Overactive Bladder Doctor Discussion Guide

1. How bothered have you been by the following?

0 = Not at all

1 = A little bit

2 = Somewhat

3 = Quite a bit

4 = A great deal

5 = A very great deal

Frequent urination during the day

0

1

2

3

4

5

An uncomfortable urge to urinate

0

1

2

3

4

5

A sudden urge to urinate with little or no warning

0

1

2

3

4

5

Accidental loss of small amounts of urine

0

1

2

3

4

5

Nighttime urination

0

1

2

3

4

5

Being woken up at night by the need to urinate

0

1

2

3

4

5

An uncontrollable urge to urinate

0

1

2

3

4

5

Urine loss associated with a strong urge to urinate

0

1

2

3

4

5

Are you:

Male

Female

2. How often do you need to go to the bathroom?

I tend to urinate:

0 to 3 times per day

4 to 7 times per day

8 or more times per day

At night, I urinate:

0 to 3 times per night

4 to 7 times per night

8 or more times per night

I get woken up at night to urinate:

0 to 3 times per night

4 to 7 times per night

8 or more times per night

3. Which of the following treatments are you using or would you like to learn more about? (check all that apply)

Non-medication treatments

I'M USING IT

I'D LIKE TO LEARN MORE

lifestyle changes

Kegel exercises (pelvic floor muscle retraining)

bladder training

functional electrical stimulation

biofeedback

surgery

Medication treatments

I'M USING IT

I'D LIKE TO LEARN MORE

Detrol LA® (tolterodine extended release; once daily)

Detrol® (tolterodine immediate release; twice daily)

Ditropan XL® (oxybutynin extended release; once daily)

Enablex® (darifenacin extended release; once daily)

Oxytrol® (oxybutynin patch; twice weekly)

Trosec® (trospium; twice daily)

Uromax® (oxybutynin controlled release; once daily)

Vesicare® (solifenacin; once daily)

4. What bladder issues are bothering you?

I am not receiving treatment for OAB. (check all that apply)

I'm not sure whether I have OAB.

I'm wondering if I might need treatment for my bladder symptoms.

Other:

LIST ADDITIONAL CONCERNS HERE

I am currently receiving treatment for OAB. (check all that apply)

I'm not sure if my treatment is working.

I'm concerned about side effects from my treatment.

I'm concerned that my treatment may interact with medications I'm taking.

I'm not sure how to use my treatment.

Other:

LIST ADDITIONAL CONCERNS HERE

If a new treatment is recommended, I have some questions. (check all that apply)

How much will this treatment help my symptoms?

When can I expect it to start working?

What can I do if I'm not sure whether my treatment is working?

How do I use the treatment?

How long should I use the treatment for?

What side effects should I expect?

Are there any changes I should make to my lifestyle?

Other:

LIST ADDITIONAL CONCERNS HERE

Your score is 0.

This is in the normal range, so you probably don't have an overactive bladder. However, if you are concerned about your bladder and urination, you may want to talk with a health care professional.

Use the Quality of Life Assessment to assess in detail how bladder issues are affecting your life.

Print a copy of your responses to take to your next visit with your doctor.

The contents of this site are for informational purposes only and are meant to be discussed with your physician or other qualified health care professional before being acted on. Never disregard any advice given to you by your doctor or other qualified health care professional. Always seek the advice of a physician or other licensed health care professional regarding any questions you have about your medical condition(s) and treatment(s). This site is not a substitute for medical advice.
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