Overactive Bladder Differential Diagnoses

  • Author: Pamela I Ellsworth, MD, FACS; Chief Editor: Edward David Kim, MD, FACS   more...
 
Updated: Jan 10, 2012
 
 

Diagnostic Considerations

The term overactive bladder (OAB) refers to a symptom complex. Therefore, the first part of the evaluation of OAB is to review the patient’s lower urinary tract symptoms to ensure that the symptoms are consistent with OAB.

A diagnosis of OAB depends on the presence of urgency, which differs from a simple urge to void. A typical urge to void is a normal sensation that progressively strengthens when deferred. In contrast, urgency is an abnormal condition that is characterized by a sudden onset of urgency and difficulty in deferring urination.

Nocturia is often confused with lower urinary tract symptoms (LUTS) and assumed to be a symptom of OAB or benign prostatic obstruction (BPO). Not all patients with OAB or BPO have nocturia, and the relationship between nocturia and OAB is not well understood. A 2011 consensus statement on the evaluation and treatment of nocturia concluded that most patients with nocturia do not have OAB and that most patients with OAB do have nocturia.[22]

Other causes of urinary frequency, urgency, and urinary incontinence must be excluded. Incontinence has several subtypes: stress incontinence, mixed urinary incontinence, overflow incontinence, and transient incontinence. Transient incontinence may be related to any of a number of conditions, easily recalled by means of the mnemonic DIAPPERS: D elirium, I nfection, A trophy, P harmaceuticals, P sychological factors, E xcess urine output, R estricted mobility, and S tool impaction.

Other conditions to consider include the following:

  • Urinary stone disease
  • Gastrointestinal (GI) or colonic pathology
  • Gynecologic pathology

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Pamela I Ellsworth, MD, FACS  Associate Professor of Urology, The Warren Alpert Medical School of Brown University; Consulting Staff, University Urological Associates

Pamela I Ellsworth, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Surgeons, American Urological Association, Phi Beta Kappa, Society for Fetal Urology, and Society of University Urologists

Disclosure: Pfizer Consulting fee advisory board, speaking; allergan Honoraria advisory board

Coauthor(s)

Wellman W Cheung, MD, FACS  Clinical Associate Professor of Urology, Clinical Associate Professor of Obstetrics and Gynecology, State University of New York Downstate Medical School

Wellman W Cheung, MD, FACS is a member of the following medical societies: American Board of Urology, American College of Surgeons, American Medical Association, American Urogynecologic Society, American Urological Association, Chinese American Medical Society, Endourological Society, International Urogynaecology Association, and Society of Urodynamics and Female Urology

Disclosure: Astallas Grant/research funds PI

LiAnn N Handel, MD  Resident Physician, Department of Urology, Rhode Island Hospital, The Warren Alpert Medical School of Brown University

LiAnn N Handel, MD is a member of the following medical societies: American Urological Association

Disclosure: Nothing to disclose.

Aneela Naureen Hussain, MD, FAAFM  Assistant Professor, Department of Family Medicine, State University of New York Downstate Medical Center; Consulting Staff, Department of Family Medicine, University Hospital of Brooklyn

Aneela Naureen Hussain, MD, FAAFM is a member of the following medical societies: American Academy of Family Physicians, American Medical Association, American Medical Women's Association, Medical Society of the State of New York, and Society of Teachers of Family Medicine

Disclosure: Nothing to disclose.

Nadia Hasan Khan, MD  Clinical Assistant Instructor, Staff Physician, Department of Family Practice, State University of New York Downstate Medical Center

Nadia Hasan Khan, MD is a member of the following medical societies: American Academy of Family Physicians

Disclosure: Nothing to disclose.

Miriam T Vincent, MD, PhD  Professor and Chair, Department of Family Practice, State University of New York Downstate Medical Center

Miriam T Vincent, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Family Physicians, American Association for the Advancement of Science, Medical Society of the State of New York, North American Primary Care Research Group, Sigma Xi, and Society of Teachers of Family Medicine

Disclosure: Joslin Diabetes Group, Harvard Honoraria Speaking and teaching

Specialty Editor Board

Bradley Fields Schwartz, DO, FACS  Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine

Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Association of Military Osteopathic Physicians and Surgeons, Endourological Society, Society of Laparoendoscopic Surgeons, and Society of University Urologists

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Chief Editor

Edward David Kim, MD, FACS  Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center

Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, Sexual Medicine Society of North America, and Tennessee Medical Association

Disclosure: Lilly Consulting fee Advisor; Astellas Consulting fee Speaking and teaching; Watson Consulting fee Speaking and teaching; Allergan Consulting fee Speaking and teaching

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Communication between urothelium and suburothelium. ACh—acetylcholine; ATP—adenosine triphosphate; M2—muscarinic receptor subtype 2; M3—muscarinic receptor subtype 3; NO—nitric oxide; P2X1—purinergic receptor P2X, ligand-gated ion channel 1; P2X3—purinergic receptor P2X, ligand-gated ion channel 3; sGC—soluble guanyl cyclase; VR1—vanilloid receptor 1.
Overactive bladder (OAB) and quality of life (QoL). Short Form-36 (SF-36). Reprinted with permission from Blackwell.
Total community and institutional costs of overactive bladder (OAB) (in millions of dollars). UTI—urinary tract infection (UTI). Reprinted with permission from Elsevier.
 
 
 
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